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Eastern region nurses discuss complex roles in today's profession

12 Jan 2016

Organ donation specialist nurse, Marie Garside based in Cambridge and Heather Riggs who works in the Department of Pain Medicine at West Suffolk Hospital have told their stories as part of the RCN's campaign to highlight the complexity of the work and to support the case for increased pay for nurses.

Working in organ donation, Marie says there is no such thing as a “normal day”.

Marie and her team based in the Eastern region have the difficult yet rewarding task of dealing with bereaved families and matching organs to patients on the transplant waiting list.

They are also involved in education, policy development and promoting organ donation in their areas.

It is a challenging job, with long hours worked and hard conversations to be had, but one that is vital to those desperately waiting for an organ.

“When you are on-call, you respond to potential organ donors,” Marie said.

“We are notified by a hospital if they have a patient who might fit the criteria for donation, so are brain stem dead or they are withdrawing treatment.

“We go in and assess the patient clinically, get their medical history and current condition. We will then talk to the family, making sure they understand the prognosis of their family member.

“Then ideally we will be involved in offering donation to the family If they want to proceed we facilitate the process. We take consent from the family, arrange blood tests, collect clinical information, we allocate the organs to wherever in the county they need to go.

“We then organise the theatre. We organise the retrieval team. We take the patient to theatre. We are present throughout the surgery. We package the organs and send them to the correct hospitals.

“We then provide care after death for our patients and then we follow-up with the family. We write to them after two weeks to tell them the outcome of the donation.

“We are there from beginning to end.”

The team also arrange memorial services for donors and posthumous awards in recognition of the donation. They continue to work with families through the bereavement process.

Marie, team manager for the Eastern Organ Donation Services Team based in Cambridge, said: “It is a really positive thing. It is all around making sure families understand what is happening. We can’t change the circumstances of their loss. But we can offer them control of the situation and give them an outcome.

“From our perspective it is very positive. All nurses deal with loss, but the truth is that we have something we can offer as well as empathy.”

Specialist nurse Marie has worked in organ donation since 2009, having previously worked in A&E and qualifying in 1990.

“It is quite physically gruelling what we do,” she said.

“When we are on call we work through 24 hours. We start at 9am and work until 9am the following morning.

“We are a 24/7 service. But when you get there, you stay there until it is done. And staff see that, so it doesn’t make it the most attractive job from those on the outside.”

Marie said while on-call work was reasonably well-paid, generally the role was undervalued in terms of the rewards on offer.

“In terms of what we do in the wider scheme of things, I don’t think people are well-paid for the level of responsibility,” she said.

“If you think that someone can go into a room, have a conversation with the family and hinging on that depends if seven people get transplants

“The amount of emotional and physical commitment isn’t really recognised in terms of pay.”

Since being promoted Marie’s base has moved, leading to a long daily commute at her own expense.

She said the issue was not just about pay, but also conditions.

“We do these ridiculous hours. There are only a small number of us. We are running a 24-hour service on 11.3 people.

“People are being pushed to the limits that they can go to.

“I think given the specialist role we are doing it could be recognised more financially.”

Specialist pain nurse Heather Riggs, based in Bury St Edmunds, has also spoken about her role as part of the campaign.

Working with patients in chronic pain which can leave them in “constant agony” is a very challenging environment in which to work.

But for nurses like Heather it can also be incredibly rewarding, helping people find ways of coping with their symptoms with or without a diagnosis.

Heather, who works in the Department of Pain Medicine at West Suffolk Hospital, Bury St Edmunds, has worked in several specialities after starting work as a nurse in 1976, including paediatrics, plastic surgery and intensive care.

But she said working in a chronic pain department had been a particularly rewarding experience.

“Working with patients with pain has been the most challenging, but the most rewarding,” she said.

“Some patients are in agony. One patient who came to a clinic was actually screaming in pain.”

Heather said working with patients in chronic pain for the last decade meant she had a great deal of empathy for their situation.

“The most challenging aspect of the role with chronic pain patients is for patients to gain an understanding that they may not always have a reason for why they are experiencing that pain, they may not get a diagnosis.

“When you have someone without a diagnosis who is in chronic, persistent pain, and may be like that for the some considerable time or even for the rest of their life it is very challenging to assist them to manage their expectations.”

“You treat the symptoms and you hope that you will be able to teach them different managing strategies.

“I use different methods for that. It is not just about medicating patients. We use a whole load of methods such as injections or other interventions, acupuncture, psychological strategies and physical strategies such as physiotherapy, goal setting and pacing of activities, relaxation and so on. It is an endless list really.

“You are trying to find what will work for each individual.”

Heather said the most rewarding part of the job was when she had managed to help someone gain a greater understanding of their condition and continue with their lives.

“That is a really big part of my job, developing coping strategies for patients.

“I have been lucky throughout my whole career because I have never had any role that I have worked in that I haven’t enjoyed.”

Heather has worked in her current role for two years but was a clinical nurse specialist in pain for eight years previously, working across both acute and chronic pain settings.  With the advance to a Senior Nurse Specialist she has taken on the added management responsibilities. She has also been involved in several pain audits and the introduction of pain as the 5th vital sign a West Suffolk Hospital NHS Foundation Trust.

Heather qualified as an enrolled nurse in 1976, completing a conversion course to registered nurse in 1992 and then taking a degree in health and social care in 2000.

Heather’s career has been varied as a result of having to move with her husband during his time in the Air Force.

After qualifying at Frimley Park Hospital in Surrey she worked medical night duty, then moving to Mount Vernon Hospital, Middlesex, where she worked on paediatric, plastic surgery and burns unit.

“That was an amazing job.  I was only there for about 18 months but I learnt so much during that time. It was a huge learning curve,” Heather said.

After about five years at the Queen Elizabeth Hospital in Kings Lynn, two years in intensive and coronary care and the rest of the time spent in private general nursing, Heather moved to Germany where she worked as a practice nurse, returning to England and joining the West Suffolk Hospital in 1989.

After a number of different roles at the trust she had a secondment to the Royal College of Nursing, returning later to the pain department.

“I have a lot of knowledge I can draw on that has been advantageous in pain because people come to you with all different types of complex issues and because of this broad based knowledge, it certainly helped me and I hope was also a help to the patients,” she said.

“Time is the biggest challenge - trying to do what you have to do within the allotted work time that I have.

With a mix of days spent on management and clinical duties, Heather also helps in the education of other staff which she said was a “huge responsibility”.

“It is a very busy role, but having said that it’s a lovely job. I enjoy it so much.”

Heather said as an RCN representative she was very conscious of the pressures faced by nursing staff in meeting targets and trying to maintain high standard of care.

“Recent research has suggested nurses have been subjected to a 9.6% real terms pay cut since 2008,” she said.

“Unless you are already at the top of a pay scale nurses did not receive the 1% pay rise this year and so we drop further behind.  I hope that any further pay rise will be inclusive for all nursing staff and not just those who have reached the top of their pay band.”