A day in the life of a Clinical Nurse Specialist
Last year, we restructured our community care services to work more collaboratively with GPs and District Nurses, strengthening our relationships across Sussex and Surrey.
We followed Myles, one of our Community Nurse Specialists, during his shift:
8am
In the office I’ll review new referrals, tasks sent from District Nurses or GP colleagues and look at my planned visits and telephone calls. I look after residents within Crawley, so work out who needs to be seen most urgently and what interventions they need. Different members of the community team look after different patients within set geographical areas, split by GP practice.
9am
There’s a meeting with my hospice team to discuss new referrals so my colleagues and I can identify those with the greatest complex or unmet specialist palliative care needs. We also discuss everyone on our Inpatient Unit Waiting List, who may be in hospital, in their own home or in a care home, and prioritise admissions depending on their needs and the availability of beds.
10am
Now it’s time for me to see someone at the hospice for an outpatient appointment. These are reserved for people who are well enough to travel to the hospice but still have concerns that we, as a specialist palliative care team, need to address. I review their breathlessness after an exercise class, and discuss their welfare needs. They work at a local hospital and because of their fatigue they need to drive to work and park close to the department they work in. We agree I’ll refer them to our Welfare Team who can advise them on making an application for a blue badge for their car.
11am
I complete my notes from my outpatient appointment. This involves making relevant referrals, submitting drug recommendations to the person’s GP for prescribing and updating other healthcare professionals involved in their care by email.
12 noon
Time for a home visit to a man who is unable to come to the hospice. He tells me maintaining his independence for as long as possible is most important to him, and we discuss what equipment may be of benefit and how carers may help. If needed I would consider referring him to other community colleagues, for example an Occupational Therapist. During home visits, I’ll often also support people with specialist symptom control, or help them make informed decisions about their future care and treatment through advance care planning, such as completing a ReSPECT form, which is a form that documents a personalised recommendation for clinical care in an emergency situation.
Since changing how we work, we tend to visit the same person more regularly, which gives us chance to get to know them and gives them greater continuity of care.
1pm
I head to Crawley Hospital for a Crawley District Nurses team meeting to discuss patients we both look after. We share any concerns and implement plans for each of us to follow.
1.30pm
Following the District Nurse team meeting, it’s time to deliver a teaching session to my District Nursing colleagues. Since we’ve been meeting together and strengthening our relationships, the District Nurses and their clinical leads have identified ways I can use my specialist palliative care knowledge to support them to build upon their existing knowledge and instil confidence in delivering good, generalist palliative care.
2pm
Lunch – time for a breather!
2.30pm
Back at the hospice I call people who I’ve previously seen face-to-face to review how they’re doing. One patient feels they don’t have any current concerns and that their illness is stable, so we agree I won’t call them regularly. I remind them that they can call our advice line if anything changes or to update their GP or District Nursing team if they need more support. This helps people to feel more confident in managing their own long-term conditions so they can live as well as possible for as long as possible.
I also take a call from a District Nurse who is at a patient’s home. She’s calling for advice because the patient is in significant pain and their prescribed medications are no longer sufficiently managing it. We discuss trying an alternative medication and I request it from the patient’s GP.
3.30pm
It’s time for a medical advice meeting with hospice doctors and other Clinical Nurse Specialists. We discuss people who we feel may need additional, specialist medical input and agree someone I’m looking after would benefit from a multi-disciplinary team (MDT) approach. I schedule a joint visit for a doctor and I to see the person at home together. This is also an opportunity to seek guidance about decisions made or ideas for my next review.
4.30pm
I participate in journal club led by another Clinical Nurse Specialist. These sessions are a chance for us to reflect on case studies and discuss and appraise recent evidence and research in the wider field of palliative care, and consider how we can apply that to our practice. We’re always looking to further excel our high quality of care.
5pm
The last part of my day is taken up with finalising any notes, actions, referrals or drug recommendations from earlier in the day before heading home at 6pm. It’s been a busy day but I’m feeling fulfilled.
