Career advice

Working with homeless people makes great use of my knowledge, skills and experience

Jane Cook had already enjoyed a varied career before she started working with homeless people, and it's become even more interesting since

According to CHAIN, the Combined Homelessness and Information Network, there are almost 3,000 homeless people sleeping on the streets of London alone – up 55% since 2010.

Jane Cook, newly-appointed integration lead for homelessness across Guy’s and St Thomas’, King’s College and the South London and Maudsley NHS foundation trusts, has cared for street sleepers for 30 years.

Picture credit: Alamy

As a Queen’s nurse she co-founded the homeless nursing project at the Queen’s Nursing Institute (QNI) and has produced national guidelines on safeguarding homeless families.

She recently helped develop dedicated beds at hostels in four London boroughs for homeless people who have been discharged from hospital. The nurse consultant also set up StreetMed, a nursing outreach service, with St Mungo’s Broadway homeless charity in 2012 (see box, below), and now trains StreetMed nurses two days a week.

Sue Rolph is a StreetMed outreach nurse with St Mungo’s Broadway in Ealing, London. Her interest in helping homeless people was first sparked by a television programme she saw as a teenager.

‘It vividly illustrated how quickly someone’s health and social problems can escalate when they are living on the streets,’ says Ms Rolph, one of the charity’s 25 full-time nurses.

With a background in intensive care and dialysis nursing and a counselling qualification, Ms Rolph came to work with homeless people after searching for a ‘completely different’ nursing career two years ago.

‘Intensive care nursing was quite regimented. But this post enables me to think on my feet and challenge the system to prevent people slipping into hopelessness and poor health’.

With a caseload of homeless clients with complex needs, Ms Rolph aims to ensure her clients receive equal access to primary care at GP surgeries, as well as reduce attendance at emergency departments and the need for urgent care.

Her clients often have mental health or substance misuse problems, which can lead to seizures, trauma and wound infections. ‘But one of my biggest challenges is ensuring clients can access the health or social care appointments that will help them,’ she says.

To reduce hospital readmissions, Ms Rolph oversees hospital discharge for her clients, ensuring they have suitable accommodation and access to primary health care.

‘I educate ward staff about their homeless patients’ community needs; for example, doctors must understand that without access to clean drinking water, a patient may take medications with alcohol.’

In this job, she says, ‘no working days are ever the same’. She hopes to use her role to ensure homeless people get equal access to primary health care and that hospital nursing and medical staff understand the effect homelessness can have on a patient’s overall recovery.

Her new role, as part of a health inclusion team, involves ‘managing, auditing, integrating and co-ordinating services so all partners and voluntary services work together to ensure homeless people’s health, social and housing needs are met,’ she says.

Her commitment to the care of homeless people was triggered years ago when working as a staff nurse in a busy east London emergency department.

‘Noticing rough sleepers with conditions such as trench foot, chest infections and minor wounds repeatedly coming in for treatment, I wondered where they went and who treated them after they had been discharged,’ Ms Cook says.

To find out, she worked in two city hostels before gaining mental health and health visiting experience and qualifications so that she could develop a broader knowledge of the public health issues that can lead to homelessness.

Figures from CHAIN show that about 70% of street sleepers have physical health conditions, such as chronic liver or lung disease, and 65% have mental health problems. Many are not registered with a GP.

Ms Cook believes that all nursing experience is relevant to a career in homelessness care. ‘The diversity of homeless people’s health needs, which range from recurring leg ulcers to substance misuse or palliative care, means all nursing experience is valuable and relevant to this specialty,’ she says. ‘Nurses’ awareness of social determinants like accommodation, life skills, welfare and health, voluntary and social care networks, is essential when assessing clients’ needs.’

A career caring for the homeless is rewarding but it can also be harrowing to encounter the living conditions and heartbreaking life stories at first hand.

‘Fortunately, as homelessness nurse numbers rise, the London Network of Nurses and Midwives and the QNI homeless health project have developed support structures like debriefing, professional networks and online training,’ says Ms Cook. Taking a placement or volunteering at a charity are ideal ways to discover if this type of nursing suits you.

According to Ms Cook, more is now being done to tackle homelessness at a national level, with development and funding of initiatives to promote safe hospital discharge and reduce preventable emergency and inpatient readmissions, by working with the voluntary sector.

‘Hopefully, my new post will enable me to pull together a wider range of agencies to ensure all work collaboratively to benefit homeless people,’ she adds.

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