‘We've Taken on a More Advanced Clinical Role’: A Multimethod Study of Community Nurses' Extended Roles in Palliative Care

ABSTRACT

Aim

To explore community nurses' experiences of changes to their roles in palliative and end-of-life care.

Design

An e-survey was followed by focus groups.

Methods

Fifty-one community nurses with recent experience of delivering end-of-life care in the United Kingdom completed a survey about changes to their roles. A purposive sample of 35 respondents participated in focus groups exploring these changes in more depth; thematic analysis was used with constant comparison.

Results

As well as two new roles—prescribing and verifying death—many participants talked about a broader expansion of their role, increasing their leadership in making complex end-of-life care decisions with patients and families. Most nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed distress that heavy workloads impaired their capacity both to provide good clinical care and to train junior colleagues. The importance of General Practitioner support with complex cases was often highlighted, but accessing such support was sometimes difficult.

Conclusion

While welcoming the opportunity to extend their palliative care roles, many participants indicated experiencing moral distress.

Implications for the Profession and/or Patient Care

Excessive workloads and patchy medical support threaten the retention of the experienced nurses upon whom community palliative care depends.

Impact

Our findings suggest that new and extended palliative care roles are viewed positively by nurses. To be sustainable, these changes require better workload management and consistent medical back-up.

Reporting

We adhered to relevant EQUATOR guidelines, using the SRQR checklist.

Patient or Public Contribution

Our Public and Clinician Advisory Group helped shape questions and commented on findings.