Productivity gains by specialist nurses.

Workload analysis showed that the specialist nursing service in lung cancer in an acute hospital was being used primarily to support processes and administration rather than providing holistic cancer care. An analysis of the inpatient population showed that many people were being admitted for non-acute problems, such as symptom control in advanced disease. As the key workers for patients with lung cancer, the clinical nurse specialists negotiated away the administrative burden and adopted standard, proactive case management in line with national standards. Their proactive and vigilant case management resulted in a drop in admissions for non-acute problems from four to a mean of 0.3 per month. This represents a significant saving in bed days. Clinical nurse specialists who practise proactive case management and re-focus services in line with best practice represent a good return on investment.