In celebration of Nurses’ day 2016 I wanted to reflect what I love about nursing and my job as Community Clinical Nurse Specialist at St Richard’s Hospice. This has proved surprisingly difficult yet effortlessly easy at the same time!
I came into this job in April 1998. Wow! I can’t imagine that I came here with the expectation that I would still be here eighteen years later. Perhaps more poignantly, that I would still love my job and the challenges it brings on a daily basis. People often say that working in the hospice must be “depressing”. Well, it can be very sad but the rewards are so much more complex.
Eighteen years after I am still proud to say I am a nurse and a nurse at St Richard’s Hospice. Changes in working practice come and go; some good, some perhaps not so good, or at least not so easy to accept! However, the one key element remains the same: the patient and their family.
The whole reason I came into hospice care was to get back into being with the patient. That’s what I love about nursing. The relationship that I as a nurse develop with my patient is central to everything that I do.
My role as Clinical Nurse Specialist means that I “carry” a caseload of patients. In this role I enter into a very unique relationship with patients and families at a time when they are experiencing probably the most difficult time in their lives. It’s a very privileged place to be: being allowed into someone’s very personal experience. My job satisfaction comes from utilising all of my clinical knowledge to guide and support them through this wretched time. People often feel very lost and my job is to help them to make the best decisions for their present and future care.
The public have a preconceived idea of nursing that generally involves “hands on “physical care. My job is very different to this and it is often hard to define.
A typical day usually involves an office based start checking and responding to messages from patients, family or other professionals. This can often take a couple of hours and may mean a complete reworking of my planned day. I visit patients in their own homes so a significant part of my day is spent driving around. My family often joke that if I left this job I could take up taxi driving as I’m pretty good at finding the quickest routes through the back roads!
Visits last on average anything from one to two hours for a first assessment to forty five minutes to one hour for a follow up visit. This can seem a long time but at the hospice we aim to try and address all areas that the illness is impacting. The most obvious symptoms are physical. As specialist nurses we use our knowledge to advise patients, GPs, District nurses and other health professionals which medications may be most effective. This involves a lot of education as patients and families may be frightened of what’s happening to them and also some of the drugs that are used to treat them. Helping someone to understand what’s going on can enable them to take back some of the control when it can feel like everything is spiralling out of their control. Much of this is done face-to- face but we also work a lot on the telephone during the course of the day.
Assisting patients and families to cope with the changes that the illness has brought and helping them to prepare for the future, good or bad, is a large part of the role. For me, the significance of the nurse patient relationship is key. Allowing someone to open up their deepest fears needs trust and people need to feel safe.
We aim to establish what the patient’s goals are for their future care. This is called Advance Care Planning. It may feel scary but the aim, once again, is to return some of the control back to the patient. They may not be able to control the course of their illness but we can help them to establish what they would and would not want to happen to them. Often facing these fears can demystify what’s going to happen and can help the patient and family to face the future more confidently; knowing who and what support is available.
This is, of course, sad. Seeing patients and loved ones losing one another is never easy. But, if I can make this experience a little more bearable because everyone involved feels emotionally and physically supported then I can go home at the end of the day with a sense of satisfaction.
Nursing comes in many guises but essentially all nursing is aimed at improving the patient experience through care and human response. I have the great privilege to meet people from all backgrounds each with their own individual life story. Every relationship has common themes but is also completely unique. Each has the ability to touch and inform both my life and and my clinical practice. I am learning every day and this is why I love nursing.
Community Clinical Nurse Specialist