Transferring My Skills Into Palliative Care

Rachel discusses her career in nursing, from Hospice work, to her latest job in a Care Home and tells us what it has taught her.

Topics Covered In This Article

Introduction

Deciding To Change

A Rewarding Experience

The Challenges Of COVID

Leaving The Hospice

Starting Work At A Care Home

A Contrast To The Hospice

Final Thoughts

Introduction

My name is Rachel Turner and I've been a Nurse for nearly nine years.

I qualified in 2013 and within a week I had moved from Northern Ireland to the South West of England and started my first nursing post which was in a busy haematology department.

The three years that I worked there I was able to put the skills I had learnt at university into action straight away, such as venepuncture, cannulation, IV therapy, syringe drivers, but I also quickly learnt more acute skills, such as blood and platelet transfusion, the use of PICC lines, and knowledge around different chemotherapies used to treat blood related disorders.

There were a vast range of patients both in age and illness, so I was always kept on my toes.

It was quite an intense first job, being newly qualified.

In 2015 then, I had the opportunity to be part of a volunteer medical team that went to a very remote part of Nepal to run a surgical ENT camp.

People walked for days to see us and over the course of several weeks we saw around 1,200 people, 200 of whom had successful operations despite my very little experience as a Scrub Nurse.

And it was a very different experience from the wealthy Western hospital that I was used to, but gave me great insight into nursing in a third world country.

Deciding To Change

Back on the haematology ward, I was involved in a team that was working towards getting an accreditation in the Gold Standard Framework for end of life care and palliative care.

It was during this time that I realized I wanted to take a different career path and so in 2016 I became a hospice Nurse.

This was also largely due to personal experience.

My own father died in a hospice when I was very young and my mum still talks about the work that the Nurses did for her and how they looked after him, so that largely inspired me to want to work in a hospice as well.

But working in the hospice was very different to my previous job.

And at first I was a little apprehensive, especially when unsupportive people would make comments like, "Oh, you'll lose all your skills. It's going to be so depressing."

But it was a great change for me.

I gained so many valuable skills, such as knowing how to communicate effectively when it matters the most, symptom management, both holistic and pharmaceutical, and I still got to keep up all my other skills that I already had.

I was used to syringe drivers by that point and was quickly made the blood champion on the ward, which they were very pleased about.

More importantly, I suppose, I became much more knowledgeable about other diseases and conditions, 'cause contrary to still popular belief we treated a lot more than just cancer. We had MND patients.

We had traumatic brain injury and care of the elderly as well.

So yeah, it was very different again.

I already considered myself more of a bedside Nurse than the academic sort.

A Rewarding Experience

At the hospice I was able to do that much more.

I was able to be that kind of Nurse that I'd never been able to be before.

We had much more time to spend with our patients, not just performing clinical duties but actually sitting down and being able to talk to them.

Patients who have accepted they're gonna die, whether imminently or not, have a strange way of teasing things out of Nurses and carers about their own lives and passing on words of wisdom, which is very humbling in a lot of ways.

Of course, the job was mentally and emotionally draining, as you can imagine, and there were some deaths that will haunt me forever.

Not because they were bad deaths but because the patients held a really special place in my heart.

It wasn't a case of favorites, but rather the patients that challenged and shaped me as a Nurse, those ones, they always leave their mark.

Dealing with relatives of loved ones who are terminally ill, whether immanently dying or struggling with symptoms, wasn't easy.

You become a listening ear, a shoulder to cry on, or the one who bears the brunt of someone's anger and grief when they don't know what else to do.

You can't take it personally.

It's not aimed at you.

But the questions they ask are tough and at times unanswerable, such as how long is it gonna be?

But as the years went on I learned how to really assess a dying person and gained the experience that only a Hospice Nurse knows to able to give better answers to the hard questions and you just get that feeling.

The hospice was an open place when it came to visiting.

The first few years that I was there, relatives could come and go as they pleased and often helped at mealtimes, staying to tuck their loved ones in at bedtime, or stayed the night if they were young or having a hard time, or of course, if it was close to the end.

The Challenges Of COVID

In 2020 I had a baby and went off for a year of maternity leave.

My last shift was Christmas Day, 2019, and the world was unaware then of what was to come.

My daughter was born eight weeks before the first lockdown and I went back to work a year later in January, 2021, and things were very different in the world and particularly in healthcare.

PPE was probably one of my biggest challenges.

I was so used to using my facial expressions as nonverbal communication, smiling at my patients to give reassurance.

Sweating in the aprons and goggles and the constant donning and doffing. But for the patients, the lack of visiting was huge.

There was a very small window where a family member was allowed to visit and only one family member per patient for most of the pandemic.

I mean, how can you ask a man or a woman to choose between seeing their spouse or seeing their children when they're dying?

It's an impossible choice to make.

I suppose it was a blessing in a way that we only had one or two cases of COVID.

