The Nutricia Homeward service supports over 30,000 home tube fed patients and nearly 5,500 hospital discharges in the UK every year. Tish works alongside over 150 nurse specialists, each of whom is committed to providing the skills and reassurance to help patients manage home tube feeding to stay out of hospital, which significantly improves patients’ and their families’ quality of life. Before joining Nutricia, Tish was a nurse in the NHS.

I became a Nutricia Homeward Nurse way back in March of 2014, so it was a long, long time ago! I was at a point where I felt like there wasn’t any room for progression in my career, and when I heard about this role it was something that really excited and interested me - so I thought why not give it a go and see what it’s like! The seven years since then have just been great.

I get the best of both worlds with this job. Previously I worked for the NHS and was on the wards all the time, where I really enjoyed building a rapport with the patients and looking after their families. But once patients left the ward, that was it; half the time, I didn't see them again. Now I am able to see my patients in the acute phase and then follow them up in the community, so seeing them on a regular basis, I really get to build up a great relationship with them and their families, which is what I’ve always wanted.

My role is focused on providing patients who require tube feeding with training and education, so when I’m visiting a patient it could be to onboard them as a new patient to the Nutricia Homeward service, to troubleshoot an issue with their tube or pump, or to sort out something that’s not quite right with their feed in general. Or it could just be for a bit of a chat - if they’re not quite sure what’s going on, or to reassure them that what they’re experiencing is normal. 

The important thing for me, before I start anything, is to always ask “How are you feeling?” I like to gauge where their head’s at, so if they have any worries, concerns or questions we can make some time to iron out their issues or anxieties before we get into the nitty gritty. It’s about letting them know that we’re not robots, that there’s an actual human there to support them with thoughts and feelings and empathy. You have to be able to adapt to certain environments and situations and almost be a little bit of a chameleon, so you can match the type of person you're seeing and make them as comfortable as possible.

There’s no such thing as a typical day. I might start off with some admin, making sure that there isn't anything to follow up from out of hours. There could be planned or troubleshoot tube replacements that need doing, or there might be a need to catch up with healthcare professionals, whether it's joint reviews or training in patients’ homes, nursing homes, or in hospitals. I might get a quick call from a patient that just wants to run something through with me, and sometimes that leads to them talking about a few different things that aren’t necessarily always clinical. It's nice to be there as a sounding board for patients that just want to have a bit of reassurance, and it’s really rewarding to be able to support them in any way they might need. 

Things have been a bit different during the pandemic. My daughter is four now, but when the first lockdown happened she was in nursery, and when the nursery closed that left me in a bit of a pickle. Nutricia put measures in place so I could work from home, and although I couldn't go out and see patients, I was able to support them via the Nutricia Homeward App, and I was able to support the wider team by almost becoming their sort of mini PA. I was taking calls from their patients, coordinating nurse visits and booking in trainings - just making sure that the local service ran as smoothly as possible, regardless of my being unable to be out and about with everybody else.

Using the Nutricia Homeward App made it really easy to keep in touch with my patients from home, so even though they weren’t seeing me face-to-face the service remained just as good - if not better. Doing a discharge training virtually, for example, a lot of patients feel like “How can I get this if you're not here with me at this time?” But it helps that they have their equipment there, so they can see on the video call that I have exactly the same equipment, and we go through it step-by-step together. They can understand the training at their pace, and by the end they feel relieved; having that support gives them a feeling of “Yes, I can actually do this; I can make this part of my everyday life.”

Face-to-face meetings have been really tricky during COVID-19. I’m a very expressive person, but behind all the PPE it’s very hard for people to tell when you’re smiling - and that’s an important part of putting people at ease. The mask is a physical barrier to connecting with patients - and then there’s the face shield, the shoe covers and gowns. It’s layers and layers of complexity, and this isn’t done in a hospital or a clinical environment; this is on the patient’s doorstep, in the wind, the rain, or the scorching weather we had last year. You’re balancing on one leg trying to put a shoe cover on while the neighbours’ curtains are twitching! At the same time, you have to keep yourself safe, so there’s an element of security to consider while you’ve got all your kit on the floor and you’re trying to get your PPE on. There’s a huge element of the unknown at the moment, but it’s important that we protect our patients and ourselves.

Before COVID-19, I don’t think a lot of people realised how there’s an element of danger within the nursing services. Now, going through the pandemic and having to don PPE, having that question over whether you’ll pick up COVID-19 from the patient you’re visiting, and having heard media reports about things like people targeting healthcare workers for their PPE… going through all that, I think people are starting to develop a newfound respect for nurses.

When I tell people I’m a nurse, often they assume I work for the NHS, but when I tell them I work for Nutricia I can see people’s eyes light up because they obviously hold us in high regard and look up to us. To be associated with Nutricia in that way, and to go home feeling that I’ve had a real, positive impact on patient’s lives… I’m so proud knowing that I’ve done my job and done it well.