The role of the nurse consultant in palliative care: the story so far

Sue DukeNurse Consultant/Principal Lecturer

Royal Berkshire and Battle Hospitals NHS Trust

and Oxford Brookes University

Role: this is what I do

This is how I do it

This is the culture in which I do it

Integrate different sorts of practice: clinical, education, research and leadership, across different layers of organisation: individual, team,

board and national/international

Enhance patient care through direct care, educating practitioners, changing contextual thinking about palliative care, disseminating knowledge

“Work on the brink” “Watch like a hawk” “Rising stars”

Where nurses are the cookie dough

Where vampires, pirates and aliens roam

Where new roles are under scrutiny

Role: this is what I do

• understanding the process of care across different layers of organisation and across practices involved in enhancing care

• Nurse consultancy = integration of processes between organisational layers and dimensions of practice

  Clinical practice

Education Research Service development

Individual Provide care to patients and their families with palliative care needs

Educate individual practitioners about palliative care. education, research and leadership

Support individual practitioners undertaking research. Undertake own research

Understand and interpret policy for self and others

Team Support CNS providing palliative care

Support lecturers in palliative care and cancer care

Co-ordinate research agenda

Facilitate palliative care team development

Organisation

Influence nursing practice across the trust for people with palliative care needs

Influence curriculum design in palliative care and cancer care

Contribute to research within the Trust

Clinical lead for the palliative care for the Trust

National and International

Disseminate knowledge about palliative care at individual, team and organisational levels

This is how I do it

• Working on the brink• Watching like a hawk• Nurturing rising stars

Working on the brink

Watching like a hawk

Rising starRising starI can see that you are.I am glad,for I’ve knownthe talent’s within you.Now its grown.You shine brightfrom certainperspectives.Not fully confident from all aspects.

My challenge: To watch, hold,nurture you;demonstrate those placesunlit yet.All the whileyou judge me,un-nerve me. The places where you shine:intenselyscrutinised.

The dangerrising staris that ifwe are not careful, youwill burn out,not reach yourpotential.

This is the culture in which I do it

Homeless concept

Empty formSpatial vacuumLifeless born

Where vampires, pirates and aliens roam

Vampires suck my blood

And wait for me to turnLike them competitive.I strive to stay alive,Resist the fanged clubInstead, collaborate.

Pirates treat me as role contender, trespasser,accuse me of plunder.I am no skills thief, but see red jolly rogerswarning hold no

quarter.

Aliens baffle meTheir culture quite

unique.We find a meeting spaceIn which to hold debate Tentatively touch it, Learn to communicate

Where new roles are under scrutiny

The sociologistsTell me that these three villains, Have other names insteadTell how professionalsKeep strangers out, doubleClosure I read about. The dangers of these foesInclude demarcation and peer separationdesigned to increase powerbetween colleagues, but create enemies.

 Vampires, pirates, aliensSymbolic experience Remind me to value the nurse in consultancy Warns me not to oppress Others or indoctrinate.

Where nurses are the cookie dough

•  

Changes

Empty concept

Lived concept

Focus on differentiation

Focus on fit

Focus on establishing a role

Focus on developing

a team/servic

e

Conclusion

• Actions, performances and culture (negotiating role)

• Truthful: ‘something that both ‘figures’ in the light of our understanding of what life is generally like and throws light on the road we’ve traveled and the path ahead’ (Carson 1998:233)