Exclusive: Nursing Standard-Marie Curie end of life survey findings

More than four out of ten nurses and healthcare assistants (HCAs) have received no training in end of life care, a survey by Nursing Standard and Marie Curie has found.

More than four out of ten nurses and healthcare assistants (HCAs) have received no training in end of life care, a survey by Nursing Standard and Marie Curie has found

Many nurses said they felt underprepared to provide quality end of life care. Picture: Alamy

In a survey run in partnership with charity Marie Curie, only 58% of nearly 1,000 nurses and HCAs said they had been trained in end of life care. Many suggested that their training in end of life care was brief and infrequent. 

A total of 66% of respondents said their work involved caring for those in the final months, weeks or days of life.

Nurses and HCAs in many settings, including hospitals and care homes, told Nursing Standard that they felt underprepared for the sensitive nature of the end of life care they were expected to carry out. 

They also spoke of the difficulty of receiving the training they wanted to help them give the best care. 

‘Unacceptably poor’

Research suggests many people currently do not receive good end of life care. In 2015, the Commons Health Select Committee said patients often experienced end of life care that was ‘in too many cases, unacceptably poor’. 

In the latest National Survey of Bereaved People in England (2015), 75% rated the overall quality of end of life care for their relative as outstanding, excellent or good. But one in ten rated the care as poor, equating to almost 50,000 deaths in that year.

Care homes received the highest rating with 82% of relatives stating the care was outstanding, excellent or good, followed by hospices and care at home on 79%, and hospitals at only 69%.

Driving down standards

A shortage of skills in some newly qualified staff was highlighted by community and hospital nurses in the survey.

One community staff nurse said many inexperienced staff were now heading straight to the community where they were expected to work alone. ‘I have worked with a recently qualified nurse at a weekend, who was concerned that she would not be able to tell if a patient had died,’ she says. ‘Newly qualified nurses are cheaper than experienced ones and management are flooding the community with them, which is inevitably driving down standards of care.’

Some respondents said they had to pay for their own training courses on end of life care, and said they had difficulty finding time to complete them, due to severe staffing pressures and increasing workloads. 

One respondent said: ‘It’s frustrating that the care I have learned has had to be in my own time and unfunded. All nurses should receive this tuition as part of their basic training.’

Workload struggle 

A community staff nurse also spoke about the struggle to access education. ‘We have mandatory syringe-driver training, but we don’t receive any other training in caring for palliative patients,’ she said. ‘The local hospice runs courses that are free for staff, but fitting them in when our workload is very high is increasingly difficult.’

RCN professional lead for long term conditions and end of life care Amanda Cheesley agrees that it is becoming more difficult for nurses and healthcare assistants to attend training. ‘Many nurses, even if there is training available, are not able to attend because there aren’t enough staff to cover, they can’t get the time off, or it is cancelled because not enough people can attend.’

She says end of life care training can have wider benefits. ‘Training on difficult conversations doesn’t just enhance end of life care, but can improve care across the profession when it comes to talking about difficult or distressing issues.’ 

Only a third (32%) of respondents said they felt very confident with end of life discussions with patients, with a further 58% describing themselves as fairly confident. Nurses stated that accessing training in this area, particularly around counselling, had really boosted their confidence.

A community HCA described how she had been successfully supported in this area. ‘Trust training, peer support and good leadership have made it much easier to discuss these issues frankly and sensitively,’ she said.

Other respondents said they were concerned that they had insufficient confidence in tackling sensitive subjects around end of life care.

A nursing academic who took part in the survey also wrote about her concerns. ‘Currently, issues seem to arise from lack of education and support, staff members’ own personal fear of death and dying and not knowing what to do or say,’ she said.

Free resource 

Earlier this month, Marie Curie launched a free online resource to help nurses provide palliative and end of life care to people with a terminal illness. 

The Palliative Care Knowledge Zone aims to give general healthcare staff the confidence to talk with patients and provide the best care to meet their needs.

Marie Curie director of nursing Dee Sissons says: ‘We know that caring for people at the end of life can be emotionally draining, but also incredibly rewarding. 

‘To provide the best possible care for patients, staff need the time to develop their skills and access appropriate and timely training from the very start of their nursing career.

‘The palliative and hospice care community can also play its part. By sharing our expertise and working in partnership with others, we can help build capacity and ensure that staff feel more confident and able to deliver high quality care that meets people’s needs at the end of life.’

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