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Striving to deliver the best for palliative care patients during challenging times

Dr Denise Chaffer 28 Jan 2022 RCN President

RCN President Dr Denise Chaffer's update focuses on the work of end of life care and community nursing staff and the current challenges staff face

Over the last few weeks, I have been working closely with the RCN Professional Nursing Committee, Council and staff to explore what further support we can offer to members who are working so incredibly hard during current severe staffing pressures.  We recently hosted a webinar with RCN Professional Committee Chair, Rachel Hollis, and Geraldine Walters from the NMC to provide advice and reassurance to nurses, nursing support workers and midwives during this time and signpost to resources.

The RCN also continually updates the website with COVID-19 resources too. These pressures have continued to impact across all areas of nursing. A recent report from the International Council of Nurses demonstrates how this pressure is felt by nursing staff globally, and the extent of the nursing workforce crisis across the world. The report suggests up to 13 million more nurses will be required over the next decade - the equivalent of almost half of the world’s current 28 million workforce.

This month I have been having discussions with a number of nurses providing end of life care in both palliative care teams and community services. The provision of end-of-life care is such a fundamental part of nursing and those working within it represent the essence of nursing. I have previously worked as a community nurse supporting end of life care, we were known as the ‘twilight nurses’. I have such fond memories of this role and the unique experience this gave me in working in patients’ homes and getting to know their families at such a significant time in people’s lives. It is such a rewarding area of nursing to be part of.

Unfortunately COVID-19 has continued to have an ongoing impact on nursing teams - this is in addition to the challenges facing nursing from an ageing population and an increasing incidence of chronic illness in patients and clients. This has been further compounded by the pressures brought about by the pandemic including high nursing absence rates due to COVID-19 and isolation requirements, and high levels of community nurse vacancies - in some areas as high as 40%.

There are also challenges with under resourcing, limited access to hospice beds and other forms of expert palliative care - made worse by variations across the country to provision and access to end-of-life care. This has led to patients not being able to access the help they need in their final days and months and appears to have increased since the beginning of the pandemic, with added issues of late presentation or referral.

Nursing staff have adapted to different ways of working - including the increased use of PPE and virtual visits - while still providing the physical, emotional and spiritual support this patient group needs. Nursing staff have also had to deal with increased workload because of GPs reduced home visiting capacity , demand on other community services and complexity of patient need.

Adding to this pressure is the requirement to complete Continuing Health Care forms that are required to access care – these are often difficult to complete due to their length, as well as stretched workforce capacity. There is also an increased need for urgent assessments for symptom management and care, which impacts on the time nursing staff can dedicate to patients and clients to support their preferred proactive care plan, which is so important. The reasons for this are multifactorial and patients and carers report finding it increasingly difficult to access the usual primary care assessments and interventions. There are also reduced numbers of social carers available to support home care, which in turn puts additional pressure on community nurses and families.

The challenges of providing high quality palliative and end of life care have grown across health and social care. Despite this nursing staff working in this area of nursing continue to strive to support individuals and their families to be together at the end of life, to be able to reflect and share memories and to have peace and comfort when death is inevitable. This fundamental aim remains core.


Further information
The RCN Pain and Palliative Care and District and Community Nursing forums have developed a range of resources to support community nurses delivering end of life care available on the RCN website.
Pain and Palliative Care Forum  
End of Life Care clinical topic  
Fundamentals of End of Life Care  
District and Community Nursing Forum  
RCN Libraries subject guide 

Dr Denise Chaffer

Dr Denise Chaffer


Denise has been President of the RCN since July 2021 and is currently the Director of Safety and Learning for the NHS Resolution (formally known as NHSLA).

Page last updated - 28/06/2022