In many countries there is a long-standing tradition of people volunteering to work for a few hours each week without remuneration in a charity of their choice. In others such use of unpaid workers is seen as exploitation – "if someone is worth employing they are worth paying." Others claim that using volunteers is keeping someone out of a paid job and just a means of saving money. This section describes how volunteers can contribute to palliative care services from the early planning stages.
'Employee' or Volunteer?
It is important to understand that volunteers are not, in the legal sense, employees working without pay. Employees, and those who employ them, are subject to a range of laws in all developed countries. Volunteers are not subject to them but, it must be emphasised, most of the moral principles underlying those laws still apply.(eg good working practices and conditions, fairness, equal opportunities, no racial discrimination etc). In practice this simply means that volunteers must NOT be termed employees in any documents, particularly legal ones.
In all other respects they should be recruited, trained, supervised, supported, and (rarely) dismissed like anyone else working for the palliative care service. Put succinctly they should behave professionally even though their volunteer role is not that of a professional. Those who supervise and support them should treat them, and expect of them, as if they were professionals.
What work do they do?
The areas where they work can be divided into those with patient contact and those with no patient contact. In most palliative care services any direct contact with patients is usually minimal but still important. Unless they are trained clinicians offering their services free they do not perform ‘hands-on’ care though they might help in a Day Unit or bring them to / from the unit.
As a general rule volunteers do work that helps to create the friendly, homely, caring atmosphere that it is hallmark of a hospice / palliative care service. Some examples are:
Receiving patients and visitors when they come to the unit
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Manning the telephone ‘out-of-hours’.
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patients to / from Day Hospice or hospital
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Sitting with patients at home to relieve relatives
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All manner of work related to fund-raising
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Public speaking on behalf of the hospice
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Taking grieving relatives home after a death
Volunteer Service Manager –VSM
This post is the key one if a unit intends to sue volunteers. The care needed for selecting such a person is no different from that for the medical or nursing directors. The appointee must be in post before volunteer recruitment starts.
This person must be salaried, either on the senior management team or reporting directly to one of that team or the CEO. Regular contact with senior nursing and medical staff, as well as fund-raisers, and the volunteer leaders of all the teams into which the volunteers are divided. It is a position which demands a unique blend of skills and attributes – management, sensitive leadership, deep understanding of, and sympathy with, palliative care and knowledge of how to weld so many different people from varying backgrounds into an effective team, sometimes so large that it might be an army.
Recruiting and volunteers
The intention to appoint volunteers will normally be passed on by word of mouth, announced in newspapers and church newsletters, and within hospitals.
As for the appointment of a salaried member of staff there must be a ‘Job Description’, in this case not about a specific job but
the overall work of volunteers within the organisation,
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the ethos and objectives of the unit,
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where and how volunteers will contribute,
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what expenses will be paid,
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what hours will be worked,
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how they will be supervised and supported
and, most importantly, what they will not be expected or allowed to do – hands-on patient care, counselling, offering practical advice etc.
This same document will advise that if a personal with professional clinical; training and qualifications (medical, nursing, therapist etc) wishes to offer their services they will be invited to see the head of the department in which their skills might best be used.
Interviewing and appointing volunteers
Most units invite interested people to visit the unit, possibly spend a few hours seeing where volunteers work and whether or not they feel they could work there. Only after that do they come for formal interview by the VSM and one of her deputies / assistants.
What they will look for is personality, the ability to work alongside others, and a genuine understanding of what hospice / palliative care is. They will try to find what the volunteer feels they can contribute to the ethos. Those unlikely to be accepted as volunteers are
those who cannot work with those of a different social ‘class’
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those who enjoy organising others
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those who enjoy advising others
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those who enjoy talking about their own problems, illnesses and grief
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those who see working in the hospice as a chance to evangelise
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those who cannot respect confidentiality
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those who have had a major loss in the preceding 12 months and are still working through their grief
The appointee is then put on probation for a period of 2-3 months so that they may leave without any embarrassment if they do not enjoy the work. In that time they work under different team leaders and in different parts of the service depending on their skills and aptitudes. If they stay in post they will be given a copy of the Staff Handbook or, if there are sufficient volunteers to merit it, a copy of the Volunteer Workers Handbook specially prepared by the unit.
The VSM will always keep in close touch with new recruits, spend some time with them at the end of the probation period and again at every anniversary of their appointment.
Management Issues
Ideally the volunteer service needs a small office of its own. If that is not possible then space must be found for the VSM and a room for private meetings and interviews.
A data base must be developed for all volunteers showing personal information, availability, aptitudes, particular skills and areas of interest, tasks they should not be asked to do and areas of the unit they do want to be in.
A pin board accessible to all volunteers is useful, listing the different teams (flowers, reception, coffee shop, drivers, Day Unit etc ) and who is on duty at any one time.
Expenses
It is usual for volunteers using their cars in the service of the unit ( eg. bringing patients to and from ) to be given an nationally-agreed mileage allowance.
Other out-of-pocket expenses are usually met on presentation of receipts/ tickets.
Uniforms
Volunteers seldom wear uniforms except perhaps an apron or overall but more usually have name badges. Long service is usually marked by the presentation of a badge, each succeeding 5 years being marked by a ‘bar’ to the ribbon or special badges.
Supporting Volunteers
Though volunteers are not usually in constant direct contact with patients they nevertheless see much suffering, distress, grief and family sadness. Inevitably they are affected by it. They need sensitive, informed support from their team leader and the VSM.
Volunteers should have available to them the same levels of support as any member of the paid staff. Like them they may need some time off, a few weeks break from their duties, opportunities to cry and ventilate their feelings. Like them they may have to be told that the work is not for them and be allowed to leave without any disgrace or embarrassment.
Problems encountered using volunteers
Some want to help the patients with advice or, worse still, recounting their own experiences. They see themselves as counsellors or therapists in spite of what will have been said to them, in their orientation.
The advantages of having volunteers
They probably do not reduce the running expenses of a unit because, in most cases, they are not taking the place of salaried staff.
They help to create a homely atmosphere, in contrast to most hospitals
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They are not professional carers so seem less daunting to patients and visitors
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Their air of relaxed friendliness helps to create an atmosphere of peace and calm
" Professional" volunteers
This term describes the nurses, doctors, physiotherapists, occupational therapists and any other health care professionals who offer their unpaid services for a few hours every few weeks – working in their normal professional role. For example a nurse might offer to work one night a week, a doctor be on call two nights a week, a podiatrist come in one afternoon a fortnight and so on. Their contributions can be very considerable but
they must report to and be accountable to the senior staff member of their profession (nursing director, medical director / senior consultant etc – not the VSM though she may have been responsible for recruiting.
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they must adhere to all agreed clinical protocols and procedures in the unit
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they must be insured for the work they will do.
Finally it has to be remembered that patients and relatives will not be able to distinguish an unpaid (volunteer) from a paid member of the professional staff.
They will need the same support as is being offered to the professionals, and every effort made to ensure that they get the same ' job satisfaction ' as the rest of the professional team.
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