A day in the life of a senior specialist nurse
Pictured from left to right: Tamara, Damian, Rita and Lauren from the hospital palliative care team.
This diary was written in August 2021.
5:30am My alarm clock goes off. I go downstairs to have some breakfast and a cup of tea, and feed my dog!
6:15am I get in the car to start my commute. I live about an hour away from Oxford, but I love my colleagues and being a part of Sobell House and Katharine House Hospice, so to me it’s worth the travel and I look forward to going to work.
7:20am I arrive at the John Radcliffe Hospital, grab a disposable face mask as I walk in, and get changed into my uniform. As I’ve arrived early, I check my emails to see what’s been happening overnight for the patients who are already known to the hospital team. Wards will refer patients to us (the hospital palliative care team) if they feel they would benefit from palliative care input. We can help people with their symptom management (pain, nausea), advance care planning (thinking about the future and what’s important to them), helping with discharge planning, and help teams provide end of life care.
8:30am All of my colleagues have now arrived. Today, I am working with Alex, Damian, Rita, and Ziela, who are all specialist nurses, along with Dr Julia Bartley, an associate specialist in palliative medicine. We usually have an occupational therapist named Bronwen with us, who helps to get patients home from hospital as soon as possible for end of life care, however they are on leave this week. Most importantly, Damian has made some very strong coffee which we all have a cup of!
8:40am Our palliative care service is provided across all of the Oxford University Hospital sites (John Radcliffe Hospital, Churchill Hospital, Horton General Hospital, and the Nuffield Orthopaedic Centre). Rita checks in virtually with the nurses at the Horton and the Churchill, and reports that everyone is feeling positive about their day today.
8:50am Rita then joins a Sobell House and Katharine House Hospice virtual meeting, to see what’s happening within the hospice departments and find out if there is a hospice bed available for one of our patients, named Anna. There is a patient who is being discharged from Sobell House today, so a bed will be available for Anna later.
9:10am We start our morning handover slightly later today as the meeting ran over. During handover, we discuss the patients that are known to us; what their background is, what we are currently helping them with, and when they need to be seen.
10:05am I head out of the office to see some patients. My first patient is called Zara. Zara is dying but appears very comfortable. I notice that Zara is using a non-rebreathe facemask with high doses of oxygen, which can cause a dry mouth and throat. I ask the team to continue to wean the oxygen delivery if Zara’s symptoms allow.
The second patient I see is called Dan, who has cancer and is likely in their final days of life. I notice that the nursing staff are still carrying out observations, which can cause discomfort and distress to someone who is dying. I contact the medical team looking after Dan and they confirm that their goal is comfort at end of life, therefore observations are no longer necessary. I go back to the office to type up my patient reviews.
10:50am Now I have seen the patients allocated to me, I get ready to do some teaching with some newly qualified respiratory nurses. A big part of our role is to contribute to education and learning in the Trust, to ensure there is good palliative and end of life care for patients. Today, I am introducing end of life care, where I will be teaching the nurses how to support the loved ones of patients who are dying and how the nurses can help manage symptoms at end of life. The session goes well, and I receive feedback that the nurses now have more confidence in caring for people at the end of their lives.
11:45am I return to the office and catch up with my colleague Alex to find out how their day is going. Alex is doing triage for the hospital team today, which means managing new referrals and taking lots of telephone calls. After we catch up, I have a cereal bar as I’m getting hungry!
12:00pm I join an exciting meeting with representatives from the rest of the hospice departments. We discuss possible future projects within the hospice. As a team we are committed to continuous development, so we can ensure we best meet the needs of the people in our care.
12:30pm A much-needed lunchtime!
13:00pm We quickly make a cup of tea and then have an afternoon catch-up altogether to discuss our patients again and update one another about what has happened this morning so we can plan our afternoon.
14:00pm Our multidisciplinary virtual team meeting begins, where we discuss patients who we are concerned about. The purpose of this meeting is to gain different perspectives about patient care from a holistic viewpoint and hear ideas about how we can manage people’s symptoms.
15:15pm I have been allocated to see two more patients this afternoon. First, I go to see Harry, who is dying. I review him to make sure he is comfortable.
I then go to see Jill, who has a metastatic cancer, and I help with some nausea and constipation management. Jill is concerned about the possibility of not being able to have further chemotherapy, and is finding it hard being in hospital without family visiting (as they do not live locally). I suggest to Jill to make use of our chaplaincy service, and she loves this idea.
16:30pm I head back to the office to type up my patient reviews, and contact the appropriate medical teams to implement the changes I have recommended.
17:05pm We have had a referral for a patient in resus. Tom has a metastatic cancer and is Covid-19 positive. Whilst the restrictions have been eased, we still see patients and families that are impacted by Covid-19. I provide some telephone advice and the team recognise that Tom may not survive this admission, which has been explained to him. When we identify patients who may die on admission, we ensure they have ‘anticipatory medication’ prescribed. This is medication that can be given to a dying person if they have distressing symptoms at the end of their life. I type up my recommendations and advise the team to call the palliative care doctor overnight if they are concerned.
17:50pm I turn off and clean the computer I’m using, before getting changed ready for the drive home.
18:10pm I arrive at my car to start my journey back. I enjoy the commute home as it gives me time to reflect on my day. I think about what a privilege it is to work with such a wonderful and skilful team who are dedicated to caring for people with life-limiting illnesses. It’s wonderful knowing that the recommendations my colleagues make can make such a big impact on people’s lives.
All patient names have been changed for anonymity.