So compared to the rest of the hospital and the community, we were very lucky.

Leaving The Hospice

After a lot of sleepless nights, partly the baby, partly my brain, I made the difficult decision to leave the hospice after five years.

I'd struggled to get the promotion I wanted.

Shift patterns weren't fitting in particularly well with my childcare arrangements and family life and I felt that I needed a change.

When you have a big emotional change in your life, such as having a baby, it really makes you look at dying in a very different way.

And it can be quite difficult to separate the feelings of being a Nurse and being a mum, or indeed wife, and I decided that I needed to move on in my career.

I was still incredibly passionate about palliative care and end of life care but I had a secret passion that had been there, I guess, from the very beginning and that was care of the elderly.

So during my Nurse training I worked part-time in a care home as a healthcare assistant and that combined with the incredibly close relationship that I had with my grandparents meant that care of the elderly was etched into my heart from a very young age.

Starting Work At A Care Home

A local care home was advertising for a registered Nurse and were particularly keen on my hospice experience and they wanted to improve the end of life and palliative care for their residents and so I joined the team.

This, again, was met by a lot of criticism from some people saying, "So, you don't wanna be a real Nurse anymore since you're going to a care home.

All you'll be doing is giving out meds. The Carers do all the real work."

But not one to be easy deterred, I threw myself into my new job.

Again, I found this very different from where I had been before.

I found myself with a whole new set of challenges.

You're without a Doctor to hand apart from an hour each week when they call round to see anyone who might need changes to their medications or their care.

Any clinical emergencies or queries fall to the Nurse in charge the rest of the time and you're expected to know every detail about every resident in your care.

It was odd for me to be looking after people who were to all intents and purposes well and I did wonder at times if I'd made the right decision, however, once again, my bedside nursing was coming into its own and I started to build relationships with residents and to be able to care for them in a different way than I'd done at the hospice.

One of the challenges I'm currently facing is the continuing restrictions of visiting in the care homes.

I've only met a handful of relatives face to face since I started and haven't been able to build a rapport in the way that I might have done pre pandemic.

This makes it difficult when residents start to become palliative, especially.

Although they're allowed in that situation to visit, you haven't built up the trust with the family and it can feel hurried and forced.

However, because the resident is comfortable around you, some family members will feel at ease more quickly and you can help them deal with the difficult situation in the same way as you would otherwise.

Although not a care home exclusively for the elderly, most of my palliative residents, so far, have been well into their 80s or 90s.

And apart from the ones who are classed as COVID-19 deaths, they have died of frailty or what ordinary people called old age.

A Contrast To The Hospice

This type of end-of-life nursing is very different from the hospice.

There are, in most cases, less symptoms to manage and keeping someone comfortable generally involves less medication and more holistic nursing.

However, when a resident has been unwell and their wish is to die in the home, then I found the difference is much harder to manage.

Access to a doctor or just in case of medication takes a very long time, if out of hours or the weekend, compared to the hospice where you've a Doctor on call 24/7.

Equipment must be ordered at the time of need, which again is sometimes at weekends when it's not accessible easily.

And dressings are in short supply, as again, these are patient specific.

So managing end of life symptoms such as pressure sores or just general wounds that won't heal because of the situation can be very difficult and quite distressing for residents sometimes.

I've noticed that relatives will come and visit but be much less hands on in a care home compared to the hospice.

I suppose it's because it's a resident's permanent home they're visiting as they would've done in their homes beforehand.

Although visiting should have been easier in the care home compared to the hospice, given that residents are in their own rooms instead of an open bay, the restriction placed on care homes by the government were quite harsh I felt.

Relatives had to book slots, which was hard for those that worked during the week and not all residents could use FaceTime or technology.

And many relatives lived some distance away and had other vulnerable family members so didn't want to put them at risk, which is completely understandable.

The phone was their only connection, but for those who had relatives that no longer had verbal communication, they relied solely on the nursing staff for information.

Not knowing the residents all that well at first, I struggled with these phone calls.

I tried to remember all the communication training that I had at the hospice and began asking them about their loved ones, which really helped to build bridges.

And I think actually some relatives just needed that chat for themselves more than anything as well.

Final Thoughts

I've been in the care home now for over six months and I really hope that soon I'll recognize family members straight away and have a bond with them, that the residents will see my face and not just my eyes because we can get rid of the masks at some point, and I'll continue to gain new skills and pass on what I've learned to others coming through.

When people say, "Oh, I couldn't be a Nurse," I often reply, "No, you probably couldn't."

I'm not being rude or big headed in any way, I'm just being truthful.

I couldn't be a Teacher or an Accountant.

Nursing is a vocation, like so many jobs.

It takes a particular type of person to be one and I fear that many haven't felt their value much over the last two years.

I hope that wherever I go next I always remember how important my job is and I how much I love it and the patients that have made me feel that way for the last nine years.

Thank you so much.