Published on: Tuesday 03 Aug 2021 at 09:40
Here Rachel shares her passion for palliative care nursing, the difference Hospice care makes to patients, and why the Nurses Are Needed campaign is so important for the future.
Arriving as a student nurse
“Hi, I’m Rachel and I have been working here at St Clare for 12 years. I first came to St Clare as a student nurse, I was very young at the time – just 18, and I was absolutely petrified about being sent to a hospice. I had no experience of hospice care and just didn’t have any idea about what it would entail, or what sort of nursing they did here.”
“But I absolutely loved my student placement at St Clare. I was here for just 1 month at the time, and really got on well with the team and was made to feel so welcome. I absolutely loved the side of nursing that you see in a hospice – I loved how much time the nurses could spend with the patients, and how involved you got in their care – and how hands on you could be as a nurse.”
Joining the St Clare team
“In my third year of training I requested a second placement at the Hospice and was granted it. Again, I had great support from my mentors and was made to really feel part of the team.”
“Shortly after qualifying as a registered nurse, a job came up for a Staff Nurse at St Clare and I jumped at the chance – and was lucky to get the role. Other people may suggest you go out and get lots of different nursing experience, and that might be the right thing for others, but I knew deep down that there was nowhere else I wanted to go to work every morning, and that palliative care nursing was the right path for me.”
“It’s 12 years since I took the job and I have juggled having my children and working during that time. It’s been really important to me to carry on my career in nursing, and I see myself growing my palliative care experience and skills as my children get older – and hopefully working up to be a Clinical Nurse Specialist one day.”
“St Clare Hospice is really supportive of developing our nurses and offers lots of opportunities to gain experience in other teams and roles within the Hospice.”
“I work a mixture of day and night shifts, as well as coordinating the volunteers who support us on the Unit. The volunteers are gradually returning to support us as the COVID restrictions lift, which is really exciting as we have all missed them and their help. I absolutely love my role and the years seem to have flown by – which is definitely a good sign that I love my job!”
Palliative Care Nursing
“The special thing about palliative care nursing is how you can make such a difference to people’s lives in a short space of time. We have quite a limited amount of time with our patients – either because they are with us for symptom management and we hope to send them home as soon as we can – or because they are here at the end of their life and time is limited.”
“That means we have a small time frame to get their care absolutely right and to sometimes completely change their experience of end of life care. That is the real challenge, and fulfilment, as a nurse.”
“So many people have come here after spending weeks or even months in hospital – and just the difference in them once they arrive at St Clare is amazing. You see them settle, feel calmer, and relax because it is a much more appropriate environment for them. It’s lovely to be able to make a difference by them just being here – and that’s even before we look at their symptom or pain management.”
“Palliative care nursing is so hands on with your patients – which is why I think it’s brilliant being a nurse here. It’s a busy Unit, and we’ve got a lot to manage with patients with varied and complex needs, but we always ensure we find the time to give our patients quality time with us. In order to give them the best care, we need to listen to the patients and their families about what they need – and sometimes they just need you to be there, and to be present with them.”
Speaking about death and dying
“I was working on the night shift recently and we had a patient admitted during the evening who was, understandably, very nervous about being cared for in a hospice. They had no idea what it would entail and was quite upset. But when she arrived, I was able to spend a good hour with her, and her partner, talking her through what being here involved.”
“The patient had some really brave and blunt questions about end of life care and death, and what to expect. They were questions which I don’t think she had wanted to ask prior to coming in.”
“I was able to spend that time with her and have a really honest conversation – we talked through some of her fears about dying in pain, or dying alone. She wasn’t scared about death itself, but about what could happen.”
“By spending time with her and her partner we were really able to talk it through and afterwards they thanked me for making them feel more comfortable – not just about the Hospice, but about death in general. People don’t know what to expect at the end of life – but as palliative care nurses, we deal with this every day.”
“Every patient and every case is just as important as the previous one – and everyone is just so different with such different and complex symptoms and needs. That’s not only regarding the patient, but their family situation as well. Sometimes just by sitting down with them with a cup of tea, you can really read the situation – perhaps between them and their partner, or between a mother and daughter – and you can get a lot from just sitting, letting them lead, and actively listening to their responses.”
