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nursing in dermatology lets providers 'see the impact of our care both physically and emotionally'
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brittany primeau understands what people go through dealing with raised, red, itchy lesions or plaques on the skin. conditions like eczema and psoriasis look similar and can appear on the scalp, nails or anywhere on the body, sometimes covering a large percentage of the skin surface.
“you can imagine all the aspects of their life that this affects,” says primeau of skin issues that undermine quality of life. “it affects their confidence. it affects the clothes that they wear, the jobs that they apply for, their activities that they do.”
skin conditions affect quality of life
as a registered nurse in the
dermatology clinic at toronto’s university health network (uhn),she’s dedicated to supporting patients and their families in what’s become a specialty in high demand.
broadly, dermatology covers everything that affects skin, hair and nails, including autoimmune conditions, hair loss, acne and skin cancer. non-melanoma skin cancer, the less aggressive form of skin cancer, is the most commonly diagnosed cancer in canada, with
about 76, 000 new cases estimated annually,but low mortality thanks to effective treatment.
her top sun protection tips are reapplying sunscreen throughout the day (she does this routinely herself) and making sure your sun hat isn’t see-through if you hold it up to the light. (her skin glows with natural good health.)
cancer treatment can lead to skin infections
her clinic also works closely with oncologists to provide treatments for skin conditions resulting from any type of cancer. these could be changes to skin, hair or nails from cancer treatment, skin infections from cancer treatment or radiation dermatitis, for example, which is a common skin reaction from radiation therapy.
“because we see people in follow-up frequently, for me, it’s being able to physically see the impact of our care both physically and emotionally. i’ve seen people come in very
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shy and nervous. and i remember one young guy, he said he had never been on a date and that was something he had hoped for one day,” she recalls.
months later, he came back to the clinic like a new person.
“his skin was clear and he was wearing a short-sleeve t-shirt and he was so excited to tell us that he was going on a date. he really came out of his shell and seeing patients like that is the most rewarding part.”
dermatology nurses focus on patient education and support
while the dermatologists make the diagnosis — sometimes a biopsy procedure for testing comes first — and direct the treatment plan, nurses in dermatology like primeau support patients with education, wound care and any concerns that may arise. they give as much time as they can to make patient-centred care the focus.
“there’s often a lot of follow-ups booked. so, you really get to know people and their families. seeing the changes from appointment to appointment is incredible. and patients call all the time too, you know, because things come up. ‘i’ve run out of medication,’ or ‘i think i might be having a reaction to something.’ we follow them closely and establish relationships with them.”
the type of treatments often start with topical creams, while some people have more extensive disease and need to add an oral medication. further, biologic or biosimilar medications may be required as injectables done at a clinic or self-injected after training.
primeau emphasizes that the nursing role is key for patient education. “we’re making sure patients are comfortable with what they’re doing and they’re confident with their treatment plan and we’re following them to monitor the treatment response. sometimes people come in at that first follow-up four months later and they’re not better. and so we know, okay, this isn’t the one for you and the doctors will make a change.”
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bringing a strong skillset to the job
she’s been in the specialty for a decade, inspired by advanced procedures and treatments and constant learning. her first job was in the hospital operating room, gaining surgical skills where nurses assist with instruments and help put patients to sleep.
she made the move to plastic surgery at a clinic in the community, applying her post-operative skills, assessment skills and educating patients on wound care management, skin care and sun protection. she adds that cosmetic dermatology is a fast-evolving space with growing demand for nonsurgical treatments like lasers and injectables; education courses are widely available for nurses interested in this area.
now primeau is thriving in her current role in outpatient dermatology at uhn.
“in the operating room, we would do one or two cases per day, whereas in dermatology, it’s quicker moving, fast-paced. each physician, sometimes we have two or three physicians in the clinic per day, can see upwards of 30 patients.”
while wait times to see a specialist can take months after the referral has been made, there are a limited number of dermatologists in canada, with some provinces more underserved than others.
as well, there are some procedures that dermatology nurses can do independently, primeau says, noting cryotherapy, which is liquid nitrogen to treat warts and injecting steroids into the scalp for hair loss.
“but procedures, whether it’s a biopsy or an excision, which could be skin cancer or a benign mole or a skin tag or a cyst, something like that — the dermatologist will do those. i’m there to set up the procedure, make sure the patient’s comfortable, assist and then give the patient education for how to take care of their wound at home.”
challenges in the clinic often surround access to medications that patients need and complexity. she talks about barriers, whether it’s complicated treatment plans for patients that they need help to navigate or an alternative that’s easier to follow or cost where patients don’t have coverage. her clinic works to find effective medication that is covered by public or private insurance.
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growing opportunities for nurses
“it’s very rewarding. it’s an exciting space to be in. i think it’s a great place for nurses who enjoy the one-on-one with patients and the follow-ups. it’s a very broad and evolving specialty. there’s always new drugs on the market,” primeau says.
“i’ve been in this space for the better part of 10 years and i’m still learning about diagnoses. there’s just a lot to learn.”
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