It’s sometimes good for us to be reminded why we became nurses - especially when, like me, it’s been 30 years since I made that decision. I had one of those rewarding, life-affirming moments recently.
In among the hubbub of this year’s Gold Standards Framework (GSF) conference in Birmingham. Royal College of Nursing primary healthcare adviser Lynn Young mentioned the word compassion. She called on nurses to show more compassion, to break free of the shackles of targets and tasks. A few heckles might have gone up, but it struck a chord with me.
As a nurse there is no greater responsibility or privilege than looking after someone in the last months and weeks of their life. End of life care can also be among the most challenging aspects of our work and despite the difficult discussions and decisions it entails we should embrace it - with compassion.
The responsibility of good end of life care falls to everyone involved. Nurses have an enormous role to play in any setting. GSF empowers nurses not only to ensure all the organisational processes are in place for their patients, but also to have more time for compassionate care.
We have a mindset as nurses to always put patients at the centre and a responsibility to get it right. But, with the pressures of targets and task-oriented work, it is not always easy to find the right balance. GSF provides the structure to enable proactive care with communication at its heart. It helps nurses have those difficult conversations with patients, relatives and colleagues. And, rather than creating an extra layer of paperwork, it helps save time.
Since its inception 10 years ago, the National GSF Centre has always listened and learnt from professionals. Now different GSF programmes can be used for primary care, care homes and hospital settings. With nurses being able to take a proactive, coordinating role as the main workers in end of life care, the GSF Centre has developed a new resource - the GSF nurses’ pack, with all the information and practical steps to implement the framework into everyday practice. This will help us to enable more people to be cared for and die in their preferred place of care.
My first experience of GSF was in a GP practice in Suffolk where I worked as a specialist practitioner in the district nursing team. With limited access to hospice and hospital facilities 30 miles away, any challenges in practice encouraged everyone to think out of the box to find solutions. It involved passion, hard work and commitment but we could see the benefits and the patients were the real beneficiaries. A recent survey showed 86 per cent of patients on the supportive care register were looked after in their preferred place of care. Nurses have made a significant contribution to making this happen.
Nurses in care homes have been instrumental in implementing the GSF Care Homes programme. Almost 1,500 homes have been through its training programme and I have witnessed some fantastic transformations in practice.
Listening to some of the latest 31 care homes to have achieved the coveted GSF Care Homes quality hallmark award at last month’s conference describe the effect on the staff, residents and families was a further reminder of the compassion that exists, but goes unheralded, in more than 20,000 homes across the country.
As well as the new development of the nurses’ pack, the framework is opening up what is possibly its most critical front yet - acute hospitals. By linking the work of nurses in primary care, care homes and hospitals there is, at last, an unmissable chance to offer patients well-coordinated cross-boundary care and for nurses to take the lead to deliver the very best care for people nearing the end of their lives, in the place they want it.
The hospital programme, being piloted in 16 sites across the country, will effectively give nurses permission to spend more time with patients, ascertain what they want and help deliver it. The three simple steps of identifying those patients nearing the end of life, assessing their needs and planning their care, puts nurses in charge.
We can improve the systems that don’t work, by talking the same “GSF language”, so that nurses in hospitals can communicate with their colleagues in care homes and the community to join up the work in the different settings - always putting the patient at the centre and achieving better outcomes for them.
When I started out in the community, I had a dual role as district nurse and a practising midwife looking after people at both ends of life. I could deliver babies at home. But helping patients to die at home was much more challenging. Now, with GSF in place, we can facilitate the care of more people at home, giving compassionate care and importantly avoiding unnecessary hospital admissions and crises.
GSF has made a difference, putting the patient and their family at the centre. This is important work. Let us get it right every time, for everyone at the end of their lives. We can do this and make a difference to the quality and experience of the living and dying.
Nikki Sawkins is National Gold Standards Framework lead nurse, National GSF Centre, Walsall