Career advice

Acute care in the community: why it’s rich in career opportunities

Homecare is an acute nursing environment with a diverse range of roles at all levels
Lloyds Pharmacy nurse

Out-of-hospital nursing is an acute environment with a diverse range of roles, from preceptorship for newly qualified nurses to senior leadership positions

Although nurse Sarah Rickels works in the independent sector, most of her patients come through the NHS.

We work very closely with the NHS on a daily basis, says Ms Rickels, who joined Lloyds Pharmacy Clinical Homecare as head of nursing in 2018.

We talk to NHS hospitals around the country multiple times a day. We need to dispel that myth that this is a completely different world its not. Its just another branch of care, looking after patients who otherwise would be in hospital.

Career in oncology nursing

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Out-of-hospital nursing is an acute environment with a diverse range of roles, from preceptorship for newly qualified nurses to senior leadership positions

Although nurse Sarah Rickels works in the independent sector, most of her patients come through the NHS.

‘We work very closely with the NHS on a daily basis,’ says Ms Rickels, who joined Lloyds Pharmacy Clinical Homecare as head of nursing in 2018.

‘We talk to NHS hospitals around the country multiple times a day. We need to dispel that myth that this is a completely different world – it’s not. It’s just another branch of care, looking after patients who otherwise would be in hospital.’

Career in oncology nursing

Lloyds has been providing clinical care in people’s homes since 1975. As a provider of NHS services, they take referrals from hospital clinical teams, with services ranging from delivering medication to specialist nursing for complex conditions.

The organisation now delivers care to more than 100,000 people in their own homes, at work, or in the community using mobile units.

‘Every day is different – and that’s a good thing,’ says Ms Rickels, who qualified as a nurse in 2002 from Leeds Metropolitan University. After spending the first two years of her career in respiratory medicine, she took up what was to be her initial role in oncology at Manchester’s Christie Hospital as a chemotherapy nurse.

Several posts in palliative and cancer care followed, including specialist nursing roles, and in 2015 she was appointed lead cancer nurse at Clatterbridge Cancer Centre in Liverpool.

Sarah Rickels

Having carried out a number of leadership and management roles in the NHS, with a brief spell as a regional operations manager for Healthcare at Home, another provider of out-of-hospital clinical care – she felt the time was right to take on this national post.

‘It was the next step,’ says Ms Rickels. ‘The role gives me a huge mixture of responsibilities, including setting the strategic direction for nursing. There is a broad range of therapy areas and patient groups, in addition to oncology.’

If someone has a desire to progress, we have development plans to help them’

Sarah Rickels, head of nursing, Lloyds Pharmacy Clinical Homecare

With more than 300 nurses based all over the UK, the organisation delivers a range of therapies, including enzyme replacement, growth hormone, intravenous antibiotics, oral immunosuppressants and cancer therapies. Around half of patients require home parenteral nutrition.

The conditions and diseases managed include Crohn’s disease, cystic fibrosis, haemophilia, hepatitis, HIV, motor neurone disease, multiple sclerosis, osteoporosis, Parkinson’s disease, rheumatoid arthritis and thalassaemia.

How nursing teams adapted and innovated in the pandemic

The organisation has three key nursing teams: paediatric, oncology and therapy. Oncology nurses are trained to give chemotherapy, while therapy nurses train patients to administer their own medication – an area that inspired innovation during the pandemic, with the development of a remote nurse training service.

‘Before COVID, we would train patients to self-administer, face-to-face at home,’ explains Ms Rickels. ‘But a lot of these patients are high-risk and shielding and didn’t want us to visit. We developed our service very quickly, in the space of two to three months.’

Office-based nurses assess patients first, using criteria to check whether patients are suitable to self-administer. Training is then delivered remotely, over the telephone or by video conferencing, with follow-up support part of the package.

‘It stops hospital attendance and gives the patients independence, with the ability to manage their own condition,’ says Ms Rickels. A patient survey carried out in 2020 gave the organisation a 93% satisfaction rating for its nursing service.

Tips for moving into homecare nursing

Care is delivered in mobile units in the community, as well as in patients’ own homes
  • Don’t dismiss homecare nursing as a career option if you haven’t done it before. ‘Some people come with skills they have used in a previous role, while others need to develop them. We can support them to gain the skills they need,’ says Ms Rickels
  • A broad range of clinical skills is useful. ‘We cannulate, take bloods, and do a lot of intravenous administration,’ says Ms Rickels. ‘So we’re looking for those who have clear baseline skills in these areas. Those with a good foundation in acute care – whether medical, surgical or intensive – have all the skills they need’
  • Oncology specialist nurses are among those that are highly prized. ‘Recruiting oncology nurses is a real challenge,’ says Ms Rickels. ‘And the need will grow as we come out of the pandemic’
  • Don’t be afraid to make the transition, advises Ms Rickels. ‘The scope and scale of what nurses do here is vast,’ she says
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Nurses’ professional development, career progression and preceptorship

Nurses who join the organisation can progress into a variety of roles, either following a leadership and management path or enhancing their clinical knowledge and skills, with development programmes offered in both areas.

Roles available include senior homecare nurses, who are in charge of a team; nursing service managers, the equivalent of an NHS ward manager; practice development nurses and clinical nurse specialists; and regional operations managers, who are responsible for nursing teams in a geographical area.

Newly registered nurses who have had a lot of experience of placements in the community may also be recruited. ‘We sometimes take them in areas where we can provide wraparound support for the individual,’ says Ms Rickels.

The organisation offers a six-month preceptorship programme – also open to nurses returning to practice after a break – which includes one-to-one sessions with a practice educator and the opportunity to shadow experienced nurses to help build skills, knowledge and confidence.

‘If someone has a desire to progress, we have development plans to help them,’ says Ms Rickels. ‘We have people who joined us as homecare nurses who are now senior leaders in the organisation.’

Come to the next RCNi Nursing Careers and Jobs Fair

Lloyds Pharmacy Clinical Homecare will be recruiting nursing staff at the virtual RCNi Nursing Careers and Jobs Fair, South and East of England, on Wednesday May 19. Chief nurse Sarah Rickels will be joining RCNi career development editor Clare Lomas and Health Education England regional head of nursing (London) Nichole McIntosh for the live panel talk at noon, where they will be discussing the recruitment and retention issues affecting nurses and nursing.

Find out more, including how to register for the event


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