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Community concerns

District nurses want to spend less time on paperwork

District nurses face huge challenges in delivering increasingly complex care as demands on them continue to rise.

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A Queen’s Nursing Institute survey of 1,035 community nurses reflects profound change in the NHS over the past five years. Almost 60% of respondents believed their teams had insufficient staff to meet growing patient need – and more than 70% said morale was low.

‘The service requires nurses with increasingly specialist skills leading a team that delivers care for people of all ages, often with needs and levels of acuity that have previously been seen only in hospitals,’ says QNI chief executive Crystal Oldman. ‘District nurses are responding with increasing professionalism in the face of multiple workplace challenges.’

The RCN says the number of qualified district nursing staff in England has almost halved over the past decade. NHS statistics show there were 5,586 district nurses in July 2014, compared to 7,851 in July 2009.

Of those surveyed for the QNI’s 2014 report on the future of district nursing, 20/20 Vision – Five Years On, 24% had worked in the community for between five and ten years, 33% for more than ten years and 24% for more than 20 years. Around 32% were based in a GP practice, with others being based in clinic, hospital or other environments.

Many respondents talked about the added burden of administration and said they would like to see better discharge planning; 83% said the situation was not satisfactory.

While 69% were positive about their working relationships with GP practices, 46% indicated difficulties in working with social services, although Dr Oldman says the QNI is already seeing ‘pockets of really good practice’.

District nurse team leader Gail Goddard has seen huge changes since she started working in the community in 1990.

Her district nursing team at Hounslow and Richmond Community Healthcare NHS Trust now provides increasingly complex care, with duties including disconnecting chemotherapy, taking blood and administering intravenous antibiotics.

‘We need all the skills of a specialist nurse in a hospital and then some more besides,’ says Ms Goddard. ‘But I love my job because it allows me to get to know people as individuals.’

As well as holding a specialist practitioner qualification in district nursing, Ms Goddard became a Queen’s Nurse in 2013.

She is now part of the NHS train the trainers scheme for dementia care, and has a specialist interest in palliative care. As a specialist community practice teacher, she trains future district nurses studying for degrees and sees them become as enthusiastic as she is.

A long-awaited dementia centre will be ‘a brilliant resource’, believes Ms Goddard, whose team also hopes to establish a treatment room and further develop resources, including a well leg clinic.

‘The message coming back from the district nurses is that they absolutely love their job, but there are not enough district nurses to go round,’ she adds.

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