A Day in the Life of Clinical Nurse Specialist, Pain Medicine
Thursday, October 17 | My name is Fiona Irwin. I am a Clinical Nurse Specialist in the Department of Pain Medicine, UL Hospitals Group. The aim of the Pain Medicine Department is to provide timely, safe, patient-centred care, which has been greatly improved by the addition of the Pain Management Centre at Croom Orthopaedic Hospital. I work at University Hospital Limerick (UHL) and Croom Orthopaedic Hospital. I am a busy wife and mother to one little boy and I also own two dogs so I’m often to be found walking trying to control all three!
I joined the team in September 2017 when the service was based mostly in UHL. My prior experience was varied, including rheumatology, orthopaedics and vascular and I’d also worked in pain interventions as a staff nurse. I had a particular interest in pain as I’d noticed in the course of my work the impact that pain had on people’s quality of life. When I joined the team, I was halfway through a Masters in Pain Management in UCD which I completed within my first year as a CNS, which gave me a very strong knowledge base in this field.
With the growth of the Pain Management service, our team has expanded and we now have one pain consultant Prof Harmon, five clinical nurse specialists (CNS), one candidate advanced nurse practitioner (cANP), one clinical specialist physiotherapist, one music therapist and one clinical psychologist, who all work within the pain medicine department, which includes a procedure unit, outpatients department, and within UHL.
A typical day
My day starts at 7.45AM. Thursday is a busy day as it is one of our Pain Education Days. These occur monthly and are delivered by a multi-disciplinary team and facilitated by my colleague Avril Enright and me. These meetings help people living with enduring pain through self-management and peer support. Feedback from attendees has been extremely positive.
Our work in the service is varied. As a group of CNSs with diverse clinical backgrounds, we’re able to provide each other with support and work collaboratively. My CNS colleague Mike Griffin rings me to discuss a patient he is reviewing in UHL. Another CNS colleague, Yvonne Murphy is working in the injection suite with Prof Harmon. She assists with procedures and undertakes therapeutic walks with patients, an intervention that demonstrates the services and supports available from the entire team. The walks also allow patients individual time to discuss any concerns. During one of these therapeutic walks, Yvonne stops by to show the patient the room where patient education sessions are held, and I discuss enrolling the patient for the next available session.
CNS Orla Sheahan is also in UHL today, undertaking some ward-based education sessions with staff nurses. Both patient and staff education forms a large component of our roles as pain impacts patients of all specialities. Orla’s work in UHL today also helps promote our important role as advocates for appropriate pain relief for patients.
In the afternoon, I meet with Ann Marie Kiernan, our candidate advanced nurse practitioner, to discuss a patient who is receiving therapy for neuropathic pain. Also known as nerve pain or neuralgia, neuropathic pain occurs when a health condition affects the nerves that carry sensations to the brain. This is a fantastic service, providing these patients with a range of alternatives to oral medicine treatment.
Katie Fitzpatrick our music therapist and Roisin Hosie our clinical specialist physiotherapist collaborate on appointments for joint patients who may have difficulties accessing services. This afternoon they have an appointment for an elderly lady who cannot drive and has to rely on others for transport. During her appointment, a question relating to her medication arises and I help with this.
When patients finish at the Education Day after 3pm, I go to the Pain Theatre to enquire if any help is needed. Everything is under control, so Avril and I begin to return calls to patients who have rang with clinical queries. This may often be a case of contacting a GP, scheduling an emergency appointment or offering advice to the patient or family member. This particularly busy day finishes up at 6pm.
The unit’s Clinical Nurse Manager, Carmel Duhig, closely liaises with the care of all of our patients in Croom, and is a great resource for help with everything related to the day ward process. The service is supported by a wonderful team of staff nurses, multi-task attendants and clerical team members who all contribute to ensure the smooth running of the service.
My favourite part of being a CNS in Pain Management is listening closely to the patient’s description of how pain is impacting on their lives, in the knowledge of the difference our work can make to the lives of patients living with pain. My most memorable moments have been when many patients return a number of months after a Pain Education Day and tell us of the event’s life-changing impact, and the sense of regaining control over the pain they had lived under. As a nurse, the basic principles of patient care and being a supportive presence to our patients are always to the fore during my working day.
An important goal for our department is to provide a full six-week schedule for patients, and as a team we are all working towards having this in place early in 2024. As a team we are aiming to develop a Pain Management Programme which will be a full six week schedule for patients and is the ultimate goal for our department. It is hoped that this will be up and running early in 2024.
Tuesday, October 17 is Global Day Against Pain.