A day in the life of a community Macmillan nurse

Dying Matters Awareness Week, 10-16 May 2021, focuses on the importance of being in a good place to die. The pandemic has proven that it is more important than ever for people to think about it, talk about it and plan for it. Sophie Richardson, community Macmillan nurse, looks after adults diagnosed with non-curable cancer thought to be in their last year of life with complex symptoms and complex psychological needs in the community. She shares what it’s like to work in such a role and what it involves.

Sophie Richardson, Community Macmillan Nurse

Sophie’s story….

“Being a Macmillan nurse became my dream job after working at The Christie hospital in Manchester (cancer specialist hospital) where I met the most amazing and admirable patients. Every morning after a night shift I would start my round early so that I could support my patients through their cancer journey; I watched patients I knew very well fight cancer until the end of their life. Unfortunately, in this time I also lost my Dad to cancer, and whilst I went above and beyond for my patients to keep them comfortable, my Dad did not have this kind of care. He was not in a good place to die and unfortunately received poor end of life care, which made me more determined to make a difference.

"After my Dad died, I had a break from Oncology and carried out a promise I made to him to travel Australia where I worked as a nurse. When I came home, I was determined to widen my experience and got a job in intensive care. Whilst the aim of intensive care is to save lives, we weren’t able to save them all and I looked after many patients that we had to withdraw treatment from.  I helped patients donate their organs to others that were able to survive from their loss. I learnt so much about patients and families and how important it is to have the support at their most vulnerable time of their life.  This experience has led me to be in a fortunate position to have the skills to become a Macmillan nurse.

"As a community Macmillan nurse, I work in a team of six. I am based in Nottingham West, with two nurses in Rushcliffe and three in Nottingham North East. Between our team and the Palliative Integrated Care team in Nottingham West, we are responsible for all palliative patients with complex symptoms and/or psychological needs in the South of Nottingham.

"Specifically, my role in the team is to help patients with non-curable cancer. I manage and adjust medications to control pain, nausea, appetite and fatigue (these are just a few symptoms) to aid a better quality of life. I assist patients’ psychological needs, referring for further counselling and complimentary therapies if needed and help patients get access to necessary financial support. I also open up the conversation of dying and advance care planning and provide bereavement support to relatives.

"Every day in my role it truly is different - in the last week I have met two bereaved families offering emotional support, changed a patient’s medications to alleviate nausea and pain, admitted someone to hospital with query spinal cord compression, admitted someone to Hayward House for end-of-life care, had an multidisciplinary team meeting with the consultant, taught new starters our end of life care documentation, met a new patient that needs support with his three young daughters, arranged an outpatient admission to get a patient’s abdominal fluid build-up drained, helped prepare a relative for their loved one to die ensuring all possible community support is in place.

"I absolutely love my job, although it can be heart breaking at times, to make a patient and a family’s experience a little easier and is my reason to go to work. Dying really does matter if we can try to help our patients be in a good place to die. It will not only help the patient it will also help the family.

"As a final note, a recent patient’s relative sent this to me after their loved one died, I felt it summed up the role of a Macmillan nurse very well.

“She quietly, efficiently and professionally accessed all the resources it was possible to access, adjusting medication until he was largely pain free with minimum side-effects, anticipating needs, listening attentively to his wishes and compassionately to his fears, responding to rapid changes in his condition, advocating with other professionals on his behalf (where needed with the patience of a saint!) thus accessing scans and appropriate treatments and most critically, working with a level of love and care that was truly outstanding. There aren't words to do justice to her contribution to his quality of life over the last few months”