A day in the life of a specialist nurse

Lynn Erskine

Everyone approaching the end of their life should have access to high-quality care and be given the opportunity to make choices about their life, their care and where they wish to die. Meet Lynn, a specialist palliative care nurse, who shares a day in her life working on our outreach project to support people experiencing homelessness.

7:15

I set off on my commute to work – it’s a lovely sunny day and I’ve just seen a couple of hot air balloon flights for the first time in a long time!

8:15

Arrive at the office, grab a coffee and check in with my colleagues. I have worked in the community palliative care team for 23 years in Oxfordshire, and have recently changed role to be part of the palliative care homelessness outreach project team, aiming to support both people experiencing homelessness who have advanced ill health as well as practitioners who are supporting people with complex needs. We have received funding from Sobell House Hospice Charity and St James Place Charitable Foundation for this project to identify the needs in our local community and enable earlier access to palliative care services.

9:00

It’s time to check my emails and prepare for today’s meetings.

9:30

I discuss a patient who I have visited recently with a colleague. He has difficult pain and is known to use recreational drugs to help manage his pain on the days when his prescribed pain relief isn’t working. He became quite tearful at my last visit and said he was frightened about what was happening to him and how alone he felt at times. He thanked me for coming to see him as he often felt that people judge him for his drug use; having someone listen to him helped him psychologically as well as addressing his physical pain issues.

10:00

Meet for our weekly multidisciplinary team meeting, where the whole community palliative care team discuss patients with complex physical or psychological symptoms. The team today consisted of specialist nurses, doctors, a pharmacist and an occupational therapist. I present to the team to give a brief summary of the palliative care outreach project we are just embarking on. I ask the team if they can let me know of any patients they are currently supporting who are vulnerably housed.

11:00

I get back in my car as I am now heading to the homeless hostel in Oxford to see a patient called Helen who currently lives there and has liver failure. Sadly, individuals experiencing homelessness often die prematurely, with the mean age of death in the mid-40s. I arrive, but Helen’s key worker informs me that Helen has forgotten I am coming and has unfortunately gone out. Helen has had several admissions to hospital recently but her regular support team report she appears stable at the moment. I arrange to visit the following week.

I reflect upon another patient I visited in a similar situation, who had abdominal pain due to a build-up of fluid in his abdomen as a result of his liver failure and breathlessness. He was eventually rehoused to a flat. Myself and my medical colleague were able to advise and support in helping with symptom management alongside his GPs, and also in some correspondence with his son – the only remaining family contact he had.

While I’m here I tell Wendy, the Support Team Manager, about the project, and we discuss when I could spend some time with her and the team completing questionnaires, helping to identify clients that may have health needs.

12:15

Next I go to the GP surgery who support the residents in the hostel. I chat to one of the practice nurses, tell her more about the project, and arrange a time to meet with her colleagues to see if we can identify any patients who may benefit from palliative care support.

12:30

I drive to the Churchill Hospital and have a coffee and snack.

13:30

Join a meeting with my colleagues on the project – Nicole (Equality, Diversity and Inclusion Officer) and Maria (Volunteer Lived Experience Community Lead from the Lived Experience Advisory Forum) – to discuss an upcoming stakeholder meeting. These stakeholder meetings are key for the launch of our project to welcome different organisations, teams, and individuals to take part in the project and help shape it.

14:00

I have a meeting with the CEO of Homeless Oxfordshire to discuss developing a countywide end of life care plan for people experiencing homelessness. We talk about how we can contribute to this strategy as part of a bigger team across housing, social care, health services, and others. The results of our outreach project will inform this strategy going forward.

15:00

Take a few minutes with a cup of tea to reflect on today’s meetings. I then start preparing a presentation for the stakeholder event.

17:00

I head home – I’m looking forward to seeing my family and our new puppy – a great distraction after a busy day!