“Some people are ready to talk about death, and other times you have to tread very carefully and gently around certain subjects. One of the amazing things about working in a hospice is giving families the opportunity to have this time, and to help them to have these important conversations.”
Specialist and multidisciplinary care
“We see a lot of different patients with different needs and that is challenging for us – but we are specialist and experienced here and are supported by an amazing team of doctors who really empower us, trust us and support us.”
“The doctors really value our opinion as nurses, and they take on board that we spend a lot of time with our patients and are well placed to understand how they are getting on, whether their symptoms are getting better or worse, what complex family issues we need to support with, and any referrals that we need to make – either within the Hospice or to external providers.”
“The nurses are probably the first people the patient sees when they come in to the Unit – so I am always very mindful of that when I am greeting people who are sometimes very nervous, agitated and worried. But we wouldn’t be able to do our role without the support from everyone else in the Hospice teams.”
“We are a very good team because of the multidisciplinary nature of the Hospice – with doctors, nurses, physiotherapists, occupational therapists, social workers and counsellors all on hand to give the patient and their family a truly holistic service.”
“The nurses are just a small part of the big, multidisciplinary team available to a patient and family. We all play a part in the care of patients both in the Unit and in their own homes – all pulling together to provide the best possible care for patients.”
Looking to the future – the need for more nurses
“There have been some noticeable changes in the palliative care needs of patients, and a higher complexity of symptoms, in the time I have been at St Clare. We are busier and the need for beds has been increasing. I think that is partly through the Hospice becoming better known locally as the specialist provider of palliative care – with GPs, professionals and hospitals referring to us more – but also the changing needs of patients. We care for people with a wide range of life-limiting conditions, not just cancer, including Motor Neurone Disease, heart failure, and lung disease – and their needs are often more complex.”
“We are seeing a lot more people go through more and more treatment than in the past – and living with cancer or other illnesses for much longer. That sometimes means that people can have side effects that are more complex. So for some people who years ago might have died sooner, now live longer but may have more complex symptoms to manage that can require our specialist care and interventions in some cases.”
“It is often our care that is making sure that the life they are living remains quality life – with their symptoms managed so that they can enjoy the time they have, and are empowered to remain independent for as long as possible.”
“As a team – both the nurses and the medical team – we have a wealth of experience and specialist knowledge. We have palliative care consultants who are nationally and internationally recognised in their field – meaning we can take on more complex patients.”
“The increase in need for our care, and the increased complexity of patients’ symptoms, means that more specialist palliative care nurses are needed in the Hospice now, than ever before.”
“As palliative care nurses we undergo a lot of further training and different courses to make sure we have the knowledge we need to deliver complex care to patients. Some of the medications we use here are slightly different to what would be given in a hospital setting, or we use medication for different reasons. For example, we use a drug that is generally used as an anti-psychotic, but is actually very effective for anti-sickness caused by cancer and other conditions. Knowing how to use medications in these ways requires extra training and can only be undertaken by doctors or nurses who have experience in caring for patients like we do – so we can provide that more specialist and tailored care for people, which they cannot get from other healthcare providers who don’t deal with these cases on a daily basis.”
“We can have patients referred to us for end of life care – either from home or hospital – and the healthcare provider genuinely thinks the person is dying. Yet after a few hours with us, with their medications changed and interventions by our doctors and nurses, the person is much better.”
“They might go on to live a few weeks or months, or to return home to die at home, but we will have made a huge difference to the way in which they live their last days, and the way in which they die. So often people’s biggest fear is that they will die in pain and suffering – and that is what we are able to ensure doesn’t happen. Being able to do that means more than anything to patients, and their families.”
“We only die once in our lives, and we only get one chance to get it right for people. Supporting people to die with dignity, not in pain, and in the place they choose, is a huge responsibility but also a huge privilege, as a nurse.”
“It really is such a fulfilling job, to get to do so much for patients and their families – which is why I am still working here 12 years later!”
– Rachel
Nurses Are Needed
Rachel’s story is being shared as part of our Nurses Are campaign, as we fund more registered nurse posts across our clinical teams – supporting more local people to have the best possible death, pain free, in the place of their choice.
Find out more about our Nurses Are campaign here.
