Nursing a healthier future: How nurses are integral to medical cannabis treatment plans.

After taking time off to have her children, nonmedical prescribing specialist nurse Kim was back better than ever and was eager to get back to caring for those she knew needed her comfort, compassion, and unwavering support throughout their healthcare journey. 

But, instead of returning to working in palliative care, Kim decided to turn over a new leaf last June, and entered into the little known field of medical cannabis nursing. 

Swapping her 12-hour shifts full of commuting and community visits come rain or shine, Kim now sees over 80 patients a week from all over the UK, all while working from her home in Northern Ireland. 

We sat down with Kim, Releaf’s Head of Nursing, to find out more about why she made this switch, what her day-to-day life looks like now, and why she feels nursing is integral to not only improving patient  outcomes, but improving patient experiences. 

Read what Kim had to say below:

So Kim, tell us about yourself and a bit about your background in nursing:

Before joining Releaf last year, I spent 10 years working in specialist palliative and end of life care at Guy and St Thomas’s in London. Before that I worked in various departments within hospitals, I was even a scrub nurse at one point, and I’ve also worked in a number of different hospices. 

I actually moved to London to work in palliative care, and spent about six years of this working in the community based at St Guy’s Hospital, then I went on to do my prescribing qualification. I became the nonmedical prescribing leave for the community after this, but I still had my own case load and got to know the people I was caring for really well. 

People think when you say palliative care everyone is dying, but actually we have patients in our care for a couple of years in some cases because of their long term conditions. Then of course that transitions into end of life care. Throughout my time there, I was also the homelessness care lead and substance misuse lead.

One thing I will say is working in palliative care makes you incredibly adaptable. You need to be able to go into anybody’s house and take the approach that works best for them, whether that's someone living in a mansion in Kensington, someone living under Tower Bridge - patients won’t trust you if they don’t like you, so you need to be versatile, and it’s a great skill to gain. 

Did you ever think you’d be able to prescribe medical cannabis as a nurse?

The short answer is no, but I have always had an interest in medical cannabis. 

In my previous job there were a number of people using black market cannabis to ease their symptoms in my patient cohort, especially towards the end of life, so I was aware of how useful it can be in the right circumstances. 

What I didn’t know, until I saw the job advertised at Releaf that is, is that I’d be able to prescribe medical cannabis if I worked for the right clinic. As a nonmedical prescriber I can prescribe anything so long as I feel confident to do so, and there are certain things I wouldn’t prescribe, like antibiotics, because they really aren’t my area of expertise.

In my old role, I wouldn’t have thought twice prescribing an opioid based painkiller to someone in need of pain relief providing there are no substance abuse concerns - so, why should it be different with cannabis, I ask? Realistically, there are far fewer associated risks, side effects and contraindications with other medicines. But, it still did feel quite surreal the first time I did write a prescription for medical cannabis flower, that’s for sure!

What role do nurses play in patient care at Releaf?

At Releaf, myself and the other nurses hold follow-up appointments with patients who are under shared care agreements. Sometimes patients do think I’m a doctor when they first meet me in an appointment setting, which of course I always correct, but sometimes I even think that takes the pressure off. 

Why? Because nurses have a different style of communication with their patients than doctors tend to, our backgrounds are different, our experiences are different, and often patients respond to us differently. 

Our skill sets are so diverse, instead of specialising in one particular area, nurses have typically worked all over the care sector. We’ve met so many people, all with different conditions, lifestyles, and circumstances, so we can gel with anyone. That’s why I really do believe that nursing is the backbone of specialist care - and I know we’re really valued at Releaf.

I think there was a big shift during COVID, it really became apparent how important touch is when it comes to caring for and supporting patients, and we had to work out how to offer that emotional support without being in close quarters with someone, or putting a comforting hand on their shoulder. These skills have come in really handy here, and while it depends on the person, lots of patients find virtual appointments really convenient, and most feel more relaxed because they’re in their own home. 

Can you talk us through what a typical follow-up appointment involves?

Sure. In follow-ups we review medication and how the patient is getting on with their prescription. We ask about how things have been going and if they’ve noticed any changes in their physical or mental health. Sometimes patients are getting additional treatments like physiotherapy, or they’re waiting on another diagnosis, ADHD is a frequent one, so we’ll ask if anything has changed there too.

If it’s a patient I regularly see, I tend to start by recapping how things were at the last time we spoke and what we’d planned to do, whether we’d kept things the same, adjusted any dosages or swapped over to a different cultivar or oil, and then find out how things have been going since and make a plan for the next month of treatment. 

If the appointment is with a patient I’ve not met before, I ease into things a bit more because I want to form a good relationship from the very beginning. I ask them to tell me more about themselves, what their journey has been like, what led them to Releaf in the first place, and ask them to explain their treatment plan. 

I’ve got their notes from their doctor consultations, and I always take a look in the morning when I’m setting up my clinic for the day, but it's better to hear it first hand. Not only do you have the full picture, an idea of how this individual really needs help or support, or what their real goals are for this treatment, but so that they feel heard too. Again, it comes back to communication and trust.  

At the end of the appointment, depending on their feedback I’ll write up their prescription, and if necessary, I’ll discuss it later that day in our MDT. These are then signed off by the specialist doctors on shift. 

And as the Head of Nursing, how do you collaborate with the wider clinical team?

With the nursing staff, I hold monthly one to one meetings and clinical supervision, but they know they can come to me any time they need to, of course. In terms of the wider clinical team, we have daily MDTs - or multidisciplinary meetings - where we discuss all necessary patients. 

So, everyone who has held appointments that day attends the MDT, and if there are any patients we’ve seen that day that we feel could do with further support, or specialist guidance, we’ll discuss these. That way we have input from nurses, GPs, and doctors of all different specialities. 

When I worked for the NHS we took a similar approach, except these only took place once a week, and so at Releaf the team are all really integrated, and we collaborate together really well. 

Finally, why do you think some healthcare professionals are still sceptical or hesitant about medical cannabis?

Personally, I think it’s because education surrounding cannabis-based treatments has to be actively sought out as it’s not part of the curriculum, especially when you train to be a nurse. Meanwhile, the chatter we freely hear in the public domain is filled with misconceptions and stigma, and so people are often left feeling uncertain on who to believe. 

But those who’ve faced complex health needs know, there comes a certain point where most are willing to give things a try - regardless of their recreational associations - providing a healthcare professional they trust has recommended it. 

Lots of the patients I see now at Releaf have fallen through the cracks so to speak, they’ve not been given the support they really needed and it’s such a shame. They’ve often tried countless treatments that they had no issue accessing, but they’ve not really helped, and often, they’ve even caused further complications. 

We’re able to give them that comfort, that support, and that care, and some of the results we hear of are quite simply astonishing in terms of quality of life - just read Marlyse’s patient story for example. 

I really do feel privileged to be able to prescribe medical cannabis to patients like this, to those who really can benefit from these options, and also to check in with them regularly throughout their journey, and hear first hand how things are changing for them.