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St Barts Fountain CNS

NHS CNS’s take on Boost 100KM


Shiv & Michelle

Shievon Smith and Michelle Greenwood are both incredibly busy Urology Oncology Clinical Nurse Specialist’s (CNS) at London’s St Bartholomew’s Hospital. They gave their time to take on the Boost 100km Action Challenge and here Shiv and Michelle talk about what a CNS does and the reasons why they took on the challenge.

My name is Shievon (Shiv) Smith, I joined the team at St Bartholomew’s Hospital (St Bart’s) in London in 2017 and I’m a Clinical Nurse Specialist, also known as a ‘CNS’. My Colleague at St Bart’s is Michelle Greenwood, a fellow CNS who joined the team in early 2014.

So, what is a CNS?

  • We are highly skilled specialist nurses who care for metastatic cancer patients and we work in the hospital’s cancer clinics.
  • We carry out intricate physical assessments, offer complex emotional support and are trained in advance communication skills and level two psychology.
  • We provide support across many varied areas, not just medical. We are here to signpost patients to financial benefits and any available grant to help support our patients.
  • We complete first cycle oral chemotherapy counselling and offer toxicity support to help ensure patients remain on treatments safely over long periods of time.
  • We are classed as a ‘keyworker’. This means patients can contact us directly either via email or telephone.
  • We are the accessible member of the patients Multidisciplinary Team (MDT).
  • We are deeply invested with the patient experience, completing and acting on feedback and audits to constantly improve and evolve our services.
  • We proactively triage queries from patients and contact them accordingly. Working at such a large hospital our caseloads are exceptionally large at over 600 patients each.

Professor Thomas PowlesWe work for Professor Powles who receives country wide referrals and organises and runs many clinical trials. Urology oncology CNS’s are known to have the largest caseloads from all the specialist areas, many Trusts have a CNS for each tumour site for example bladder or kidney or prostate cancer, at others, like St Bart’s, the Uro-oncology CNS’s cover all.

Our patients have access to an emergency Oncology Hotline service and the Hotline team will inform us if a patient has used their service and of the advice given and we follow up with the patient on our next working day. CNS’s support their patients through the whole of their cancer pathway.

We take some of the pressure off our very busy consultants by running our own independent clinics. Our role with the metastatic patients is palliative care referral heavy. Many patients are frightened of the offer of support from palliative care (sometimes referred as Macmillan Nurses) it is our role to promote early referral to palliative care as they can assist with improving quality of life, day therapy referrals such as massage or breathlessness clinics, they offer complex pain management support and complex psychological support as other examples. Palliative care teams link to hospital services and work very closely with us.

Life has changed due to COVID19 for everyone including CNS’s, I was redeployed to one of St Bart’s three Intensive Care Units (ICU) as we were taken over with patients referred from other hospital sites as well as those needing cardiac surgery. One of our ICU’s was a clean cardiac referral centre for London the departments needed additional nursing support. I and Michelle are antibody negative and being swabbed every week.

Shiv’s Story:


While I was away Michelle covered my case load, which was exceedingly difficult! At home, my school aged children were in a state of fear and panic and my husband is an electrician at Excel London, which of course is currently The Nightingale Hospital London.

Our youngest daughter bounced back from these changes well, however, my teenage daughter removed herself from our family and spent most of her time in her bedroom declining to join the family. As a family when we have not been at work we have stayed at home. My husband and I have only been out to the supermarket for food, our girls Molly shiv-molly-june-boostand Emily have been at home, as a family we had not even been out for walks due to fear of passing COVID-19 on. I had previously completed two Action Challenge events; the Bridge Trek 25Km and Winter Walk raising funds for Fight Bladder Cancer UK and Prostate Cancer UK respectively. When I noticed Action Challenge were hosting virtual challenges from 50Km to 500Km for the month of June, my daughter Molly and I signed up for the 100Km. This challenge has given Molly confidence and we’ve shared quality time together. Michelle and I discussed the challenge the next morning in the office, when we thought it would be a great idea to sign up to fundraise for Kidney Cancer UK.

CLICK HERE to go to Shiv’s fundraising page

Michelle’s Story

I have worked in my role as Uro-Oncology CNS for over five at Bart’s.  My interest in kidney cancer started back when I was a research nurse caring for those on new kidney cancer drugs working with Prof Powles and Dr Shamash. When I started there were very limited drugs available for those patients diagnosed with metastatic RCC. Mainly it was Interferon and Sutent.  Being part of the trials that initiated the new TKIs and immunotherapy drugs was great – to know that patients had more access to different treatments was encouraging. As specialist nurses we have presented at meetings about the drugs, the evolving landscape of treatments and led on education days for those looking after kidney cancer patients. In recent times we have been in contact with Kidney Cancer UK and learnt more about the great services they provide for our patients but we know how much charities are struggling through COVID-19 and wanted to raise some money for Kidney Cancer UK to try and help ensure the stability of the services they offer to patients. Fitting the walking in around our busy jobs has been challenging but worth it! We would both like to raise as much money as possible for this great charity.

CLICK HERE to go to Michelle’s fundraising page.shiv-boost-tracker

We both chose to fundraise for Kidney Cancer UK because of the fantastic support they give to our kidney cancer patients, whether it is through grant or counselling support, their services are first class! The charity works closely with our team at St Bart’s and many other CNS’s right across the UK. Kidney Cancer UK has three fantastic ‘Understanding Kidney Cancer’ booklets available to patients free of charge.

It would be amazing if you could continue to support Kidney Cancer UK through donating directly to them or sponsoring myself or Michelle.

Thank you

Shiv & Michelle.


As a charity we would like to thank Shiv & Michelle for sharing their blog and choosing to fundraising for us during these difficult times that they have described. It is brilliant to hear from Shiv and Michelle their kind words about our support but also to hear directly from them about their roles as CNS’s, thank you to you both. 

We also hope that this blog helps patients and families understand the role of a CNS and also the changes that Covid has bought to their roles.