Nurses are experiencing extraordinary pressures throughout the country. We are working in a smaller number than we were in the earlier stages of the pandemic. This is threatening not only the safety and well-being of those being cared for, but also our own health and mental wellbeing.
People believe that district nursing is a better option than working in a hospital setting. This is probably due to the fact that district nursing teams are often referred to as an older workforce by the media. It leads to the assumption of district nurses becoming retired to take over nursing in their retirement years.
“We are responsible to oversee and coordinate care for people with complex needs on an everyday basis.”
As a new staff nurse, I felt strongly that I would be best able to build a solid foundation of knowledge in a variety of specialist areas by working in the community. We are skilled in complex diabetic care, chronic, acute wound care, palliative, and end-of life care, as well immunoglobulin therapy, Hickman line care, and other core skills.
Communication is the most important skill we can learn in the community. We are responsible to coordinate care for people with complex needs. We work with multiple health professionals to respect their wishes and advocate on behalf of our patients.
Innovative community teams have been formed over the years to prevent unnecessary hospital admissions. This is about helping people with long-term disabilities to remain independent and at home longer. It also includes teaching self-management and teaching.
These teams are often led by advanced nurses practitioners. The role of the district nurse team is to coordinate care for people by liaising when necessary with GPs and other healthcare providers to promote person-centred, collaborative care.
“District nursing can be a very exciting job, as no two days are ever the same.”
To reduce the burden on GPs, specialist services, there has been a great emphasis on further training district nursing teams. Community staff nurses are now able to confidently and competently assess patients for acute illnesses or deterioration. They can perform physical examinations, auscultating the chests, interpret symptoms and make differential diagnoses.
They can then use their clinical skills to escalate to appropriate people or services, advocating for the person and upholding their wishes. This may include staying at home and avoiding hospital admission. A high number of community nurses hold a non-medical prescribing certification, which allows them to prescribe the appropriate treatment without the need for GP input.
District nursing is an exciting job. There are never two days exactly the same. There are many opportunities for nurses to develop, whether they are new, returning to practice after a long time, or returning from a ward.
Queen’s Nursing Institute published in 2019 a report that showed nearly half the district nursing workforce were planning to retire or leave by 2025. It is a daunting prospect to see such a large turnover of staff in the next three years. However, there is a strong emphasis on shifting care from hospitals towards supporting people to stay in the community. But the shortage of GPs in the country is well known. Where is this support expected?
As care shifts to the community, district nurses teams will be expected to learn more skills to help people with complex and difficult needs. The shift in care to community settings is transforming the profession of district nursing into a highly skilled, innovative workforce. I believe it is time for them to be appreciated and valued for their ability adapting in such a challenging setting.
Jessica Gilmour is a specialist district nurse (SPDN), with NHS Lothian
