Nursing in Practice speaks with the matron of Ampleforth Abbey to learn about life nursing in the religious sector.
For Karen Harrington, matron of the infirmary at Ampleforth Abbey in Yorkshire, her 25 years in the NHS were organised around drug rounds, mealtimes, times to change dressings and times for nursing reviews.
But since finding a chance job advert in a local paper 11 years ago, Ms Harrington’s daily work has been set to a very different schedule.
Within the grounds of the 200-year-old Benedictine monastery, Ms Harrington’s working life now proceeds according to the chiming of the monastery’s bells which follow, without fail, the order’s strict schedule or Horarium.
‘There are bells within the monastery which even denote things like coffee, and there’s another bell for when coffee finishes,’ Ms Harrington told Nursing in Practice, ‘in monastic terms, everything revolves around the prayer times’.
As Matron, and sole nurse of the abbey’s infirmary, Ms Harrington leads her team of 10 healthcare assistants to ensure that the 30 monks, referred to as Fathers or Brothers, and their visitors are able to ‘live their chosen life’. The abbey also welcomes many residential visitors for retreats, and people can visit for daily services and prayer.
Ms Harrington and her team begin work every morning to ensure that the Fathers in her care are up and able to attend the morning service and receive Mass.
‘Mass is at 9 o’clock, so you absolutely have to get everybody for mass who wants to go. That’s your first and foremost task every morning.
‘That comes before everything else, and anything else in our day in terms of nursing care we plan around prayer times.’
All the care that the infirmary provides to the residential Fathers and visitors to the abbey is centred around ensuring their patients can live according to the monastic principles they have dedicated themselves to.
However, this does create some difficult nursing problems when the Benedictine faith places such emphasis on the value of hard work, she says.
‘At least three of our Fathers are over 90, who still work’ says Ms Harrington, ‘they travel, work, teach and write. So, we need to ensure they can work safely into their old age.
‘Probably more than anything it’s about saying, ‘you have permission to have an hours’ rest this afternoon,’ because even in ill health, if they are able, they will absolutely try to do all they can.’
Ms Harrington’s team is able to deliver a wide range of care, with services ranging from ‘vaccination through to minor injuries, chronic disease management, staff wellbeing clinics, counselling, and pre and post operative care.’
While the team does work closely with a local general practice and undertakes a lot of shared work with them, Ms Harrington says that in the last six weeks alone the team has been able to see 128 people who otherwise would have needed external support.
Ms Harrington says her team try to do as much in house as possible.
Travelling in the winter is really difficult, and it is at least a two-and-a-half-hour journey to the nearest district hospital. ‘If you look around where we are you’ll see that it’s both incredibly beautiful and incredibly rural, so we have the added issue of access to services.’
One aspect of care which Ms Harrington says she is particularly proud of is the palliative care service offered.
Like much of her work, this service relates closely to the spiritual life of the Benedictine community, and the care is given on site.
‘The Fathers have joined the community; the Abbot is their next of kin; this is where they wish to die and we’re here till the end of their life.’
‘Our palliative care is up there with the best because we have not just nursing care, but spiritual care. There is a vigil at the end of death and the individual is never left alone for a second.
Working in the sector
The infirmary’s unique position at the boundary of spiritual and medical practice does create unique challenges, largely springing from the fact that the infirmary is not regulated by the Care Quality Commission (CQC).
The infirmary is part of a large organisation, Ampleforth Abbey, which is not itself a medical organisation. This means Ms Harrington’s work sits outside of the regulatory activity of the CQC.
One on hand, this gives the team more flexibility in how to tailor their services for the specific needs of the monastic community at every level from medicine and equipment, down to other details.
For example, all of the infirmary’s paperwork is customised to say ‘Father/Brother’ where it might otherwise say ‘patient’.
Yet, as Ms Harrington discovered after moving from her previous role in working in a community hospital, ‘you have to work a lot harder to make sure you are delivering a community service’.
Every aspect of care in the monastery is unique, yet this means a lot more work for the nursing team.
During the pandemic particularly, Ms Harrington found that the Infirmary’s unregulated status left them without government support that other health and social care settings might receive.
PPE did not just ‘land on your desk like it does in the health service, it just doesn’t happen when you’re not regulated’’, she noted.
Ms Harrington, whose previous remit was pandemic planning, recalls calling around contacts in health and social care to find a box of masks for less than £120, as well as sharing contacts and resources with teams across the country.
‘If you look at the facts and figures, and the demographics of our community, we shouldn’t have got through [the pandemic].’
‘Credit is due to the team and the monastic community, and to the GPs who never failed us from day one. I think it was quite incredible what we achieved.’
Positive work-life balance
Despite all the challenges, and the logistic difficulties of custom paperwork, Ms Harrington says that the Abbey is a truly fantastic place to work.
While none of the staff need to be of any particular religion, the principles on which they are employed reflect the values of the Benedictine order: hospitality, integrity, respect, and equilibrium.
With feast days, events and outings (all aligned with the monastic calendar), as well as flexible hours and support to take extended breaks when needed Ms Harrington says working at the monastery ‘takes work-life balance to another level’.
‘The flexibility in the way we are able to work is incredible. Not that we don’t have our stresses and strains, but it’s just such a place of joy and life.’