Background Staff working out of hours need clinical support with complex patient care. Our Senior Specialist Nurses (SSpNs) have extensive skills and knowledge in managing complex clinical and emotional issues for palliative patients. They are well positioned to be flexible and support an innovative change in practice, driven by changing circumstances in healthcare, by participating in the ‘First-on-call’ rota. A Palliative Care Consultant is always second on call.

Aims

• To utilise the advanced skills of our SSpNs by their participation in our ‘first-on-call’ rota, providing expert out of hours support.

• To role model the advanced skills of our SSpNs (Health Education England. Multi-professional framework for advanced clinical practice in England. 2017) inspiring junior colleagues to undertake training, improve their own advanced practice, for their personal development and the organisation’s benefit.

Method SSpNs were included in our ‘first-on-call’ for a three-month trial period. Responsibilities to include: Assessing and prescribing for inpatient unit; Providing support to the Clinical Nurse Specialist on call for complex issues for our community patients; Offering advice about symptom control and clinical decisions to paramedics and primary health care colleagues. Feedback collected from service users.

Results Feedback demonstrated a highly successful pilot:

• SSpNs can manage many of the issues that arise out of hours.

• Consultants confident that SSpNs conduct thorough assessments and seek advice when needed (e.g. with complex symptoms/medical problems in accordance with the organisation’s Independent Prescribing Procedure).

• SSpNs inclusion in the rota provides clinical leadership and flexible cross-cover with ‘first-on-call’ doctors.

Conclusions SSpNs utilise their advanced skills and expertise dynamically to successfully support out of hours working across internal and external services. This has enhanced SSpN practice and inspired development in junior nurses; creating a clear career pathway contributing to both healthcare and personal job satisfaction. Ensuring seamless specialist support for patients and carers.