Palliative care volunteers are regarded as non-clinical members of the palliative care team. Volunteers perform different roles depending on local need, these roles may include biography, bereavement support, community visiting, complementary therapies, inpatient support, memorial services and paediatric (children) support. A paediatric service may deliver programs differently to a service which focuses on adults. An overview of these roles is included on this website.
Why do people volunteer?
It helps to think of two types of volunteers – Let’s call them Type 1 and Type 2:
Type 1 volunteers are mostly motivated by their altruistic values. They may have lost a loved one in palliative care. For example they might be a retired health professional wanting to continue their involvement as a volunteer; or they might be an artist, or art therapist, hairdresser, driver, chef, fundraiser or masseuse who can contribute time outside of their work commitments.
Type 2 volunteers are mostly motivated by achieving some sort of vocational goal including (1) Student Internships; (2) Student volunteers; (3) Centrelink volunteers; and (4) Job seekers:
- Student Internships is a form of volunteering for work experience that is an accepted part of vocational preparation. Some universities are moving to make Student Internships mandatory for all undergraduate students.
- Students volunteers are people who are completing a course of study, which might be related (nursing, extended care, physiotherapy) or unrelated (law, business) to palliative care and who want to volunteer until the end of their studies as a way of fulfilling their own motivation to participate in a unique experiential opportunity. Their interest is time-limited and opportunistic but nonetheless valuable.
- ‘Centrelink volunteers’ or ‘Centrelink volunteering’ is shorthand for the option of a person on unemployment benefits to undertake volunteering which will exempt them from Centrelink’s unemployment-benefits activity test. Both the person and your service must be registered with Centrelink.
- Job seekers are people looking for experience within a work setting to add value to their resume. While they may be genuinely interested in palliative care and volunteering their primary focus is on gaining experience to make them more attractive to an employer, and so their interest in volunteering is likely to be very short term.
Recruiting and selecting volunteers
A professional approach to the recruitment and selection of volunteers is essential to a volunteer service. Guides and resources on the recruitment and selection of volunteers have been published by Volunteering Australia and are available online.
Not all palliative care volunteer services advertise for volunteers. Some services find that word of mouth promotion in the health service and within the community brings adequate numbers of quality candidates.
Some services advertise on the Go Volunteer website (an initiative of Volunteering Australia) and others on Seek Volunteering and Ethical Jobs. There are many web-crawling job-boards that will promote volunteering jobs which are posted on reputable websites – so if possible post vacancies on the health services’ website to improve exposure. Your local Volunteer Centre, Community Health Centre, Local council, newspaper or library are other possibilities.
Not all applicants will be suitable for a volunteer role. Managers generally ensure that all applicants are made aware, possibly at the time of their first enquiry, that a position is not guaranteed.
Many services start the recruitment approach by having an initial conversation with the candidate, possibly over the phone, to identify their strengths, motivations and interests. Taking short-cuts in the recruitment phase might result in the engagement of unsuitable candidates and consequent problems for the service. During our survey of volunteer services one clinician made the following comment about their early experiences in recruitment:
For our first recruitment program 25 years ago we ran an advert in the local paper, and took anyone off the street, and some people were there because of their own needs, so along the way we had to weed out people often around boundaries … so now we ask them the reasons why they would like this work, they are told up front that acceptance of their application isn’t a guarantee that they get a placement because they might be filtered out during the training program.”
A small number of candidates may have maladaptive reasons for wanting to volunteer in palliative care. For example a person may want to ‘set to rights’ a wrong suffered, or they may want to assert their particular worldview about spirituality, euthanasia, pain management, alternative therapies or biomedical science which might be at odds with the policy position of the health service.
The manager should try to make sense of why the person wants to be involved in palliative care volunteering, identifying if they have the potential to develop the skills and knowledges required of them, and getting a sense of their interpersonal and communication skills.
A person who has experienced bereavement involving palliative care may bring excellent skills as a volunteer, but the accepted practice is that they be at least 12 months post bereavement before commencement.
All candidates should be made aware of the relevant organisation’s policies particularly as they relate to identity and security checks such as the WCC (Working With Children) Check and Criminal Record Check.
Of the candidates that are likely to be suitable, the next stage is to invite them to be involved in Induction Training. In most services, Induction Training must be successfully completed before volunteer status is confirmed.
The Induction Training phase is critical to ensuring that the candidate is properly skilled before they engage with vulnerable members of the public, so consider carefully what you are aiming to achieve with any training. Volunteering Australia offers some points to consider:
- Decide if training is needed, and what kind of training is needed. For example, training is not always the best solution to a performance issue.
- Specify the learning outcome. Do you have a clear picture of what you want to achieve by the end of the training? How would you describe the skills and attributes of a competent volunteer?
