A day in the life of a Hospice Nurse
This diary was written in April 2021.
07:15 Arrive at Sobell House and get changed into my uniform and PPE (personal protective equipment). I check to see if any nurses have been redeployed to another ward for the day, and which patients I have been allocated. Depending on how many staff are working, each nurse is usually allocated 4-6 patients during a day shift.
07:30 Handover begins. The nurse who was in charge overnight runs through all the patients currently at Sobell House, and lets us know of any patients that may be admitted onto the ward today. The coordinating nurse highlights any care needs, concerns, symptoms, or medications that have been given overnight that we need to be aware of.
08:00 I start work on the ward. I often have new starters or student nurses working alongside me which I really enjoy. However, today I am not allocated another member of staff, so I start my shift by reading through any plans and notes written by my colleagues from the previous day and overnight. These notes could come from doctors, the therapy team, or social workers – we’re a multidisciplinary team at Sobell House.
08:15 I start the medication round. While administering medication to my first patient, Bernard, I notice he appears distressed. His wife is here to visit, so I introduce myself to her. We discuss a plan and I review his drugs chart. Bernard can have some further ‘as required’ medication to help relieve some of his agitation and make him more comfortable. Our consultant arrives to review Bernard, and we discuss Bernard’s needs with his wife, where it is agreed that we will increase some medication in Bernard’s syringe driver and trial him on a new one-off dose of intramuscular medication. Once this has been administered, I arrange a facetime call with a member of our chaplaincy team and Bernard’s wife. I set this up in Bernard’s room so that he can hear the chaplains voice too.
I go and say good morning to another patient, Frank, who at present has a chest infection and requires suctioning. Once that’s finished I give Frank mouth care to ensure his mouth does not get dry. I then draw up Frank’s medications and administer those.
The consultant has just been to review Frank. We agree that a meeting with Frank’s family to discuss his ongoing care plan is important, so I phone them and we arrange a video meeting for later today.
09:30 Once I have finished administering all morning medication, I answer any call bells which are alerting me that a patient needs assistance.
10:00 I work closely with the nursing assistants at Sobell, and today we plan which patient we will help to bathe first. Our patient, Freddie, asks to have a shower, so I attach him to a portable oxygen cylinder to enable him to have a shower with his wife assisting him. We then go to help Shelia, who is unable to get out of bed for long periods of time, so instead we help her to have a wash in bed, enabling her to be as independent as possible. In my role, I need to ensure that personal care is as comfortable as possible for people, so I think ahead if any of my patients need pain relief before bathing.
10:45 With another nurse I draw up and administer Bernard’s new syringe driver as it has been prescribed.
11:00 We always try and take a (socially distanced) tea break with all of the nurses and nursing assistants for 15 minutes in the morning, to catch up on the mornings care and any care that still needs completing. However, as you can imagine, it’s difficult to get everyone to sit down at the same time!
11:15 We have a board of all the patients who currently have syringe drivers in situ. Syringe drivers are continuous subcutaneous infusions which have a range of different medications in that help to manage symptoms such as pain, sickness, fits, agitation, or breathing problems. Syringe drivers need two nurses to set up and draw up the medications as most of them have controlled drugs in them. This requires time throughout the day, so we make a note on the board for when each syringe driver is due to run out of its 24hr medication so that we can replenish it in time. Today, myself and another nurse make a start and check with our ward doctors to see if any medication changes have been made.
12:00 I catch up with any phone calls or messages people have left for me. I call the next of kin of my patients to update them if they’re not present on the ward. Where possible, I give the opportunity for the next of kin to speak to the patient directly on the phone, which is done via the wards portable phone or iPad. This is particularly important due to the current Covid-19 visiting restrictions, which have been challenging for us all.
13:00 I check the drugs chart to see which of my patients require lunchtime medication. First, I ensure each of my patients are set up with their lunch and if they need any assistance to eat. When administering medication, I check if any of my patients require extra medication such as anti-sickness. Shelia is experiencing abdominal cramps, due to her tumour pain from cancer so I look at her drug chart and medical notes to administer the appropriate medication. I will then go back to review if this has been effective for Shelia later in the day.
14:00 In reviewing Bernard throughout the morning and enabling him to have a full wash in bed, I have assessed he is still struggling with symptoms of distress and his breathing, so I go back to his room with another nurse to administer some further medication. Whilst talking to Bernard’s wife in his room, we notice Bernard is taking his last breaths.
It is exceedingly difficult in the current Covid-19 pandemic as to protect everyone, hospital trust policy limits visitors onto the ward. However, in this circumstance Bernard’s sons are also able to say goodbye to him in his final hours and we give the family some time together.
In the hours following Bernard’s death, I speak to our bereavement services team and give support and information to Bernard’s family regarding their next steps.
14:30 Time for our daily safety huddle, where the nursing staff that are free have the opportunity to voice any patient safety issues, and say what has gone well and what has not gone so well.
14:45 In Frank’s treatment and care plan I need to carry out his vital signs twice a day, so I take his blood pressure, oxygen saturations, heart rate, temperature, and respiratory rate and escalate any abnormal results to the medical team. Frank is requiring oxygen via a face mask so I ensure he is on the right amount of oxygen. His face mask is causing some marking to his face so with the help of a nursing assistant I pad the face mask with foam to relieve the pressure of Frank’s face and apply cream to his face to help soothe his skin.
15:00 A video meeting is set up with Frank’s family, the specialist learning disability nurse and consultant to discuss Frank’s care. This is often known as a best interest meeting. We listen to the families concerns, any issues raised, and set out a plan going forward.
16:00 It’s my time to have a break. A chance to eat some food, and write down a plan for myself and prioritise what I still need to complete for my patients.
16:45 Freddie is taking dexamethasone – a corticosteroid medication – so he requires once a day blood sugars. I go to see Freddie and with consent get a blood sample before dinner to check his blood glucose level. This medication can often interact with the level of glucose in the blood. I notice that Freddie is coughing on the fluids he is drinking so I gain consent to refer him onto the speech and language team. I make a note to do this later via our electronic computer system.
17:00 I notice on the charts outside the patient’s rooms that a few of my patients need some help to change their position to prevent any pressure damage. I work alongside a health care assistance to reposition a patient and change his incontinence pad.
17:30 Bernard’s family have said their final goodbyes, so with the help of a nursing assistant we wash and wrap Bernard and remove any lines and medical devices attached to him. Bernard is now taken to the mortuary by porters.
18:00 I check the drugs chart to see what medication my patients are on and administer those. I assess all my patients to see if they need any further pain relief or anti-sickness. I enable patients to eat their evening meal if they can, with assistance from myself or a nursing assistant.
19:00 I start handing over information from the day regarding my patients to the co-ordinating nurse, so they can then handover to the night staff.
20:00 Night staff take over care, so I sit down to finish any documentation that still needs completing to ensure all patient care and information is detailed and clear.
20:20 It’s home time, and a moment to reflect.
Working as a nurse on a palliative ward during the Covid-19 pandemic has its challenges, and one of the biggest challenges has been limiting visitors onto the ward. It has been heart-breaking for staff to restrict loved ones from seeing their family and friends in order to reduce the spread of Covid-19. I have witnessed how this has been upsetting for all involved, especially during a distressing time in the individual’s life.
However, it has been an honour to continue to see the inspiring way people and their families accept and battle with an advanced disease. As well as to work alongside an amazing team to provide patient safety, control of symptoms and meet care needs at the end of a person’s life.