18th August 2020
Clair Fitzgerald is Healthcare at Home’s clinical nurse specialist (CNS) for the North region. Here she talks about her role, the range of support that’s provided to patients and families and how no two days are the same.
Our main role is to support patients as little or as much as they need. We start by carrying out a holistic needs assessment and that really helps to highlight the particular areas where we can help. We often signpost patients and their families to charity support services including Maggie’s and Penny Brohn. Both have been offering brilliant support digitally during the pandemic when access to local support hasn’t been possible.
We ensure patients are referred into community palliative care nursing teams including Macmillan to help with pain and symptom management. Although we can’t prescribe or change pain medication, a big part of our role is making sure patients are comfortable and have the medication and support they need. We regularly contact GPs to ask for pain relief to be prescribed for patients and we can also help to facilitate occupational therapy assessments for the provision of any support equipment such as wheelchair cushions or commodes. We also support patients who wish to apply to be part of the Blue Badge scheme.
Another aspect of our role is referring patients into hospice services. One of my patients is an international Bupa patient and didn’t have a GP. As this gentleman was palliative, it was challenging but I was able to help him register with a GP. As he didn’t have a National Insurance number, I thought he wouldn’t have been able to access the Blue Badge scheme. Yet, I was able to get him one and that was amazing. I’ve also been in touch with his local hospice to arrange for him to receive palliative care there when he needs it.
You’re always learning something in this job – no two days are the same!
At times, patients especially need counselling support. I recently contacted Maggie’s as one of my patients was having a tough time. They are wonderful and they let the patient set the guidelines around what she wanted to talk about to make sure she was comfortable as she had previously had counselling that hadn’t gone particularly well.
I’m still in my first year as clinical nurse specialist for the North region. I was previously a chemotherapy nurse at Healthcare at Home and prior to that, I was a CNS at another cancer centre. My region covers North East and North West England, North Wales, Scotland and Northern Ireland and each local area works slightly differently. During the lockdown, I’ve mostly been keeping in touch with patients via telephone, video calls and emails which provides more reassurance given they are shielding.
I go out to see one of my patients every week and I’m always there for three hours and they just talk. They don’t ask for anything from me, they just want someone to listen. They talk about anything and everything and just by sitting and listening, I’m making a difference for that patient. Just letting people talk at times while you listen is so important.
At Healthcare at Home, we know that carers and families need support too and that’s where Maggie’s and Penny Brohn’s services can really help. I have a patient that I visit regularly and I think his wife needs my support more than he does. As his carer, I think she finds it all a little more difficult than him but they don’t want any support. She just likes to be able to talk and that time we have together is a bit of an outlet for her. I’m hoping they’ll have a look at what Penny Brohn can offer. We also signpost families for advice and information from Macmillan Cancer Support on how to talk to children and teenagers about cancer – it’s so important for them to have someone to talk to about how they are feeling too.
My role is much more than I thought it would be. I’m definitely more hands on than I was when I was working in my previous roles. Communication also seems to be so much faster because as a clinical nurse specialist, you’re in the centre of everything on behalf of your patients. Liaising with everyone that’s involved with a patient’s care to make sure their treatment pathway is smooth is essential.
We’re supporting patients and families through a difficult time and building a trusting relationship is imperative. We are allowed into their world so we can help them to cope with their diagnosis and treatment while they continue to live as well as they can. We help to educate patients and families about symptoms to look out for and we encourage them to report any changes to us quickly so we can try and prevent avoidable hospital admissions.
Having cancer care at home is much more convenient for patients and it’s such a nicer and more personal environment. We offer one-to-one care where it’s just the patient and their nurse too. Some patients have to travel quite a distance for treatment and it can be a very, very long day for them, particularly if they have to wait around for test results. Home care can take away some of the stress patients may feel and they enjoy you being there.
We have a team of clinical nurse specialists that support our patients and I think that’s a real point of difference with Healthcare at Home as other home care providers don’t offer this specialist role. We can advocate, signpost and ensure patients get the extra support they need.
For more information about our cancer services, please email firstname.lastname@example.org