Background Changes in medical staffing at the Nightingale Macmillan Unit (NMU) Derby, led the team to think differently about the clinicians supporting this specialist palliative care inpatient area. Two experienced band 7 Clinical Nurse Specialists (CNSs) were seconded into a novel role. Here we evaluate the impact of this change.

Aims To enrich the skill mix of an otherwise less experienced medical and nursing workforce; working alongside the junior medical team and medical students. To provide holistic assessments for new inpatients, with a focus on symptom management and teaching to improve patient and staff experience outcomes. To provide continuity of care for patients especially as junior doctors work shift patterns on hospital rotations.

Methods Two experienced CNSs with backgrounds in community and hospital palliative care settings commenced a 12-month secondment in April 2023. Both were non-medical prescribers and one with clinical decision-making. Rostered Monday to Friday to ensure at least one on duty each day.

Initially, the junior medical team (F1 doctor, 2 F2 doctors, GP registrar) shadowed the CNS on ward rounds. Subsequently the CNS shadowed the doctors’ ward rounds to observe their assessment skills. Particular focus on ensuring the psychological elements of assessment were incorporated.

The CNSs undertook a patient experience audit (FAMCare) and collected feedback from rotating junior doctors.

Results Feedback has been positive from both patients, relatives and staff.

’Working with the CNS sharing ideas and discussing patients with each other has been really important in learning and managing patients in palliative medicine.’

’I have developed my communication skills with patients and their family members by observing the CNSs at work with patients and team members.’

Conclusion This pilot secondment was deemed successful and resulted in a permanent whole time equivalent CNS role on the Nightingale Macmillan Specialist inpatient unit, which has been successfully filled.