The Nightingale North West recruited members of the medical and nursing teams from many different backgrounds. Some had not worked in adult medicine before, while others had been out of work.

I perceived a lack of confidence in palliative care from discussions with nurses and doctors in the ward environment. This was clearly going to be a crucial part of working at the Nightingale. Practitioners’ confidence develops when their skills are high, empowering them to seek advice, and is a useful measure in the development of a quality service. Nursing and medical staff at the Nightingale were surveyed. Confidence in palliative care was reported at 65%, and only 38% for those with no prior experience.

Acting as a junior doctor representative on the palliative care management team helped address these issues. We laid on training sessions for staff, focussed on the logistics of palliative care at the Nightingale, alongside a separate consultant led session addressing identified learning needs. These sessions signposted to specialist advice and guidelines, so staff knew how to access additional expertise and support. The management team adapted national guidelines to take into account the resources available at the Nightingale. These guidelines were made available on the hospital intranet, and in a physical resource folder on the ward.

These interventions modestly improved confidence in palliative care from 65% to 68% over 3 months, but significantly improved for those with no previous experience, from 38% to 51%. All training attendees reported feeling more confident. Those who received the most training saw confidence improve by 8%, compared to 2% for those who received the least.

Working as a junior doctor leader ensured the palliative care management team were aware of and responded to day to day issues on the ward affecting patient care, helping make interventions to improve the service.