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Graduate case studies

Graduate case studies
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Nicola - 
Specialist Nurse

Even though many of our graduates will have progressed in their careers since completing a case study, they are still of interest to students who wish to gain an understanding of the world of work.

About the job

Main responsibilities

My role as a Specialist Nurse involves individualised, holistic assessment and ongoing management of patients' complex physical, psychological and spiritual palliative care needs.

Care is provided in a patient's home and can start at any point through a palliative diagnosis, often for symptom management or advanced care planning, or in the last days/weeks of life.

The role also requires me to provide specialist advice and support via our telephone triage service; which is utilised by other health care professionals, patients and their families.

I'm responsible for presenting patients at the Hospice Multi Disciplinary Meeting each week.

My role also involves providing Palliative Care education to other community health care professionals and student nurses on placement.
As our team is a part of a wide range of community nursing services I am actively involved in attending Palliative Care meetings at local GP practices each month to discuss patients on the GP Palliative Care register.

Typical day

My day begins at my office base, at our local Hospice. I start by checking any calls/messages received overnight from patients/families or out of hours District Nurses/GP's. From this I will return any calls and action issues identified where possible.

I attend my home visits. First assessment visits can take an hour or two, or possibly longer, due to the complex nature of our patients. A review visit is often an hour, reviewing any ongoing symptoms.

After visits I return to my office. I document visits on patients' electronic community record and action any issues found that day. This will usually mean contacting a patients' GP and District Nurses to recommend a plan of care and advice on medications.

What do I enjoy about my job?

I enjoy meeting patients and their family at home, in their own environment. I feel I get to know patients and families at a very difficult time in their lives. As such I feel privileged people share their thoughts and wishes with me as many they say they struggle to discuss with anyone else. While it isn't always possible to meet a patients' wishes we will aim to respect them wherever possible. I get comfort when we can meet someone's wishes for how they would like to be cared for at the end of their life.

I enjoy the variety, no two days are the same.

Challenging aspects

The biggest challenge is coping with people's emotions. Patients, their families and my own emotions. Seeing and managing death and dying each day can be very tough, particularly when we are heavily involved in a patient's care. I'm fortunate to work within a very supportive team, this includes frequent psychological support through peer supervision.

Why did this area of work appeal to me?

I worked as a Nursing Auxillary and Health Care Assistant before completing my nursing degree. I knew from these two roles I wanted to care for palliative patients. Once qualified I worked in the acute hospital setting and then in community district nursing. Both jobs again confirmed I wanted to care for palliative patients. I knew while working in acute hospital setting I found the most satisfaction in helping a patient feel more comfortable and in control their symptoms and in helping them and their family plan for the time an illness will be more advanced. I found myself giving more time to patients who were dying as I wanted to make it as dignified as possible for them and their loved ones.

Skills/qualifications I use in my job?

I use assessment skills every day. This skill was mostly gained during my nursing degree but has continued to evolve as I've become more experienced as a nurse and then within my specialist area of work.

I am required to be competent in using advanced communication skills, as I'm often involved in difficult discussions, decision making and breaking bad news. As a specialist nurse I have studied and completed an Advanced Communication module at Masters level and also attended a national Advanced Communication course which is mandatory for the Specialist Nurse role.

A large part of my role is to provide specialist advice regarding medications to GP's and other medical professionals. Knowledge about medications has been gained mostly through my nursing practice over the years. I have also gained qualifications at Masters level for this area of practice - most recently a module in Complex Symptom Management.

I'm also relied upon to provide mentorship and education to students and other health care professionals. Again this is a skill I have developed during my nursing practice and supported with study. I've completed my Mentorship Course and studied further at Masters level.


Career information

Brief history since leaving University

2008 - Completed the Advanced Diploma in Adult Nursing Studies at the University of Sheffield.. Qualified onto an acute medical ward specialising in Gastroenterology and Haematology.
2011- Completed my 'top up' to gain my degree in Adult Nursing.
2012 - Commenced Masters degree in 'Supportive and Palliative Care' via distanced learning, provided by Sheffield Hallam University. 1 module completed.
2013 - Started work as a Community Staff Nurse for a 24 hour rapid response nursing team. Completed 2 Masters modules.
2014 - Completed Mentorship Course and 2 Masters modules.
2015 - Moved into Clinical Nurse Specialist in Specialist Palliative Care team within acute hospital setting. Completed Advanced Communications course and 1 Masters module.
2016 - Moved to current job as Clinical Nurse Specialist in Community Specialist Palliative Care team. Commenced Dissertation for Masters degree to complete this qualification.

Where do I see myself in the future?

This year my aim is to complete and pass my Masters degree. The job I'm in now has been my dream job for many years so I intend to stay in this role for the foreseeable future. It isn't essential to my role but I would like to complete a prescribing course in future, when I feel confident enough to do so. I also love providing teaching and education, I plan to study more in this area in future to enable me to teach in education settings.


Advice to students

My piece of advice to students

I would give the advice that I have been given over the years:
Gain as much practical experience as you can in different settings. Nursing in hospital and in the community are two very different things, I feel I've gained vital experience working in both settings.

Be enthusiastic and push yourself. To gain experience in areas I didn't see in my day to day practice I spent time with nursing teams and other professionals on days off. This can be tiring but it helped broaden my knowledge and experience.

Educate yourself. Again, this can be hard and tiring. However, I wouldn't be in my current role if I hadn't continued to study. I'm not naturally academic but I have found studying for my Masters degree more enjoyable as I've chosen to do it in the area of nursing that interests me.

Other comments

Believe in yourself, but never be afraid to ask for help.



Send Nicola a question about their career.


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Last updated: 24 Jun 2017