IT survey reveals mismatch between what community nurses want and what they have

With one in three community nurses still using paper-based systems, more needs to be done to develop effective systems for the sector 

Queen's Nursing Institute chief executive Crystal Oldman urges senior nurses to embrace opportunities to inform the systems used in community services

Picture: Alamy

A survey on the use of information technology in community nursing services by the Queen’s Nursing Institute (QNI) reveals that involving nursing managers helps care providers to deliver more effective systems and to engage and support staff in their use.

A survey of more than 500 community nurses found that 74% thought IT systems are a more reliable way of working than using paper records and 84% thought that mobile technology always or sometimes saves them time and increases productivity.

Fragmented and inconsistent

But almost 29% of respondents – almost one in three – still work with mainly paper-based systems.

The survey also shows that there are at least 67 differently named IT systems currently being used in community healthcare.

This fragmented approach comes despite the plans set out in NHS England’s Five Year Forward View to embrace technology and ‘exploit the information revolution’, and health and social care secretary Jeremy Hunt’s call for the NHS to be paperless by 2020.

Embracing opportunities

QNI chief executive Crystal Oldman urges senior nurses to embrace opportunities to inform the systems that are used in community services.

1 in 3

community nurses still work with paper-based systems

Source: Queen’s Nursing Institute

‘There are some examples of good practice in terms of nursing management, where the managers can see where the members of the team are, where the pinch points and particular pressures are and where there is capacity within teams,’ she says.

‘But nurses said to us in the survey that they are seeing systems that aren’t user-friendly and the answer is that we need to be there right from the beginning when the systems are being built.’

Outdated and poorly designed

The report, Nursing in the Digital Age, points out several barriers that are causing community nurses to struggle with access to good IT systems. 

Outdated or poorly designed software and equipment, including computers that are heavy, have cumbersome security systems or short battery lives, all hinder nurses’ work.

Systems are generally not designed for community nursing and are poorly adapted from other sectors, nurses said.

Community nurses' attempts to use IT equipment in patients’ homes are plagued by poor connectivity, especially in rural areas. 85% of respondents reported this as a challenge that leads nurses to spend time transferring paper records onto systems back at base.

Financial difficulties are preventing the purchase of the right products, and there are issues with the availability of support so that IT problems can take hours to resolve. 

21% of respondents said that lack of training prevented community teams getting the most from the IT systems available.

Communication difficulties

Frustration at the use of different systems that could not communicate with other settings or services was clear from community nurses. While 80% reported access to GP records and 57% access to digital hospital discharge letters and summaries, only 11% could access social care records.


of community nurses think IT systems are a more reliable way of working than using paper-based systems

Source: Queen’s Nursing Institute

In cases where information was being shared among healthcare professionals, this access was cited as being ‘invaluable’ to services and patients, enabling the provision of up-to-date information about patients’ conditions and allowing clinical decisions to be made quickly and often remotely.

Respondents also described other ways in which IT supports service delivery, including electronic prescribing, the use of diagnostic tools, data collection, updating patient records and referring patients to specialist services. Other ways technology was used include monitoring wounds through photography, instant messaging and virtual consultations.

Senior nurses' role

Respondents explained how important it is that senior nurses are involved with IT projects from conception. Nurses said this leads to systems that are better aligned to how they work, and enables the senior nurse to provide support and training for their staff.

‘Nurses need to have an inspirational lead on this so that they see the potential for systems and understand that their input would advance systems more effectively,’ one nurse said.

A senior nurse told the survey investigators: ‘Having someone from the front line of district nursing, such as myself, has aided the transformation when moving the service to paperless working because of my understanding about what works and what doesn’t, along with the nurses' roles and the pressures they are under.’

The QNI has called for nurses to be involved with the development of all healthcare IT systems. One recommendation is that organisations appoint a chief nursing information officer to lead the implementation of IT and work with IT support and system developers to ensure that clinical needs are reflected.

Every nurse an e-nurse

Positive change is under way when it comes to boosting clinical involvement in IT improvement. Last year, the NHS Digital Academy was launched to train and support chief information officers, senior clinicians and aspiring digital leaders to drive the NHS’s digital transformation. And last August, NHS Digital launched e-nursing week, which advocates for a digital workforce and supports the RCN’s drive for every nurse to be an e-nurse.

'Nurse leaders can bridge the gap between IT professionals and clinical staff'

There has also been heavy investment since 2016 through NHS England’s global digital exemplar programme, which supports trusts already leading the way in technological advances. So far, however, this has focused on acute, mental health and ambulance trusts.


of nurses say rota and workforce planning is undertaken manually

Source: Queen’s Nursing Institute

The RCN agrees that, while IT systems are vital to the future of the NHS, too many of the current approaches are unfit for purpose.

A report due to be published by the college at RCN congress in May shares many of the findings of the QNI report and a similar gap between the hopes and lived experience of nurses and midwives using IT systems.

RCN knowledge and resources manager and e-health lead Ross Scrivener says: ‘There needs to be greater involvement with nursing both in the design and implementation of systems. 

‘Nursing input should reduce the risk of poor choices being made. Nurse leaders can bridge the gap between IT professionals and clinical staff. These boundary spanning roles are key enablers.

‘These roles exist but nurse leaders and managers need to be encouraged and supported by their organisations to take them on.’


Only 33% of respondents reported that workforce planning tools, such as e-rostering, were used in their teams. In most cases, nurses reported that workforce planning was undertaken by staff manually.

The number of district nurses fell from 7,716 in 2010 to 4,400 in 2016. The major shortage of staff in community services is preventing e-rostering being used to its full potential, according to the QNI report.

‘Rostering is chaotic, mostly because we are haemorrhaging staff and have to staff early and late shifts, triage new referrals and staff the leg ulcer clinic. The rotas for those can be sensibly planned but need rearranging weekly due to changes in staffing. We just get our heads down and get through the visits as best we can,’ one nurse said.

Where e-rostering was used, team leaders usually retained primary responsibility for its management, the report states.


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Erin Dean is a freelance health journalist


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