Sarah qualified as a registered nurse 6 months ago and was employed straight from university by a palliative care unit on an established preceptorship programme. Sarah had been a high-achieving student and won a prize for the top mark in her nursing cohort. Her expectations both of her ability and of the job satisfaction to be found working in palliative care were high. However, she has begun to find getting up for work more difficult and has been late for a few early shifts. She has been heard to say that she feels incredibly tired all the time. She has phoned in sick for odd days and is often found sitting in the office chatting to other staff once her practical tasks are completed.
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1. Which of Sarah’s behaviours might be signs of stress?
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Correct answer:
Emotional exhaustion, an indicator of prolonged stress, can be experienced as chronic fatigue, which may make it difficult to wake up in the mornings and may lead to poor timekeeping and odd days off. Although Sarah is completing her nursing tasks, she appears to be avoiding making emotional connection with patients and families by staying in the office and preferring to chat to colleagues possibly indicating emotional overload.
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2.Sarah had high expectations of finding job satisfaction from palliative care nursing. What may have happened to cause her stress?
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Correct answer:
Her own beliefs and thinking about dying may have been disrupted. She may have been confronted with thoughts about her own mortality or of those she loves. She may have found equipment, tools or systems have been less efficient than she expected or staffing/resources to be more stretched. She may have felt ill-equipped with the necessary knowledge and skills to deliver care to people approaching end of life.
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3. As Sarah’s preceptor, how would you explain the emotional labour of palliative care nursing and advise her to look after herself?
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Correct answer:
Patients and relatives not only need good physical care, but they also need and expect to have their emotional needs recognized and met. This is much more of a demand on nurses if no physical cure is available and the episode of care results in death and bereavement. Sarah needs to acknowledge this demand and ensure that she allows time for herself outside work to relax and unwind. She also needs to recognize what systems and strategies are in place within the work place to support her.
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4. What organisational strategies would you be looking for to support Sarah as she adapts to her role as a palliative care nurse?
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Correct answer:
- Regular and effective appraisal and supervision, for example, an allocated preceptor and protected time to give feedback and allow debriefing.
- Good systems of communication, for example, regular dissemination of relevant information both verbally and in writing.
- Workforce skills development, for example, supported induction and work-based practical skills development with annual evidence-based clinical updates.
- Strategies to actively promote workgroup cohesion, for example, regular multi-disciplinary team meetings and team building events.
