‘I love my job’: Why we need to rethink wellbeing support for healthcare assistants in palliative care

There is something that does not sit easily together - a workforce that overwhelmingly loves its job and at the same time feels invisible, undervalued and under-supported. Over the past five years, I have researched the wellbeing and support needs of healthcare assistants caring for people with advanced illness at home. What they have told me challenges a lot of our assumptions about burnout, compassion fatigue and what good support actually looks like.

What keeps them in the job

The strongest finding in my recent study was unambiguous: healthcare assistants love their jobs (1). They described a strong motivation to help others and found the work deeply rewarding. As one put it, 'I love my job. Absolutely love my job. I love supporting families, helping them' (1). In our survey, 80% reported average to high mental wellbeing - higher than the figures reported for other healthcare professionals and the general UK population - and those with higher wellbeing were significantly less likely to intend to leave(2).

What is behind this? The relationships. The mostly overnight, one-to-one model of care may itself be protective, allowing deeper relationships and fewer of the stressors when rushing between patients. Knowing that someone had 'a good death', and hearing from families that they had made a difference, is what keeps them going. But that meaning comes at a cost, and the system has learned to lean on it.

Doing essential job, feeling invisible

This is where it gets more complicated. That satisfaction coexists with systemic undervaluation. Healthcare assistants told me they were dismissed as 'sitters'. Their pay does not reflect the complexity of the work, the emotional labour, or the cost of living, and some found their clinical observations ignored. They provide most of the direct care to people with advanced illness, yet remain largely invisible.

So I keep coming back to one question. Are we relying on their dedication to compensate for structural gaps in pay, recognition and support?

As one survey participant said, 'We all put in so many extra hours without pay and you will never hear anyone complain about that' (1). That commitment is remarkable. It should not be taken for granted.

Support that could really work

A clear pattern emerged in what support was used. The generic self-directed resources available at the time, such as anonymous helplines, wellbeing apps, and online hubs, were rarely taken up, with only 17% of respondents accessing any of them (2). The support people did reach for was relational: line manager support was by far the most widely accessed, at 87%, and clinical supervision groups were both well used and valued (2). Support is used, it seems, when it is human, fits the realities of the work.

But uptake is only half the story. What mattered most was the quality of those relationships, not access. And across all the studies, the same message came through - the support people value most comes from those with shared the experience.

And then there is peer support. In my first study, newly employed healthcare assistants built their own informal systems - texting whoever was on the same night shift, checking the rota to see who else was working - because they needed someone who understood the challenges they face. One described how, on her first solo shifts, just knowing another colleague was 'a phone call away or a text message away' made all the difference(3). As another put it, 'With your colleagues, you can have a cup of coffee, you can laugh, you can joke, you can cry' (1).

My realist review asked what it is about peer support that produces an effect, and under what conditions(4). It pointed to three approaches - facilitated group meetings, 24/7 peer access, and informal mentorship - that create psychologically safe spaces between people with shared experience, where they feel validated, valued and learn from each other. The result is better wellbeing and stronger team relationships, which may in turn support better quality of care. This relational quality is peer support's particular strength. Other forms of support matter for other things, and the real gain comes when they work together.

Conclusion

Healthcare assistants find real meaning, purpose and satisfaction in caring for people with advanced illness and their families. That dedication is precisely what makes the gaps in pay, recognition and support so easy to ignore - and so important to close. We need to build support that responds to that, rooted in human connection. That is the focus of my doctoral research: co-designing a workplace peer support intervention with the workforce and their managers, grounded in the evidence and in the realities of care in people’s homes. Because a workforce this committed deserves a system that meets it halfway.

References

1. Patynowska KA, McConnell T, Finucane A, Maun E, Fantoni ER, Clemo J, et al. ‘You’re a human being and not a robot that goes out to work’: A qualitative study exploring factors impacting on wellbeing and intention to leave among lone working healthcare assistants providing palliative and end-of-life care in the community.

2. Patynowska KA, Maun E, Fantoni ER, McConnell T, Finucane A, Clemo J, et al. Workplace support, wellbeing and intention to leave among lone working healthcare assistants providing palliative and end-of-life care in the community: A mixed methods study. Palliat Med. 2025 Dec 6;02692163251395576. doi:10.1177/02692163251395576

3. Patynowska KA, McConnell T, McAtamney C, Hasson F. ‘That just doesn’t feel right at times’ – lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study. Palliat Med. 2023 Sep;37(8):1183–92. doi:10.1177/02692163231175990

4. Patynowska, K, Hasson, F, McConnell, T, McIlfatrick, S. Understanding workplace peer support among healthcare assistants providing palliative and end-of-life care at home: a realist review. [Accepted for publication].

Published: Jun 05, 2026