OP-9 It’s a lot more in-depth for us than it was before’: a multi-methods study of community nurses’ extended roles in palliative care

<h3>Introduction</h3> Community nurses play an essential role in caring for people dying at home. Changes in ways of working, accelerated by the Covid-19 pandemic, have placed community nurses even more centrally than before within the complex patchwork of community palliative care provision. <h3>Aims</h3> To explore UK-based community nurses’ views and experiences of their new or extended roles in palliative and end-of-life care since the pandemic. <h3>Methods</h3> A multi-methods study: a quantitative e-survey of 51 UK-based community nurses was followed by qualitative semi-structured focus group interviews with 35 participants in 2023. E-survey responses were analysed descriptively. Qualitative data were analysed inductively using thematic analysis. <h3>Results</h3> Community nurses identified two specific roles that were new to many of them: verifying death and prescribing. Many nurses also talked about a broader, more fundamental expansion of their role; they described themselves as replacing general practitioners and palliative specialists in making important and often complex decisions with patients and families. Nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed dissatisfactions, particularly concerning the quantity of work expected of them and the extent to which they had to take the lead in managing complex problems. They described heavy workloads impairing their capacity both to provide good clinical care and to train and support junior colleagues. There was concern that many general practitioners lacked adequate expertise to provide effective back-up. <h3>Conclusion and Impact</h3> These findings have two broad implications for policy-makers and commissioners seeking to ensure high-quality care and recruit and retain more community nurses. First, they should recognise the importance of allowing experienced nurses enough time to facilitate their juniors’ experiential learning, alongside providing high-quality care for patients. Second, medical back-up for nurses managing complex end-of-life situations should be strengthened in the community.