Anita Astell

Improving end of life care for care homes residents by promoting the role of nurses

Two incidents involving Anita’s parents had a huge influence on her life and work. Very early in her nursing career and completely out of the blue, her father built a care home and asked Anita to manage it. Then, years later, Anita’s mother’s ‘good’ death, at home and surrounded by her family, inspired her to provide even more personalised care. Now, Anita is passionate about sharing best practice, creating ever closer ties between care homes and other health and social care organisations, all while promoting the work of nurses.

Anita’s story

“Although I’ve not taken an oath like doctors, it feels like I have. I don’t need to take an oath to know my professional obligation. It’s integral to me. Nursing is a huge part of my life.”

Growing up, Anita always wanted to care for children and imagined she’s be a paediatrician. By her own admission though she failed to achieve good enough grades at school. A short stint working for two of the UK’s best known retailers came to an end when she realised she couldn’t resist the medical calling. 

Having qualified as a nurse, Anita was very happy working in wound surgery and completed a specialist course in burns and plastics. It wasn’t until one very memorable day that her career took a very different, and what turned out to be very long term, turn.

Anita was at her parents’ home one day when there was a huge crash and they realised a bulldozer had smashed into the back of the house. Anita hurried to her father’s nearby GP surgery. He then revealed that he’d hired the bulldozer to come and start work on an extension to their house that was being converted into a care home. He also handed his daughter an application form for the role of matron.

32 years later, and Anita is still working at Wren Hall, a home dedicated to the care of people with dementia, that has won numerous awards and is rated as ‘outstanding’ by the Care Quality Commission.

As if running a care home isn’t intensive enough, Anita also plays a major part in tirelessly promoting the care home sector and the role of registered nurses working within it. Among the many external roles she performs, Anita is a member of the board of Skills for Care (a national organisation which helps create a well-led, skilled, and valued adult social care workforce) and is Executive Director of Nottinghamshire Care Association.

Through her work to establish Nottingham as a vanguard site for the new care model, Anita was recognised with an MBE. 

It’s her more recent work during the COVID-19 crisis that Anita gained some national recognition. Her unique contribution in supporting other care home managers with their end-of-life care during extremely challenging times, saw her feature in a number of news items nationally.  She has done this in three ways: setting up a WhatsApp group to support other care home managers, influencing the government to work in better partnership with care homes, and providing hands-on support for other homes, delivering PPE to homes in need at the height of the pandemic in April 2020.

What drives you to make a difference?

While having the title Managing Director, Anita still considers herself a nurse. “Nursing is very much at the heart of what I do. People find it hard to comprehend but my PIN (a unique registration code every registered nurse receives) means everything to me.”

In fact, Anita is so deeply committed to the principles of nursing that she insists that if one of her staff was to report bad practice on the part of her husband (also a nurse), she would take action. 

“That’s how much nursing means to me. It’s something inside me and really strong. I’ve not taken an oath like doctors, because I don’t need to, it’s just my professional obligation.”

How do we see the art and science of nursing expressed? 

It was Anita’s experience of her mother’s death that transformed her approach to care. Twenty years after her original diagnosis, her mother had a very sudden deterioration and was given two weeks to live. Unsurprisingly, Anita cared for her at home and as she approached her final hours, Anita and her family made sure to create a really non clinical, homely feel, with many of the relatives lying on the bed with her as she died.

“As took her last breath I was able to reflect that it was a really good way to die and I resolved to make sure everyone in my care had the ability to have a death like my mum.”

Now, residents at Wren Hall approaching the very end of life and their families can access the end of life care suite, decorated in a homely style, complete with a large double bed, sofas and blankets. It’s also named after Anita’s father as it was where he used to sit.

Anita is convinced that while her early nursing experience might have been a very different field, it certainly provided her with many of the attributes that help her in her current role.

“I always worked in intensive clinical and emotionally-led settings, ones for which you need brilliant communication skills, empathy and compassion. I think for working in this field you also have to be really strong, not hard but just have a good understanding of the reality of life.”

Anyone tempted to diminish the role of nurses working in care homes with people approaching the end of life, would be reproached by Anita.

“In our home we use the same pcychometric testing for nurses wanting to come and work here as are used for intensive care nurses. When people knock care home nurses and say it’s juts about wiping bottoms, I remind people that they actually need the same skills as ICU nurses.”

How can nurses strengthen their leadership and impact?

“For 30 years I have been trying to promote the care home sector and the role of registered nurses working in care homes,” says Anita. “I am now working to create a specialist qualification for nurses working in care homes.”

Anita’s ambition to increase the status of nurses in care homes is by no means the limit of her ambition. It’s just the start. 

“I’d like to see a social care faculty that can bring together all the different organisation like the ‘Queen’s Nursing Institute’ and ‘My Home Life’ to support all care home staff and provide them with the training they need that’s designed from their perspective, using real life experiences, like the one I had with my mother.” 

“There are plenty of training opportunities for care home managers and the care staff, but not the nurses, and the training there is for care home nurses isn’t specific to them. If we train up the other staff – it reduces the workload of managers.”

“I am a manager but like to think of myself as more of a leader and I think many nurses are good leaders. I am really proud that over 31 years I have developed 96 people to become registered nurses, three midwives, one social worker and six nursing associates. And I hope that’s not the end!”

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Anita Astell
Nottingham United Kingdom