Background The shortfall in health care professionals at all levels has been accentuated in the specialist palliative care workforce recently (Buchanan & Campbell. BMJ. 2013; 347:f6201). Internationally, this is described as reaching a ‘crisis’ (Mahase. BMJ. 2023; 380: 713), whilst simultaneously, the population needing palliative care is increasing (Sleeman, de Brito, Etkind, et al. Lancet Glob Health. 2019; 7:e883–92). Retirement of Clinical Nurse Specialists (CNSs) led to unfilled vacancies in our specialist team, which could not be filled locally with experienced CNSs.

Aim To employ fully competent CNSs to work in the CNS team in the first instance, whilst training new CNSs to fill the gap in the long-term.

Methods With more people working remotely through the COVID-19 pandemic, successfully supporting patients, it was decided to create several Virtual CNS (VCNS) roles. Appointing experienced CNSs from across the UK and Europe, to work remotely, triaging, taking and making calls and offering virtual CNS visits through technology, addressed this gap. Alongside this, a trainee programme was devised to train and offer progression for less experienced nurses wanting to advance their careers in palliative care. Four very experienced VCNSs, and five TCNSs were successfully recruited into the team. Whilst the TCNSs undertook a two-year training programme, the VCNSs filled the immediate workforce gap.

Results The hospice experienced a 50% increase in referrals over the last eighteen months. The VCNSs and TCNSs augment the existing team, allowed the hospice to cope with the increased need to triage these referrals and manage a subsequent 25% increase in caseloads. The training of CNSs, alongside the augmentation to the experienced team, means that this increased capacity is set to continue and will help address the predicted increase in future numbers of local people requiring hospice care.

Conclusion Although the problem of an ageing workforce remains, we have found a solution which allows us to address the immediate problem and simultaneously created a career pathway for less experienced nurses.