A day in the life of a specialist nurse
In this ‘day in the life’ diary, we accompany Rachel on a busy day on the wards.
6:30 I set off from home for a chilly drive into the John Radcliffe (JR) Hospital, enjoying the mist over the fields along my drive in.
7:30 I arrive at the office, put the kettle on, and spend half an hour enjoying my breakfast with a cup of tea. I tend to arrive early to avoid the traffic, but this half hour of calm is a good opportunity to prepare for the day ahead.
8:00 I check our electronic patient record system for any referrals made overnight. There are three this morning from the JR wards, including a patient in our emergency department who has been referred to us so we can support a rapid discharge home as she is approaching the end of her life.
8:40 I join a video call with my colleagues in the Churchill and Horton Hospital offices. The hospital team provide on the ground cover for all four Oxfordshire hospitals from three different bases. This is a good time for us all to check in and plan our day.
9:00 Our team for the day in the JR includes three nurses, two occupational therapists, and a palliative medicine doctor. We discuss our patients, allocating which team members will visit them today. I agree to review the rapid response referral in the emergency department as my first port of call.
9:15 The emergency department is very busy, with lots of noise and bustle. I find Anne and her husband Roger in a cubicle. Anne has been admitted with a chest infection; Roger tells me that they would have preferred to have stayed at home but Anne was very unwell and he was worried so they agreed to come into the JR. Roger tells us he promised he would support Anne to die at home and would like us to get her home today. Anne already has a package of care and a hospital bed, but they are struggling with moving her in bed at times, so I call my occupational therapist colleague Daisy. While waiting for her to arrive, I make Anne a cup of tea and Roger goes outside to make a call.
10:00 Daisy has organised some additional equipment and called the care agency supporting Anne to ensure they are happy with the new kit. The medical team arrive, and we all agree to get Anne home today – there is little more we can do in hospital. We discuss the medications she will need and I complete the paperwork required to allow this to be administered by a nurse at home if needed. Luckily the emergency department transport crew are available, so I help transfer Anne to the stretcher and she leaves the emergency department smiling. Her medications will be delivered by courier later today. I refer her to my colleagues in the Sobell House community team for ongoing support.
10:45 I pop back to the office for a drink and to catch up with Jenny who is triaging our new referrals. She mentions an urgent referral for a patient who is distressed, and I agree to go and review him.
11:00 I head to the neurosciences ward to meet Gary, a young man with a large brain tumour. He has been on the ward for five weeks but has deteriorated overnight and the team are worried he is dying. His wife Kate and young son Ryan are present when I arrive. Gary is unconscious but looks very breathless and is groaning. The nurses have been giving him injections of painkiller but don’t think they are working well. Kate is worried Gary is in pain. I talk her through my assessment, and we talk about starting a syringe driver to control Gary’s pain and breathlessness. Ryan has been very quiet, I ask if he has any questions. He wants to know about dying, and what will happen to his dad. His questions make Kate cry, she hasn’t known how to talk about this. I spend some time answering Ryan’s questions honestly, he is 12 but asks questions I might expect of someone older. I prescribe the syringe driver and chat to the nursing team. I agree to come back later and check that Gary is more comfortable.
12:30 Time for lunch. The team make time to meet up together and have lunch – it’s a time to reflect on the morning, plan for the afternoon, and share some stories from outside of the hospital walls.
13:00 I’m back on the wards, this time on our complex medical units. I visit Barry, who is dying comfortably following a change to his syringe driver yesterday. I help his son give him mouth care using a very nice single malt whiskey that he has brought in and we share a joke. Mouth care is a really important part of end of life care and is more than just cleaning people’s teeth. Tending to people’s oral care maintains their comfort, self-esteem and dignity.
I then visit Carole, who tells me that her nausea is much better after a change I made to her medication yesterday, and we celebrate this fact with her first cup of tea in a week.
I move down the ward and see Colin, who is going to a nursing home tomorrow, a plan which has been in the making for the past week. He is both excited and nervous, and we spend some time talking about his emotions at leaving his home of the last 20 years. I write my notes as I go, catching up with ward teams and trying to avoid the numerous chocolates offered to me! The team are familiar faces around the hospital and always warmly welcomed.
14:30 I get a call from Jenny who has received a call about Gwen who I had planned to review tomorrow. The physio team are worried about her pain and I agree to review her today instead. On arrival, Gwen is clearly in pain but desperate to get out of bed. I help the ward nurse administer some morphine, and then see her with the ward physio. Around 30 minutes after the morphine, we have Gwen sitting on the edge of the bed for the first time in ten days. Getting to the chair is a step too far for today, but we make changes to her painkillers and a plan to return tomorrow and try again.
15:30 Another quick stop at the office for a drink, a sneaky biscuit, and to call Anne’s GP to update them about her wish to have end of life care at home. The GP will update her records to reflect this should an ambulance be called again.
16:00 I return to Gary, Kate, and Ryan. The nurses look relieved and tell me Gary is much more comfortable. Ryan is watching a film sitting on the bed with his dad. Gary looks calm and comfortable, and Kate looks visibly relaxed too. Kate asks whether the feeding tube can be removed to make Gary look more like himself. We discuss the pros and cons and agree to keep the tube as it is the only way of giving some essential medicines, though I secure it in a way that allows Ryan to put on Gary’s glasses which he always wears.
17:00 I return to the office to check my emails and respond to a request for a teaching session from our neurosciences intensive care unit. It is a session I have done before, and one that feels even more pertinent given my time with Gary today. I check in with my colleagues on the other hospital sites, and shut down the computer at 6pm.
18:00 I set off for my drive home and listen to a podcast as a way of decompressing so I am ready to go again tomorrow.
I love my job and the impact we are able to make as a small piece of Sobell House in the hospitals of Oxfordshire. I feel proud to be able to support patients in our acute hospitals, making a daily noticeable difference to people’s symptoms, quality of life and comfort. Being the person who says it’s okay to have a gin and tonic in the emergency department is a good perk too! The pandemic hasn’t been easy in the hospitals, but I am so proud of my colleagues and the difference we are able to bring to patients, families and ward teams every day.
Please note that names have been changed for confidentiality.