How to get ahead in ... palliative care

This specialism traditionally appeals to more experienced nurses who want to get back in touch with the art of nursing

Palliative care nurses can come from any field but they tend to have experience in cancer care. Photograph: Getty Images

Elaine Stevens knew just 18 months into her nursing career that she wanted to specialise in palliative care. Her decision, 30 years ago, made her one of the first specialist nurses of her kind. Her peers were attracted to more glamorous nursing careers, such as emergency or acute care.

Stevens, who is now a nurse academic training the next generation of palliative care nurses, says she was drawn to the role because of its focus on quality of care. She says: "Your role is still about good care, but it's directed at the quality of life as opposed to the quantity of life. That is where the satisfaction comes in."

According to Stevens, who is chair of the Independent Association of Nurses in Palliative Care, it is uncommon for newly qualified nurses to be attracted to the role. Traditionally, the specialism appeals to more experienced nurses who may be disillusioned with "high tech care" and want to get back in touch with the "art of nursing".

"I think it's about realising that there may be something better you can offer people if high-tech care isn't the answer," she says. "I think what tends to happen is that nurses migrate towards palliative care as time goes on and they see the opportunity [it offers]."

It is also common for palliative care nurses to come from a cancer care background, according to Ruth Bradley, director of care at St Joseph's Hospice in Hackney. "They can come from any field, but predominately they tend to have a lot of experience in cancer care. They usually have some palliative care experience and want to work in end of life care."

St Joseph's has a team of 15 clinical nurse specialists – including three team leaders – who cover three east London boroughs. The team, which is recruiting for a new clinical nurse specialist, shares responsibility for the hospices' 350 patients, the majority of whom are living in the community.

"At times, we can be a more central focus of the care and at other times we may be more peripheral, but if symptoms deteriorate and life care needs change, we increase our input," says Bradley. "Most people want to stay at home, but things can change if people deteriorate or the family finds things difficult."

Compassion and empathy are the obvious personal characteristics expected from a palliative care nurse, but there are others which are just as important: "You have to have a good handle on your own mortality and be comfortable with your own mortality. You also have to have good communication skills – being able to talk to people about some very distressing situations," says Stevens.

The specialist nurses also have to have "a regard for quality", according to Bradley: "They need to believe in justice, equal access to service and be able to reach out to people from diverse backgrounds and be culturally sensitive."

A "real regard for holistic care" is also key, she says. It requires a mix of clinical skill but also the ability to provide psychological, cultural and spiritual care, not only to the patient but to their family and friends. "Palliative care enables you to assess the whole person; it requires you to manage a deterioration in symptoms, which requires great skill. It's more than the physical symptoms – it's about the psychological toil and the social impact. It draws on so many skills. You are enabling quality of care in very difficult circumstances. You feel you can make a difference, and that is where the satisfaction comes in."

The chance to make a significant difference to a family dealing with death is what drives palliative care nurse Roxanne Vieira-Moreno at St Joseph's. She says: "I am looking after a young woman of 33 at the moment who has only weeks to live. We are writing letters to her sons who are only young. Her sister will give them to the children when they are 18. I am part of this thing for this mother who is leaving this gift for her sons. It's very hard and I wouldn't say it's an easy thing to do but that is where I get my satisfaction."

This article is published by Guardian Professional.