In 2022, St Helena hospice considered recruiting paramedics as a way to solve some recruitment challenges. The hospice was approached by the East of England Ambulance Service (EEAST), who were keen to find ways to retain their paramedics and helping them gain more specialist skills. St Helena and EEAST met to discuss shared roles which could help improve skill sharing, recruitment and retention. They developed a pilot programme together.
Outcomes
Three paramedics worked in a weekly rotation between the ambulance service and St Helena Hospice’s community team. The community team ran a 24/7 helpline and rapid response service for people receiving end of life care.
The paramedics used their existing skills to respond quickly to patients who needed emergency care at home. This enhanced the knowledge and skills of the hospice’s community nursing team. Paramedics were sometimes able to provide urgent care that the community nurses could not, for example if a patient had a wound as a result of a fall.
The paramedics also gained new, more specialist skills, from working with the hospice team.
The combination of skills in the team meant they were more able to respond to urgent situations. Staff could assess whether a patient could be cared for at home, in the hospice, or in hospital. This enabled people to remain at home if they wished to and avoided unnecessary admissions.
The paramedics passed their knowledge on to their colleagues within the ambulance service. This helped their colleagues gain more understanding about how to assess people with palliative needs. They were also more able to have conversations about where people would like to receive care.
During the pilot, St Helena saw an increase in other paramedics using their 24-hour helpline to get advice during a call-out.
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“There aren’t that many opportunities for paramedics to work in specialist fields as far as I know, so this is a unique opportunity to develop my skills while working alongside clinical specialists.”
Daniel Richardson, paramedic on rotation with the hospice.
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“I'm constantly able to keep updated with new treatments and medication and management of conditions, and I can bring that learning into the Hospice for patients to be treated at home. And likewise, if, as a paramedic, I go to someone who's deteriorating quite rapidly or may present as being end-of-life in the community, I can bring the knowledge learned from St Helena Hospice.”
Scott O'Rourke, paramedic on rotation with the hospice.
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“For our patients, it's keeping them in a place where they want to be cared for and giving them support so they can remain at home and are less likely to be conveyed to hospital.”
Nicky Coombes, Hospice in the Home matron, St Helena.
Facilitators, challenges and advice
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Key facilitators
Once the paramedics were recruited, they undertook a week of classroom training and induction. They carried out joint home visits with the community team for three months before beginning to work alone. Staff from the hospice team also shadowed paramedics from EEAST on the road to help them understand each other’s roles.
EEAST have developed an end-of-life care module, with the University of East Anglia. This is a unique opportunity for paramedics to gain skills in this area.
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"It's extremely valuable for both services for improving our response to end-of-life patients…On my first day I went out with two St Helena nurses and I was absolutely amazed at what the Hospice provides. We can then make a shared decision with regards to the most appropriate pathway for that patient.”
Sarah Langridge, paramedic on rotation with the hospice.
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Challenges
Some of the hospice staff were anxious about working with paramedics because they didn’t understand why paramedics were needed on the team. However, as time has gone on, the nursing staff really value the skills the paramedics bring to the team and regularly ask for a paramedic to join them on certain calls.
The hospice did not originally have all the equipment that paramedics are used to using on call-outs, such as ECG machines. However, EEAST were able to provide this equipment during the pilot, so that patients could receive the best care possible in their homes.
Tips and advice
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Don’t try and fit a paramedic into a nurse role. Give them their own role, utilise their own diagnostic skills as emergency care workers and allow them to build upon their skillset in a way that complements a hospice’s existing nursing roles.
Future development
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The hospice has recently recruited two permanent paramedics. The pilot has finished but St Helena is looking for more funding to develop future recruitment.
