Introducing…a palliative care nurse clinician

Sarah Romeril has held a variety of roles across her 11 years of nursing practice. She started her career working at the Hamilton General Hospital site before moving to a position in the Emergency Department (ED) at Joseph Brant Hospital all the while working at Carpenter Hospice in Burlington. When a nurse clinician position opened up with the Niagara West Palliative Care Team (NWPCT) in 2018, she saw a wonderful opportunity. For Romeril, who holds a Masters of Nursing degree and is specialty certified, the holistic, patient-centred nature of palliative care drew her practice toward this speciality. Sarah is an Assistant Clinical Professor in the School of Nursing at McMaster University and an Associate Member of the Division of Palliative Care hosted by Department of Family Medicine which serves the whole Faculty of Health Sciences at McMaster University. She is also a member of palliative care nursing associations regionally, provincially and nationally.

What led you to pursue a career in palliative care?

I held student placements during my undergraduate studies and remember feeling like palliative care is an area which deserved more system-level focus and improvement. Patients come to the ED with complex illnesses, some with multiple admissions and struggle to navigate the system. Over time there can be real sense of a loss of identity within standardized care. I felt there were opportunities to improve the care experience for patients, particularly with earlier integration of palliative care. Practicing palliative care gives me the privilege to care for patients and families across all age groups, with varieties of illnesses, to help personalize their end-of-life journeys and improve their quality of life.

Tell us about the Niagara West Palliative Care Team, how it operates and the services it provides:

The NWPCT is a population-based shared care model providing comprehensive palliative care to patients with life-limiting illnesses. We’re an interprofessional team of two physicians, the nurse clinician role, a navigator, two counsellors, and home and community care coordinators; we are a teaching team providing educational opportunity and support to learners. We believe in meeting the patient where they are at and we work across care settings throughout West Niagara. This means we follow patients across their journey including hospital, home, long-term care, retirement homes and/or hospice. We are well partnered and integrated within the system locally and regionally.

The NWPCT model is integrated within other health-care models delivered at West Lincoln Memorial Hospital, which focuses on primary care capacity building. We partner with primary care physicians and nurses to help them grow their palliative care skills and provide customized support.

What does a day in the life of a palliative care nurse clinician look like?

No two days are the same. We work together as a team to ensure we have holistically met the needs of patients and families. Clinically, we spend a lot of time in the community consulting with and caring for patients. Our work involves providing comprehensive clinical services such as pain and symptom management. It involves system navigation, making patients aware of available services and helping connect them with what they need. We help patients and their families with advance care planning to determine their end-of-life needs and wishes. We also offer psycho-spiritual support to patients to help them and their families through the journey, including bereavement support. It’s an honour to be able to help people fulfil their end-of-life goals, while being there to support the family through the process as well.

This role also includes opportunity to integrate principles of advance practice nursing through innovation, education and facilitate systems level advocacy and support.

What’s your philosophy toward palliative care?

Every person should have access to palliative care to support their journey with a life-limiting illness. Early integration of high-quality, comprehensive palliative care is critical to achieving this vision. Evidence shows that early integration can improve outcomes and quality of life. It also helps to removes the burden of navigating the health care system while personalizing the patient’s care.

The NWPCT values and is grateful for its strong relationships with many partners, both local and across the region, which help ensure Niagara West residents’ needs are being met. This includes primary care, home and community care, McNally House Hospice, Rose Cottage, emergency services and WLMH. The community of care providers in West Niagara is amazing.

What are three things you feel people should know about palliative care?

  1. Patients live longer and better with early integration of palliative care.
  2. Palliative care should be available to all Canadians when facing life-limiting illness
  3. Palliative care is more than just end-of-life care and it includes a focus on quality of life and living well throughout an illness journey

WLMH is currently in the planning stages toward being rebuilt. Will the new WLMH enhance the NWPCT’s ability to serve patients?

Our team has been involved in the planning for the new hospital. We’re looking forward to new opportunities in the future hospital to further develop and create new partnerships with other care providers. The team is committed to new innovations and opportunities to meet emerging needs of the West Niagara community, which is home to one of the fastest-aging populations in Ontario.

We’re also looking forward to some of the technology that will be in place when the new hospital opens. Our team works out in the community and collaborates with a variety of care providers for each patient. Some of the new technologies being brought in like Odyssey (the initiative to operationalize HHS’ incoming hospital information system) will give increased access to real-time information, system access and communication with other care providers. Tools like this can enhance the way care providers work and the care we can provide to our patients.