- Focus on the learner learning, not the teacher teaching. Is there a different learning methodology that would be more suitable? Does the person have skills which could exempt them from parts of the training?
- Use assessment to deepen the learning experience. This is not only a chance to measure against the performance outcomes, but to receive feedback about what has been absorbed. How will you measure that the volunteers are competent to commence?
- Evaluate the effectiveness of training. Is there a strategy in place to evaluate outcomes from the program after an appropriate interval?
Trainers might use material from the Palliative Care Volunteer Training Resource Kit 2012 or they might develop their own resource material. Palliare: A Handbook for Palliative Care Volunteers in NSW (2018) is designed for individual use by volunteers.
Each NSW palliative care volunteer service has developed their own training program to suit their own needs and resources. In many cases they engage local clinicians to provide the training. In smaller not for profit organisations the training may be delivered predominantly by one or two clinicians, or by the manager. Formats might be 1 or 2 days, up to 8 days in length. Sample training programs are shown below:
Sample Formats for Induction Training
Sample 2 Day Program (2 full days) (with thanks to the John Hunter Children’s Hospital)
This format is intended to be used for volunteers who are experienced within the health service is a similar field to palliative care, and who need an orientation to volunteering within the palliative care setting.
0900 – 1030 What is Palliative Care? How does volunteering make a difference?
1030 – 1045 Morning tea
1045 – 1230 Communication and family dynamics
1230 – 1300 Lunch
1300 – 1400 Clinical/health and treatment issues
1400 – 1500 The role of the volunteer
0900 – 1030 Spirituality
1030 – 1045 Morning tea
1045 – 1230 Grief and bereavement, self-care and boundaries
1230 – 1300 Lunch
1300 – 1400 Practical care and support
1400 – 1500 Next steps
Sample 9 Day Program (9 part-days) (With thanks to Tweed Palliative Support Inc)
This format is intended to be used for candidates who are new to the organisation and new to palliative care support.
Day 1 – What is Palliative Care? The role of the clinical and support team
Day 2 – Communication, Volunteer Rights and Responsibilities
Day 3 – Family dynamics, Caring for the Dying (body and spirit), the Funeral Ritual
Day 4 – The Dying Process, Advance Care Directives
Day 5 – Grief and Loss, Massage for volunteers, Clinical knowledge
Day 6 – Spiritual care for the dying, the role of the Social Worker
Day 7 – Field visit, guest speaker with personal experience of loss
Day 8 – Palliative Care and the GP, Stress Management, Bereavement and Meditation
Day 9 – Patient care and contact, Letting-go and Completion
Whatever the format used the manager has an interest in knowing that the candidates have absorbed the material and have achieved the learning goals for the training program. This might include
- Post-training interviews, serving as an opportunity for the manager and another (a clinician or experienced volunteer) to meet with each candidate and gauge their knowledge through questioning. This format might also serve to discretely raise any issues of concern with them.
- Competency-based approach, using one or more assessment processes to confirm competence (knowledge, skills and attitudes). This could be done using a written test each week or periodically.
- Buddy shifts, involving mentoring and observations by an experienced volunteer while the candidate is involved in practical experience.
- A combination of 2 or more of the above methods.
Some candidates may leave during the early stages of training having realised that it is just not for them, and others might simply be unsuitable. As manager you will find it easier to schedule opportunities to discuss progress with each candidate. Some of the checkpoints for these discussions include:
- When the initial application is received
- At initial interview (telephone or face to face)
- Within the early part of the training
- During the mentoring phase at, or toward the end of, the training
This method provides several screening points at which candidates who perform poorly can be eased out of the program, and the best candidates selected to volunteer.
So far we have assumed that all candidates are equally skilled and require an equal amount of training. It might not be desirable or valuable for all candidates to be bought through the same pathway. Some exceptions might be:
- Services may choose to fast-track some candidates who have previous experience such as former health professionals.
- Some candidates might be in roles without direct contact such as fundraising, storage or administration.
- Candidates might be experienced former volunteers within the same service or a very similar one and are well known to the volunteer program, thus justifying their fast-tracking into a volunteer role.
There may be other examples. Managers should check their policy framework to ensure that fast-tracking is a possible option for them. A competency-based approach to training helps the manager collect information to justify their decision to by-pass the usual training obligations.
Successful completion of all elements (including the ‘buddy-shift’ or mentoring phase) usually confirms the candidate as being accepted as a volunteer. The formality of a ‘graduation’ celebration, witnessed if possible by members of the clinical team, should form an important rite of passage in confirming to the volunteers the gravity of their role and function within the palliative care team.
Supporting and managing volunteers
The training period represents only the beginning of learning for the volunteer. In time they will experience situations not addressed or absorbed in their initial training and they may: experience complex illness conditions; be confronted by challenging family dynamics; lose their way with their boundaries; find themselves out of their depth spiritually; be emotionally invested beyond their resources; or experience the fatigue that sometimes comes with compassionate work.
