QNI sets out future standards for community children's nurses

In an effort to address some of the issues in community care, the Queen's Nursing Institute has published new voluntary standards for children's nursing

Community children’s nurses (CCNs) should be the future of the NHS. After all, they provide care to some of the most vulnerable people, keeping them out of hospital and living as independently as possible.

It is a role that demands a wide variety of skills. CCNs need to be negotiators, coaches, teachers and, of course, nurses. They need to collaborate with others and coordinate care for children with acute illnesses, long-term conditions, disabilities and life-limiting illness.

But to date, the role of community children’s nurses has remained largely undefined and too often overlooked, says the Queen’s Nursing Institute (QNI).

This conclusion is based on research involving 350 UK-based CCNs. They were working for NHS hospital trusts and community services sometimes in mixed teams, including physiotherapists, occupational therapists, psychologists and health visitors.

Respondents described how they struggled to access training and saw posts decommissioned just as demand for those services was rising.

Patients being turned away

The number of children living in the UK with complex needs has risen by 50% since 2004 to 73,000 – and even that is likely to be an underestimate.

Despite these rising numbers, many patients are being turned away. Nearly half of the CCNs said they worked in teams that had to refuse referrals at certain points.

‘There are widespread concerns around the capacity of the CCN teams to meet growing demand’

Crystal Oldman

The nurses who responded to the study said, in most cases, it meant sending patients to hospital for treatment – the very place the community teams are trying to help their patients avoid going to.

Weekends were a particular pinch point despite many services providing seven-day cover.

To help address the situation, the QNI has published a set of standards defining what a CCN looks like. They cover four domains:

• Clinical care
• Leadership and management
• Facilitation of learning
• Evidence, research and development

The Nursing and Midwifery Council responded immediately by saying they will be taking them in as part of its review of post-registration standards, currently taking place.

'Great potential'

But QNI chief executive Crystal Oldman says she also wants the standards to be used by nurses, patients, commissioners and policymakers to develop the specialty.

She says the system is missing a trick by ignoring ‘the great potential of CCNs’.

‘CCNs have a growing importance for the NHS. They are able to reduce the reliance on hospital services, which may be less appropriate and may put a larger physical and emotional burden on children and their families.

‘But there are widespread concerns around the capacity of the CCN teams to meet growing demand.’

Such concerns are shared by Royal College of Nursing professional lead for children’s and young people’s nursing Fiona Smith.

Ms Smith says the sector ‘urgently needs investment to cope with rising demand’. In particular, she points to the lack of professional development.

The survey revealed one third of CCNs had indicated using annual leave to take part in training, while more than one quarter worked in teams where no-one had a specialist qualification.

Ms Smith says: ‘With a large section of the workforce expected to retire in the near future, the opportunities for children’s nurses to acquire additional knowledge and skills for roles in the community, and to tackle staff shortages must be boosted.’

But it is not just a matter of time. There also appears to be a shortage of courses, the QNI research suggests.

Limited access to specialist qualification

The CCN specialist practice qualification is an NMC recordable qualification, but there are only nine higher education institutions across the UK offering it – and none at all in Scotland.

Nurses across the board expressed concern about this, pointing out caseloads were increasing in number and complexity, and more skills would be needed to cope. Some nurses reported working for years in senior positions before being given training, while others were having to rely on generic in-house courses on leadership and management.

This means charities are having to step in and fill the gap, the QNI says. Both WellChild and the Roald Dahl Marvellous Children’s Charity fund nurses to provide care to sick children.

Sophie Dziwinski, head of programmes at Roald Dahl Marvellous Children’s Charity, which has 70 nurses in its network, says: ‘These are such complex roles – training and development are essential.

‘You cannot expect nurses to develop the specialist skills they need without helping with their development'

Sophie Dziwinski, Roald Dahl Marvellous Children’s Charity

‘We prime these posts for two years, before the NHS takes them on. We invest in training. We let them go to conferences. I do wonder what would happen if we weren’t doing this?

‘You cannot expect nurses to develop the specialist skills they need without helping with their development. We need the NHS to provide more investment if we are to give sick children the care they deserve.’

The QNI standards for community children's nurses

Clinical care

• Demonstrate a broad range of expertise that supports person-centred care.
• Able to assess complex, continuing and palliative care needs, or those presenting with acute illness, so that appropriate referral can be made.
• Co-produce care plans with families and promote self-care.
• Promote mental health and well-being.
• Undertake the case management of complex needs where appropriate.
• Demonstrate advanced communication skills that engage and involve.
• Prescribe a range of interventions within scope of competence.

Leadership and management

• Lead, support, clinically supervise, manage and appraise a mixed skills team to provide nursing interventions.
• Ensure safe and effective distribution of workload.
• Lead, manage, monitor and analyse clinical caseloads.
• Manage and coordinate programmes of care.

Facilitation of learning

• Promote and model effective team working.
• Create a positive teaching/learning environment.
• Develop strategies to teach, assess and support unregulated staff.
• Manage change to meet the evolving shape of services.
• Lead and foster a culture of openness and recognition of duty of candour.

Evidence, research and development

• Ensure care is based on all available evidence, published research and best practice.
• Identify trends in the characteristics of and demands on the community children’s nursing service.
• Produce plans that identify key risks and future management strategies.
• Enable local projects to be planned, implemented and evaluated.