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Starting the dream nursing career at age 44

Award winner Sharon Manning discusses her nursing journey and shares her tips on caring for people at the end of life

Award winner Sharon Manning discusses her nursing journey and shares her tips on caring for people at the end of life

Award winning Sharon Manning, a Macmillan clinical nurse specialist in gynaecological cancer at Glan Clwyd Hospital in North Wales, has been lauded for her innovative work in end of life cancer care. But she began her NHS career in a different way.

‘I moved to Wales in 1989 not knowing anyone or the area,’ she says. ‘I was divorced with two young children and was mopping floors, cleaning toilets and doing laundry as a domestic at the same health board I work for now.


Sharon Manning

'I then decided I wanted to be a nursing auxiliary and worked in paediatrics for four years before I gained an NVQ level 3 in healthcare studies and joined the ear, nose and throat team.’

It was during this time that Clatterbridge, the leading cancer care centre, started a weekly outpatient clinic at Betsi Cadwaladr University Health Board.

‘They didn’t have a nursing auxiliary, so I said I would work with the board, it was at that point I developed my overwhelming interest in oncology. I would sit with the doctor when he was explaining treatments to patients and it was an area I wanted to try and excel in.

‘One day, during a team meeting, a registered nurse said to me that my opinions weren’t needed, so I went straight out of that meeting and to the school of nursing to find out how to train to become a nurse,’ explains Ms Manning.

Game changing

The health board eventually set up the cancer centre on site and Ms Manning worked there as a healthcare support worker. She got her degree in adult nursing in 2004, when she was 44, and on qualifying applied for a job as a nurse in the oncology department.

‘I worked in outpatients and a lung cancer specialist nurse I was working with said she was going on maternity leave and wanted me to cover for her. I was apprehensive at first, but worked in that role for nine months and it changed everything.

'The role gave me a taste for something I desperately wanted'

‘The role gave me a taste for something I desperately wanted, I never stopped learning and knew that a role as a specialist nurse was the career path for me.’

 After covering her colleague’s maternity leave, Ms Manning went back to her previous job in outpatients, but in 2011 a vacancy for a Macmillan gynaecology specialist nurse came up.

 ‘It was a band 7 role. I was the only one who was interviewed and I didn’t get the job. The job advert came up again months later and it was now being advertised as band 6. I applied again and got the job.

Sharon Manning's tips for helping patients in advanced stages of cancer

  • Help patients make informed decisions about receiving treatment for advanced ovarian cancer.
  • Learn how to deal with difficult conversations when patients may not understand that chemotherapy is unlikely to be curative.
  • Discuss intimacy and how patients feel about themselves and communicating their feelings with their partners.
  • Inform patients on the self-management of drainage at home for recurrent malignant ascites.
  • Good communication between secondary and primary care nurses is an important part of effective patient care.

‘I had to give yearly reports to Macmillan on my progress. I knew that I wanted to work so hard they would not be able to do without me and the job became permanent in 2014.’

The health board then adapted Ms Manning’s post, but she retained the Macmillan title. It was during this time she became aware that many of the women who were in the later stages of ovarian cancer were discussing their poor quality of life.

Ms Manning says: ‘The women were saying that they couldn't breathe or eat because of the fluid in their stomachs. They might turn up to emergency department because of the pain. I thought there has to be something better to help them.’

Earlier this year, a Nursing Standard and Marie Curie survey revealed 94% of UK nurses said they have seen dying patients stranded in hospital because of delays in providing the funding and care that would allow patients to return to the community.

Development of malignant ascites

People with gynaecological cancer in the palliative care stage can develop malignant ascites, meaning there is a painful build-up of fluid in the stomach.

It can require catheterisation directly into the stomach. Women who needed a peritoneal catheter would have a day-case admission for each drainage of the catheter, which could be once a month or every six weeks.

Ms Manning explains: 'I said to the consultant that there had to be a better solution for these women. He told me to go and see if I could find something.'

She took up the challenge and did a lot of research. In 2015, she found a drain that was cost effective.

'It cost £194 to place and we sent the patients home with five drain bags, which cost £93. Patients would then get any further bags from their GP and we've never had a GP who has said they were not funding it.'

The hospital's cancer centre then worked with district nurses to let them know what they were doing with the drains to help their patients.


Macmillan clinical nurse specialist Sharon Manning with a patient 
(Credit: Sharon Manning/Macmillan) 

'If a patient is having a drain fitted I will fax the drain suppliers with the district nurse's details, and they contact and train them on how to take care of the drain,' Ms Manning says. 'The drain is tunnelled under the skin and the dressing is waterproof so patients can shower with it.

'The whole idea is district nurses will support the patients with the drain, then their partner or carer carries on and the drain line comes out after death.’

She adds: 'I particularly remember one patient who had learning difficulties. We knew she had a lot of diseases and we decided to put in a permanent drain and peripherally inserted central catheter line. From that point until she passed away, she was drained about 65 times over two years – that would have been difficult for her if we hadn’t had the drain system. She was very scared.

'I was 44 when I got my nursing degree. Sometimes I have to pinch myself about what I've achieved'

'She was able to die at home because the district nurses were supporting her. When I think about what we achieved with that one patient, it was incredible. The drains offer patients more dignity.'


Ms Manning with a patient
Credit: Sharon Manning/Macmillan

Ms Manning has been given an award for her work by the health board and the organisation is looking at embedding the drain system across the hospital in different departments. The specialist nurse’s work has also featured as part of a fundraising campaign by Macmillan which raised £420,000 for the charity.

'Do what you love'

In March, she met Prince Charles at a Buckingham Palace reception to celebrate NHS staff and she has been awarded a Macmillan Innovation Excellence Award for her outstanding work. A Macmillan Fellowship is helping to fund additional teaching qualifications so she can share her work through lectures and conferences across the UK.

Ms Manning says: 'I firmly believe that you get out of nursing what you put in. Yes, there are challenges across the NHS, but you have to be enthusiastic about change and changing things for the better. I was 44 when I got my nursing degree. Sometimes I have to pinch myself about what I've achieved.

'My son worked his way up through the army from leaving school. He's now a captain and has served in Afghanistan. He always says to me that if anything happens to him I should remember he is doing a job he loves. That's how I feel about nursing – I love my job.'

Ascites

Ascites is a build-up of fluid between the two layers of the peritoneum, the membrane that lines the abdomen. The excess fluid causes the abdomen to swell. Cancers that can lead to ascites include ovarian, breast and womb. Advanced liver disease and heart failure may also be responsible.

The condition often develops over a few weeks but may occur within days. It can be very uncomfortable and result in symptoms that include:

Abdominal pain, loss of appetite, indigestion, constipation, nausea, breathlessness and fatigue.

Ascites may develop for several reasons, such as:

  • Cancer cells spreading and irritating the lining of the abdomen
  • Cancer cells blocking the lymphatic system
  • Blocked circulation of blood through the liver, if the liver has been affected by cancer cells

Sources: Macmillan and Cancer Research UK

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