A history of urological nursing in the UK

It is difficult to pinpoint exactly when nurses moved from being general nurses to identifying themselves as urological nurses.

Nurses, like surgeons, would have looked after people with urological problems on general wards and so it is fair to assume that as the surgeons branched out into the specialty the nurses that worked in those specialist hospitals became specialised too.

Nursing history

Before the 1880s most people were nursed at home rather than in hospitals. Consequently any nursing tended to be done by family members or servants.

Caring for a person’s intimate needs was not considered seemly for well brought up females especially if not a member of the family and basic needs such as hygiene and feeding were seen as the domestic duties of servants.

Certainly nursing was not seen as needing many skills, knowledge or abilities and those employed as such very often were able to do little else.

Florence Nightingale herself described them as being “ too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else” (Thomas, 2016).

This all changed as more people began to receive hospital treatment as technology became more sophisticated.

More educated woman began their nurse training at the newly opened schools of nursing and by the late 19^th century the way nurses were perceived changed and they were regarded as having the higher levels of nursing skills needed on these hospital wards.

Florence Nightingale herself was the founder and patron of the Nightingale Training School at St Thomas’ Hospital in London in 1860 following on from her leading a team of nurses caring for solders in the Crimean War and of course Mary Seacole’s role in setting up a convalescent home for soldiers in the same war.

Another nurse, Ethel Bedford Fenwick, had a big role to play in shaping how nursing progressed though she is not as well known or often mentioned in the literature.

Ethel was born in 1857 and was a surgeon’s daughter. He died when she was a child and she was brought up in Nottinghamshire by her mother and her step father who was a wealthy member of parliament.

Though she did not need to work she decided she wanted to be a nurse and became a special probationer (eg someone of a middle class background who paid a fee in exchange for her training) at age 21, ultimately becoming matron at St Bartholomew’s hospital in London at the age of 24.

She retired from nursing at age 30 after the birth of her son after her marriage to Edward Bedford Fenwick who was a surgeon (incidentally his brother was the eminent urologist Edwin Hurry Fenwick).

However, she did not give up on nursing or her quest to tackle the varying standards of training and bring all nursing under one profession (NMC, 2019).

Edith firmly believed that nurse training should be of at least three years duration (not the one or two years that was customary at the time) and that only those nurses who had completed this training could call themselves “nurse”.

She was committed to the professionalisation of nursing, firmly believing nurses had their own set of professional standards and attributes and should not be seen as just doctor’s handmaidens.

She was also adamant that nurses should be registered disagreeing with Florence Nightingale who did not think this necessary.

She founded the British Nurses’ Association and lobbied parliament tirelessly for over 30 years to establish a nurses’ register.

Ultimately, the Nurses Registration Act of 1919 established the first professional register. Ethel Bedford Fenwick’s name is listed as state registered nurse number 1 and 2019 marked the hundredth anniversary of the UK nursing register.

Over the years, nurses distinguished themselves during the first and second world wars where they could rise to officer status as part of the Queen Alexandra Imperial Military Nursing Service (QAIMNS). Male nurses were finally allowed to join the profession in 1951.

The United Kingdom Central Council took over the role of registering qualified nurses in 1972 and this role was in turn taken over by the Nursing and Midwifery Council in 2002  (Ford, 2017; Griffen, 1995).

Nurse training evolved over the years and eventually by 1986 nurse training moved out of the traditional hospital based schools of nursing and into colleges and universities.

Instead of the apprenticeship model of learning nurses now emerged with diploma level nurse training and by 2004 it was decided that all nurses should have degree only preparation.

By 2009 all nursing courses in the UK became degree level courses.  The profession is now seen as representing a highly skilled sector of workers which has its own specialised body of knowledge.

Nurses are trained in institutions that are under the regulation of the profession itself and only nurses on the register are employed as qualified nurses to look after patients.

Only a member of the profession is competent to assess another professional’s work as it is the profession that defines what nursing is and how it is organised and developed.

And all nurses are governed by a code of ethics to ensure the safety of patients and ensure they are not exploited. This code also regulates how the profession interacts with other professions.

As time has moved on the opportunities for nurses to expand their skills and abilities and consequently their practice has grown exponentially.

Nurses now undertake extended roles often taking on junior doctors’ roles to provide nurse led services from diagnosis to treatment and aftercare and since 2002 are able to train as non-medical prescribers.

Urological nurses have embraced their potential and over the years identified areas where they could put their knowledge and skills to good use in setting up services for patients.

Urological nurses nowadays run anything from pre-operative assessment clinics to minor surgical interventions and anything in between.

History of urological nursing

The first hospital for Stone and Diseases of the Urinary Organs, which was founded in in 1860 at 42 Great Marylebone Street, can arguably be pinpointed as the time the first urological nurses came into being.

By the 1900s when the first suprapubic prostatectomy was performed by Mr Peter Freyer, the hospital had established itself as having the reputation of successful removal of bladder stones by litholapaxy but also moved its emphasis to surgery for prostatic obstruction.

Any nurses working there at the time were, therefore, the first stone and prostate care nurses.

