A day in the life of a senior community nurse

Lisa Howe

Meet Lisa Howe, who works as a Senior Specialist Nurse in our community palliative care team. Lisa is passionate about providing people with the very best care possible. In her ‘day in the life’ diary, she gives readers an insight into her busy working day as she visits patients at home and within other community settings.

This diary was written in September 2021.

7:30am My day begins with my favourite bowl of granola, raspberries, honey and yogurt – the best fuel! I leave home and drive to Abingdon.

8:30am I go to the Abingdon district nurse’s office where I catch up with the hospital at home team to see if they have had any calls about my patients overnight as I might need to review their medication today. I check my emails to ensure I have answered what I need to and keep up to date.

9:00am I do a video call with my south locality team members to check in for the day and see what kind of day they have ahead of them and if we can help each other in any way. We work very much on our own each day so is great to be able to talk and see colleagues’ friendly faces. We all get on well and the comradery is exceptional!

9:45am I visit John at home with his wife Anne. John has prostate cancer and spinal cord compression which means he is paralysed from his waist. He is in a lot of pain today so I administer some pain relief and call Sally the District Nurse to help me hoist John back into bed as he is currently sat in his wheelchair. Anne looks worried and so I give her time to talk. She knows John is dying and they don’t have much time left together. John is struggling to take his medications by mouth so I prescribe a syringe driver for him following a conversation with his GP. Syringe drivers deliver pain relief medication at set times around the clock and will help us to manage John’s symptoms properly, and ultimately make sure he’s in no pain and remains comfortable for the time he has left.

11:30am I visit my next patient, Mary, in one of the local nursing homes. Mary has just been discharged from hospital and the hospital palliative care team have asked me to review her symptoms now she is back at her care home. Mary has chronic obstructive airways disease. This means she struggles with her breathing on a daily basis and the care home staff need support in how to manage this. I think about medications that Mary may need and review what she has been taking and what has been helpful or not. I also think of ways to support Mary’s psychological and emotional wellbeing. I refer Mary to our palliative care therapy team who can visit her to look at breathing exercises and relaxation techniques to enhance her quality of life.

13:00pm I have some lunch in my cool bag and often sit on one of the benches near the river (if it’s not raining otherwise it’s my car!). My phone rings and it’s Callum from our palliative care hub asking me if I can call Gillian back, who I met last week. She wants to discuss her medication as she needs some advice and support.

13:30pm My phone rings and it’s one of the GPs I work very closely with. They want some advice from me in converting oral medication into injectable medications for a patient. They know I do this a lot and trust my knowledge and skills base to make a plan together.

14:00pm I have a meeting at another GP surgery. We discuss some of the palliative care patients that I am looking after. We ensure that we have not missed any important care planning with the patient e.g. have we discussed preferred place of care and what do they feel about hospital admission. It is vital that we ask patients and families what is important to them and tailor our care to suit each individual.

15:00pm I meet Chris. He is 46 years old and has colon cancer and lung secondaries. He has no further treatment options and his care is now under our team. This visit is an introduction to our service. Chris looks worried and anxious on my arrival. I soon reassure him and make him feel more relaxed. I explain that our aim is to focus on his quality of life encompassing his physical, emotional, spiritual and psychological needs. I make some adjustments to his medications as he is struggling with sickness. We laugh together and Chris agrees to see me again to review his symptoms. I make a referral to our benefits support team as one big worry for Chris is about his finances. He said he felt glad he had met me and that he didn’t realise we could support with so many things.

16:30pm District nurse Polly calls me to let me know that Joan passed away this afternoon. Joan was settled and peaceful. I had seen her yesterday with her family. She had wanted to remain at home for end of life care. We had managed to achieve this for Joan with the support of her family and carers. I was grateful to have met Joan – she told me about a mountain in Austria that I must visit and walk up before I die. I will do that and think of you Joan.

17:00pm I have some notes to write from today’s visits so I head to the GP surgery. The receptionist knows me well and always makes me a welcomed cup of tea! They often ask me why I do what I do every day. Good question – I will answer that at the end.

18:30pm I leave the surgery and head home – I’m hoping I can go for a short run today when I get in. I’m training for the Oxford Half marathon and raising money for the Sobell House Charity. Let’s hope I can make the distance!

I love being a member of the community team. I always feel very privileged to be in this position and do what I do every day. It’s not easy and some days are extremely hard and emotionally challenging. I want to provide good end of life care to all of my patients and families. I always think that it could be my mum, dad, sister or brother etc. and with that way of thinking you can’t go wrong. The pandemic has brought many challenges but as a team it has made us stronger. I am very proud of all of my colleagues and feel we provide an exceptional service to our patients and their families within the community which they so rightly deserve.

All patient names have been changed for anonymity.