If you have recently been involved in palliative care nursing, there is every chance you have encountered Christopher Cliffe or Peter Jenkin in Victoria or South Australia respectively over the past few years.
But while Christopher, a registered nurse, former CEO of CRANAplus and Chair of the Coalition of National Nursing and Midwifery Organisations (CoNNMO), and Peter, a nurse practitioner at an aged care facility, have taken different paths into the sector, they both show huge passion for their work.
“I thought it was an amazing… opportunity and honour to work with people often in the toughest days of their life… and bring comfort and support to them,” Christopher says, having started working in palliative care five years ago as part of an ongoing commitment to maintaining clinical practice alongside his career in health leadership.
Meanwhile, Peter, who has been working as a nurse for three decades, the decision to focus specifically on palliative care came after witnessing hospital practices early in his career that left him questioning the usual way of doing things.
“People were dying without actually knowing they were dying sometimes, without having ever overtly being told or given the opportunity to prepare,” he reflects.
The subsequent emergence of palliative care nursing as a professional field within South Australia quickly led to a career shift, where he has specialised since.
The two nurses, who together have more than 60 years’ experience, and who both heavily emphasise the clinical aspects of their work, have markedly different day-to-day experiences, demonstrating the variety of paths that palliative care can offer nurses.
Working for a community-based provider, Christopher is assigned four or five patients each day that he visits in their home to ensure their palliative needs are met.
Conversations, depending on the client, may variously focus on complex clinical symptoms, their existential distress or how “practical” solutions, such as making a will, the future care of their pets or how their death will be. Meanwhile, on-the-job procedures encompass everything from the management of constipation to the titration and administration of opioids.
“It can be an incredibly diverse clinical encounter,” Christopher says, noting that each visit can take up to an “hour or so”, and the frequency of visits to certain patients can vary.
“Visits might be monthly or they might be twice a day: It really depends on where they [the patients] are on their palliative journey.”
The end of the day involves documentation, meeting with other staff members, and a “handover” to the clinical manager to ensure that care is “consistent”.
Meanwhile, Peter describes his nurse practitioner role with not-for-profit aged care provider as having a heavy emphasis on clinical practice, but that it is also “multi-focused”.
It means that, as well as frequent clinical consults regarding pain or medication management, as well as advanced care planning, he is also called upon to provide specialist training, policy analysis and research within the organisation.
Outside of this, he also occasionally teaches at Flinders University, chairs the aged care sub-group of the SA Statewide Palliative Care Clinical Network, and is currently a member of the National COVID-19 Clinical Evidence Taskforce Palliative and Aged Care Panel.
It’s a lot of hats to wear, and Peter admits that giving them all their due can be tricky.
“One of the key skills of the role is just balancing all of those [tasks] and making sure that everyone’s getting enough of me. Even more important though is ensuring there is enough time for self-care” he says.
Additionally, while both nurses enjoy their work, they nevertheless believe there are some important areas that their field needs to address in the short to medium term.
Peter says he is concerned about a variety of issues in the sector, including COVID and the lack of compulsory training for nurses and aged care workers in the requisite skills for palliative care.
“I’m still gobsmacked that palliative care is not a compulsory part [of training]…. You know, we have nurses, or care workers for that matter, coming out who have never been on a shift where someone’s died, or never had any experience with that,” he says.
While both nurses believe the sector has an important role to play, at the end of the interview, Christopher points to a quote from Swiss-American psychiatrist and near-death expert Elisabeth Kubler-Ross to highlight the underlying moral and philosophical promise of caring for those who are terminally ill and dying.
“She said, ‘My patients taught me not how to die, but how to live’…. I think that’s a really good summation for our speciality of palliative care nursing.”