I first met Charlotte in a queue. It was a grey Tuesday morning at a testing centre in London, and we were both waiting to sit our OSCE – the practical exam every internationally trained nurse has to pass before the NMC will let you anywhere near a patient. She was from Auckland, I was from Christchurch, and within about ninety seconds we’d established that we knew some of the same people, had trained at overlapping times, and shared an almost identical level of anxiety about what was about to happen inside that exam room. We’ve been close friends ever since.

Charlotte and I took quite different paths once we got our NMC PINs. I went into acute medicine. She went into oncology – specifically, a specialist role at one of London’s major cancer centres. It’s a field I have enormous respect for but have never worked in myself, and over the years I’ve watched Charlotte grow into it in ways that have genuinely changed how I think about nursing. I asked her if I could write about her experience for this blog, and she said yes, on the condition that I didn’t make her sound heroic. She says she’s just doing her job. I disagree, but I’ll try to honour the request.

Why Oncology?

Charlotte didn’t come to London planning to specialise in cancer care. Back in Auckland, she’d worked in general surgical nursing at Middlemore Hospital – a busy, high-acuity environment that gave her strong foundational skills but left her wanting something with more continuity of care. In surgical nursing, she told me, you meet patients at their most acute, you help them through recovery, and then they leave. You rarely find out what happens next.

When she started applying for NHS roles, an agency put her forward for a position at a cancer centre she hadn’t initially considered. She went to the interview mostly for practice and came out having accepted the job. Something about the way the team talked about their patients – not as cases or diagnoses, but as people on a long and often difficult journey – resonated with her deeply. She said it felt like the version of nursing she’d always wanted to do but hadn’t known existed in that form.

The Learning Curve

Charlotte is honest about how steep the first year was. Oncology nursing requires a specialist knowledge base that goes well beyond what general training covers. She had to learn complex chemotherapy regimens – not just what drugs were being administered, but how they interacted, what the expected and unexpected side effects were, and how to manage acute reactions when they occurred. She had to become fluent in a vocabulary of staging, grading, and treatment protocols that was largely new to her. She studied for additional certifications, including the UK’s Systemic Anti-Cancer Therapy qualification, which she describes as one of the hardest things she’s ever done professionally.

But the clinical knowledge, she says, was actually the more straightforward part. What she found harder was learning to sit with uncertainty and grief on a daily basis. In surgical nursing, the trajectory is usually clear – a patient comes in unwell, has a procedure, and gets better. In oncology, the trajectory is often ambiguous. Some patients respond beautifully to treatment. Others don’t. Some arrive with curable cancers and leave in remission. Others arrive knowing that treatment is about buying time, not beating the disease. Charlotte had to learn how to be present for all of those outcomes without emotionally collapsing under the weight of them.

What a Typical Day Looks Like

I asked Charlotte to walk me through a standard shift, and the answer was that there isn’t really one. But a rough shape exists. She usually starts with a handover from the outgoing team, reviewing which patients are mid-cycle in their chemotherapy, who’s been admitted with treatment complications, and who’s new. She’ll check blood results first thing, because a patient’s neutrophil count or kidney function can determine whether that day’s planned treatment goes ahead or gets postponed – a decision that carries real emotional weight for people who are counting down their cycles.

A large portion of her morning involves preparing and administering chemotherapy. This is meticulous, protocol-heavy work. Every drug is double-checked. Every dose is verified against the patient’s weight, blood results, and treatment plan. The personal protective equipment alone is a ritual – gowning, gloving, handling cytotoxic drugs with a level of care that reflects just how potent they are. Charlotte says she never rushes this part, no matter how busy the ward gets. The consequences of a chemotherapy error are too severe to allow time pressure to creep in.

Afternoons often involve managing side effects – nausea, pain, fatigue, mucositis, psychological distress – and coordinating with the wider multidisciplinary team. Oncology nursing doesn’t happen in isolation. Charlotte works alongside oncologists, radiologists, pharmacists, dietitians, psychologists, palliative care specialists, and social workers. The team meetings, she says, are some of the most intellectually stimulating conversations she’s ever been part of in a clinical setting.

The Emotional Dimension

This is the part Charlotte finds hardest to talk about, and the part I think matters most. She has held the hands of patients who were receiving their diagnosis for the first time. She has sat with families in quiet rooms and watched them try to absorb news that would reorder their entire world. She has cared for patients over months – sometimes over a year – building relationships that go far deeper than anything she experienced in surgical nursing, and then she has been there when those patients died.

She told me about one patient, an older gentleman who’d been on her ward through several rounds of treatment over the course of a year. They’d developed a rapport built on shared dry humour and a mutual appreciation for terrible daytime television. When his condition deteriorated and the decision was made to transition to palliative care, Charlotte was the nurse who sat with his family and helped them understand what the coming days would look like. She was on shift when he died. She went home that evening and cried in her kitchen, then came back the next day and did her job again.

I asked her how she manages that, and she paused for a long time before answering. She said the grief doesn’t go away, and she doesn’t think it should. But she’s learned to carry it differently. The cancer centre has a clinical supervision programme and regular debriefing sessions, which she credits with keeping her functioning. She also runs – long distances, usually alone, usually early in the morning before a shift – and says the physical routine gives her a place to process what her mind can’t always handle in the moment.

A New Zealand Nurse in a UK Cancer Centre

I asked Charlotte whether being a New Zealand-trained nurse made any practical difference in her oncology role, and her answer surprised me. She said the clinical transition was significant – different drug protocols, different documentation systems, different regulatory frameworks – but the deeper adjustment was cultural. New Zealand nursing, she said, trains you to be holistic and patient-centred, and that translated well. But the NHS operates at a scale and pace that Auckland doesn’t, and learning to maintain that holistic focus inside a much larger, more bureaucratic system was a skill she had to develop consciously.

She also said that being an outsider – someone who came to the specialty without preconceptions about how a UK cancer centre works – was sometimes an advantage. She asked questions that locally trained nurses might not have thought to ask, simply because the answers weren’t obvious to her. More than once, those questions led to conversations about why certain things were done a particular way, and whether there might be a better approach.

What She’d Tell Other Kiwi Nurses Considering Oncology

Charlotte’s advice is characteristically direct. First, don’t go into oncology unless you’re prepared to invest in continuous learning – it’s not a specialty you can coast through on general knowledge. Second, be honest with yourself about your emotional capacity, and don’t mistake resilience for suppression. You need to feel the difficult things, she says, or they’ll catch up with you in ways you don’t expect. Third, find your people – the colleagues who understand what the work costs, who will debrief with you honestly, and who will make you laugh when you need it most.

And finally, she says, don’t let the hard parts obscure the extraordinary parts. Oncology nursing is watching someone ring the bell after their final chemotherapy cycle. It’s a patient telling you that your care made an unbearable time bearable. It’s the privilege of being trusted with people’s most vulnerable moments and knowing that your presence made a difference.

Charlotte would hate me for writing this, but she’s one of the finest nurses I know. And if her story encourages even one Kiwi nurse to consider this specialty, then she’ll have to forgive me.