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In this superb interview Lilian tells us so much about her own job as a palliative care / oncology nurse, as well as her thoughts on nursing in general. She’s a truly positive advocate of the nursing industry and this is well worth a read!
27th April 2010
What is your current job title, and what band are you?
I’m currently working as an oncology case manager for an insurance company, managing 100+ individual members’ oncology claims and liasing with both patients, family members, hospitals and consultants to ensure appropriate and timely intervention and management of malignant disease. I’m a Band 7 nurse (in equivalent in NHS pay-scale).
You don’t need to tell us the exact name, but what kind of organisation do you work for?
A personal health insurance company.
Tell us how and why you got in to nursing?
More by accident than by design, as many family members are nurses and I did not get the exam results I needed to confirm my university place when I left school! It seemed like a good idea at the time, good training and plenty of opportunity for job security.
Do you remember your first day at work in healthcare?
Yes, I was absolutely terrified! My first ward experience was learning how to make beds and how to move people in bed on a male surgical ward. It is not a skill you can pick up at school or working in the local shop as you are growing up, and delivering personal nursing care for someone can make you feel just as vulnerable and awkward as the patient you are trying to help if you don't really know what it is you are doing!
What do you like most about your job?
I love the privileged intimacy that being a nurse allows, when I am working with people who need support or help, for whatever reason. Being a nurse means I am "allowed" to speak to people and help them when they are potentially at their most vulnerable. It is a special relationship that engenders trust and respect, and for me it means the possibility of making even just a small difference in someone's life. I have specialised in palliative/oncology nursing for most of my working life and have many wonderful memories of special moments and people with whom I have worked (patients/family members/multidisciplinary team members) who have taught me so much about myself as well as about how to help and when to help... and just as importantly when to step back and let people help themselves.
You’ve been in healthcare and nursing for 25 years. What are the positive changes you’ve seen in that time?
I was one of the last nurses to train in the old "apprecenticeship" style in 1985 -1988, before the move towards a more academic based training in universities/colleges with the advent of Project 2000. I think nurse training today empowers new nursing students to be dynamic; to challenge outmoded practice and strive for an evidence-based approach to caring that puts the patient at the centre of any given healthcare setting and encompasses all aspects of their care, rather than as a name and a diagnosis in bed no X. The ritualised practices have gone and the potential is there for more nurses to develop their own automomous practice as independent nurse practitioners working in the integrated healthcare field, which is fantastic.
Do you miss anything from what the industry was like 25 years ago?
Yes, there are some practices that have gone completely and the ritualised bedbaths and "back rounds" have been relegated to the joke books and memories of old style nursing and nurses’ reunions. But I feel very sad that some of these "tasks" during the course of the day have disappeared. They would give you the time to spend in privacy "behind the curtain" with a patient who might then use that time to share worries or concerns with you about their health or circumstances. It would also give you time to asess nutritional status through helping someone to chose a menu and eat a meal. A bedbath or assisting with personal hygiene activities may take half an hour, but it also presents an opportunity to assess levels of independence through watching how easily they move around the bed or around the room or allowing them to talk about the worries they may have expressed about the difficulties they are experiencing with maintaining their independance at home.
Talking to them and their families will then help to get more information, following up on your own personal obeservations, So many of these "basic" nursing tasks have been "downgraded" to Healthcare Assistants’ tasks and the opportunities to be a real nurse are being lost in the process...... My own experience of working on the wards, and from having been a patient myself recently, was that the trained nurses on the wards now seem to be so tied up with medicine rounds and ward management that they no longer have the time to make these assessments or provide the reassurance that makes a difference between a patient feeling like "just another body in a bed" and a unique individual in a clinical setting.
You’ve also worked in Germany – what were the big differences you noticed between UK and German nursing practices?
Nursing in Germany is still very much in thrall to doctors. Nurses tend to do exactly what the doctor says based on a very medical model of care, rather than planning and delivering personal care based on nursing assessment. Personal care is delivered in a very impersonal way. There are social cultures in Germany which are very different to the UK, and german people expect a very different care setting, where patient privacy and dignity are less important. It seemed much more "harsh" to me than my experience of working in the UK as a nurse. Given the choice, I would not work as a nurse in Germany.
Specifically with regard to oncology – what skills would you suggest someone needs to possess if they want to work in this area of nursing?
A sense of humour, a sense of humility and the ability to be open minded and non-judgemental. A palliative care /oncology nurse needs the ability to empathise and really actively listen to what is being said - and what is not being said - in any interaction.
Know your strengths, and when to refer on/delegate to someone else who can do the job better than you, and learn from them. Cancer patients - especially those who are dying of malignant disease - don't want sympathy. They need someone who knows how to care for them, support them and their familes when they are at their lowest ebb. To give them confidence and hope - not necessarily that they will get better, but that they will be able to have their symptoms managed and their suffering alleviated so that they can "live" a good quality of life until they die. A good selection of jokes are also essential as ice breakers... some of the best jokes I have ever been told have come from people I have nursed in the last weeks and days of their lives.
Finally, what advice or help would you give to anyone wondering whether to take up a career as a nurse in the UK?
Work for at least 6 months as a healthcare assistant in a setting where you will be giving intimate personal care to a range of very dependant people. You should be well supported by experienced staff who can teach you the "acquired knowledge" that you cannot get from analysing textbooks or observing procedures as a supernumerary member of staff on a busy acute ward.
This kind of experience will stand you in good stead, no matter which area of nursing you later go into. It allows you to learn the basic "bedside manner" which inspires confidence and the communication skills in both patients and colleagues. You’ll learn how to talk to people about the very personal aspects of their life and illness. And you’ll develop the patience to "work" at the pace of someone who cannot help themselves so that they can do as much for themselves as they possibly can; making them feel as if they have achieved so much more for the benefit of your having spent time with them as an individual.
It is also a good way of finding out very quickly if it is not the job for you after all! We have very many nurses who are technically excellent but have no bedside manner or ability to deliver fundamental therapeutic care activities comfortably, and it has a very negative effect on the poor patients they care for!