The manager is the first point of contact for the volunteer to provide support, direction, correction and empathy.
Most managers say that a significant part of their role is helping their volunteers understand and maintain their ‘boundaries’. ‘Boundaries’ refers to the acceptable range within which a volunteer may act. ‘Maintaining their boundaries’ refers to volunteers making appropriate decisions about how to act – such as knowing what to do if offered a gift, whether or not to share a phone number or what tasks are beyond their scope of practice.
Clinicians often find it challenging to measure their own performance. How well did I do that? Did I do well? It takes time for a clinician to gauge the adequacy of their empathy, compassion, listening and communication but over time they will become more adept at applying boundaries, seeking assistance, taking instruction and acting autonomously. The same is true for volunteers. As manager part of your role will be to guide the volunteers in understanding how well they are performing their roles. This might include:
- Responding to ad-hoc requests for support from the volunteer, or perhaps from a clinician who is working with the volunteer/s.
- Meetings and discussions with the volunteer, encouraging disclosure and providing a mentoring style support. This may be conducted by the manager or delegated to an experienced volunteer. Discussion may be initiated by asking the volunteer to bring with them responses to prompting questions on performance and communication.
- Seeking and collecting feedback from others who have been involved with the volunteer such as clinicians and clients.
- Meetings and discussions with volunteers in a group setting, usually on a monthly basis and sometimes in conjunction with an information or training session.
Most volunteers will do the right thing if they know what that is. So setting-out expectations clearly in a handbook or policy manual is essential for managing the performance of volunteers.
Typically managers of volunteers will offer opportunities to volunteers to learn, network and debrief through monthly volunteer meetings. The aim is to find topics of relevance and interest which will engage the volunteers and support their learning needs. Ongoing development might also be mandatory within the health service for the purposes of achieving quality accreditation.
Not all volunteer services manage to achieve a consistent professional development program. Some of the factors affecting consistency include:
- Whether or not the volunteers are community visiting. Some services report that arranging community visiting volunteers to attend events can be problematic partly because they are located away from the centre.
- The capacity of the service to offer a variety of interesting and topical subjects to volunteers. This is a particular issue for rural and regional volunteer services.
Regular meetings involving catering and learning opportunities are also a valuable form of recognition for volunteers.
Valuing and recognising volunteers
Volunteers or not, everyone in the team wants to feel that they have value and are valued. Many services have developed ways to recognise the contribution of volunteers in the form of activities and events. Some of these activities are timed to coincide with events during the year such as:
- National Volunteer Week (May)
- National Palliative Care Week (May)
- National Student Volunteer Week (August)
- World Hospice and Palliative Care Day (October)
- NSW Health Awards (November)
- International Volunteer Day (December)
- NSW Volunteering Awards (culminating in December)
These specific events and activities are valuable and obvious ways to invest-in and encourage the volunteer group. There are also other more subtle contributors which are powerful predictors of how valued volunteers might feel within the service, some of which are outlined below (whilst these points are highlighted here they are not exclusive – in many ways the theme of this book is about valuing and recognising volunteers).
Some other ways to value volunteers includes:
- Valuing volunteers by acknowledging their learnings and ambitions. A volunteer who wants to learn and contribute will want the service to value what they have learnt. Where learning is not mutually valued then it might result in dissatisfaction and frustration for the volunteer.
- Valuing volunteers by including them in the team. Part of the role of the manager is to be actively involved in checking-in with volunteers to see how they are coping, but also in nurturing relationships with clinical staff so that volunteers are naturally accepted as a valuable part of the team.
- Valuing volunteers by involving them in decision making and service development. As appropriate, asking volunteers their views on the performance of the service, engaging experienced volunteers in reviewing the training program and material, and using volunteers to assist with interviewing new volunteer applicants are all valuable ways to recognise the value of your volunteers.
Recognising the contribution of the volunteer not only validates their effort but tacitly affirms to the volunteer group how the service values them.
A change in personal circumstances (health, moving location, caring for a loved one, study, work) is the main reason for volunteers leaving their role. Our 2014 research (A Snapshot of Palliative Care Volunteering in NSW 2014) found that on average some 22% of volunteers would be inactive at any given time about 10% of palliative care volunteers would leave a service during the year.
For performance or other reasons some volunteers may have to be dismissed, and this may be the end result of the manager following the organisation’s performance management approach. Different legal obligations apply to volunteers than to paid staff and the manager should make themselves familiar with these.
You should also check your organisation’s policies and procedures for specific instructions about farewelling or terminating volunteers.
Palliative Care NSW publishes Palliare: A Handbook for Palliative Care Volunteers in NSW (2018) as a learning resource for volunteers. Palliare can be downloaded for free [pdf] or copies ordered from us.