By the time the hospital moved to new premises in Henrietta Street and amalgamated with the three other hospitals around Covent Garden (to become known as the 3Ps which confusingly included the Shaftesbury Hospital, the former French Hospital in Shaftsbury Avenue), their importance as centres of excellence and innovation meant doctors and nurses who wanted to extend their knowledge and expertise moved there to work and train.

The English National Board (ENB) course in renal and urological nursing ran there until the change in nurse education moved into universities rather than being run in schools of nursing directly attached to a hospital.

Post-registration courses such as the ENB ones followed suit and the courses are still run today with nurses gaining degrees and masters in urological care.

The original course is still linked to the urology department at University College London Hospitals (UCLH) where the 3Ps were ultimately relocated on closure of the Covent Garden hospitals with a joint appointment of a urology nurse as lecturer practitioner between the hospital and university.

Over the years more university modules and short courses in urological care have become available in the UK and Northern Ireland.

However, as with all post-registration education in recent years, funding is limited and these courses are few and far between.

The education of urological nurses is one of the key reasons the British Association of Urological Nurses (BAUN) was inaugurated and continues to be the main aim of the association 25 years on.

Interestingly in 2015 the urology department moved yet again from the main UCLH tower building on the Euston Road to Westmoreland Street in Marylebone.

This is just round the corner from 34 New Cavendish Street, which now marks the spot of the original house (42, Great Marylebone Street before the streets were renamed) bought as the first hospital for bladder stones and other urological diseases in 1860. So back to where it all started!

History of the British Association of Urological Nurses (BAUN)

In 1992, Sarah Heatley, a urology research nurse started BURNS – the British Urology Research Nurse Support Group.

This spurred other urology nurses to contact nurses working in urology up and down the country to establish if there was a need for a similar organisation supporting urology nurses in general.

A call went out and, at a memorable meeting at the Royal College of Surgeons in London in 1995, the room was crowded with nurses working in urology who were not only interested in the concept but were passionate that there was a real need for an organisation to support them and BAUN was born.

Of course were it not for the hard work of a self-less few nurses who put themselves forward to form the first committee/council BAUN would not be where it is today.

As a member of BAUN since its inception on that day in 1995, the author has vivid memories of the first study days they organised and ran for the new membership.

These usually ran in parallel with BAUS conference days as many nurses habitually attended that conference so it was felt that they would be able to attend sessions at both events.

For a while the Wednesday in conference week was dubbed “nurses’ day” and this had a separate programme which included joint sessions between BAUS and BAUN members.

There were some very brave nurses who stood up to speak and run the gauntlet of a barrage of questions and criticisms from the medics in the audience.

However nurse’s day did mean 300-400 nurses descending on the conference venue on masse and there were some BAUS members who objected to the presentations and exhibitions being overrun by such big numbers.

The author remembers walking into an afternoon session only to realise that the lunch time closed BAUS meeting was not quite over yet and to hear one consultant (who shall remain nameless) complain about this and propose that nurses be banned from future conferences!

Happily the BAUS president at the time did not agree to this however soon after the nurses’ programme was moved from the Wednesday to the Monday – in other words the day before BAUS conference started.

Naturally many nurses were not happy with this as it meant having to stay on to attend BAUS presentations and the exhibition which made the whole thing too costly for many.

Also, the exhibition was not up and running on the Monday so those who only came for that day could not benefit from seeing the new products and speaking to the representatives.

Company sponsorship for nurses to attend conferences was not easily available at the time with many companies preferring to sponsor doctors or specialist nurses working in stoma care or continence.

Consequently, BAUN made the decision to breakaway from this format and started to hold its own independent study days up and down the country, eventually launching its own annual three-day conference. Over the last 25 years the association has continued to grow and flourish.

Most of this is down to the commitment and hard work of urological nurses from all sub specialities taking on the role of council members (now trustees) and the vision and leadership of the 10 presidents who took on the post since its inception (Box 6).

From the first president to the current incumbent each has broadened the remit and scope of the association as urological nurses’ career pathways evolved and expanded.

With 800 plus members and several projects on at any one time the association now also depends on a professional management company for its day to day management and most importantly for the organisation and running of the annual conference.

BAUN now has charity status and is committed to its remit of providing educational services for its members and urological nurses in the UK (Box 5).

It provides study days which are free to members to attend and the annual conference remains the highlight of the urology nurse’s calendar.

BAUN has long established collaborative relationships with the European Association of Urological Nurses (EAUN) and the Australian and New Zealand Urological Nurses Society (ANZUNS) thus not only sharing ideas and practice but also working on joint projects which will ultimately impact on urology nurses worldwide.

The relationship with BAUS continues with amongst other things collaborations on practice guidelines such as cystoscopy training for nurses.

The association continues to evolve and understands the importance of communicating with its members via the quarterly newsletter, the BAUN website and more recently through social media.

Members use these forums for keeping up to date with the latest news about BAUN but also for sharing innovative practice, exchanging views and advice on setting up services, practice issues or difficult cases.

One of the biggest milestones for the association was the launch of the International Journal of Urological Nursing (IJUN) in a bid to encourage urological nurses to publish their work.

This is an area in which urology nurses need encouragement and nurturing to engage with the process and share their knowledge and expertise and was the incentive to invest in such a big project.

The journal is now in its 12^th year and publishes work from urology nurses all over the world.  It remains the only international peer-reviewed journal of its kind.