St Catherine’s Clinical Nurse Specialist Suzanne Holt describes how varied a day in the life of a CNS nurse can be, as she cares for people with life-shortening conditions in their own homes and out in the community.
8.30am: There are eight nurses in the CNS team and we cover patches across Chorley, Preston and South Ribble – my area takes in parts of central Preston, Bamber Bride and Walton-le-Dale. As I live in Penwortham, my day starts by either visiting a patient close to my own home, or coming to hospice first for a team briefing. We plan our days to ensure that we spend as much time with patients as possible, and less time on the roads driving between appointments.
9am: If I’m seeing a patient for the first time, I carry out an initial assessment with them and determine their care needs. Referrals are made through people’s GPs, so we work closely with doctors and district nurses, as well as taking the time to understand our patients’ and their loved ones’ wishes and priorities. It’s a privilege to visit people in their own homes because it helps us to have an understanding of their home and family life and their personal circumstances, and gives us a unique opportunity to really get to know people as individuals.
I’ll assess whether they need our support once or twice a week, fortnightly, or monthly, and put together a care plan; this develops over time if someone’s clinical needs change.
10.30am: I’ll move on to another patient’s house, and this could be a follow-up visit. We aim to make people feel as comfortable as possible at home, to avoid any unnecessary hospital admissions.
This involves working with patients and their families on issues such as pain and symptom management, fatigue management which is a common side-effect of certain illnesses and medications, and nutrition (such as recommending supplement drinks and ensuring they have a balanced diet appropriate to their needs).
We prescribe medication through the GPs, and we can make arrangements for things to be put in place to make the patient more comfortable and have more independence, such as wheelchairs and home adaptation assessments.
11.30am: We visit all sorts of houses, from town centre terraces to farm houses out of the back and beyond – I always make sure to have my wellies in the car, just in case!
We also visit people in care homes who are living with conditions such as cancer, motor neurone disease, and heart failure. Elderly people can have other conditions such as dementia, so it’s important for us to understand that their needs will be affected by other such factors.
My job is so varied and I meet people from all walks of life, which is what I love most about the CNS role. But of course, this can present many challenges so it’s important that we are aware that people’s conditions, cultures and wishes are all individual and must be respected and taken into consideration.
2pm: Following lunch, the afternoon can involve more community or home visits, or one of our monthly meetings with the GPs in the area we each cover. These meetings involve going through the GP’s palliative care register and planning ahead, discussing who may benefit from a referral to the CNS team in the near future.
4pm: For those who are well enough to leave home, we hold regular clinics at GP surgeries and other community locations for our patients to come to us for their appointments. This is a good way of seeing more people in a period of time, compared to spending time driving from one place to the next.
Sometimes, we refer people to the inpatient unit at the hospice for a short period of pain and symptom management, until they are well enough to return home and continue accessing the care of St Catherine’s through the CNS service.
At weekends, we take it in turns to man the 24-hour advice line operated by St Catherine’s. We get calls from GPs, district nurses, patients and family members about a wide range of issues. I think it’s reassuring for people to know that there’s always someone at the other end of the phone to listen and offer advice in between our visits.