Analysis

During the pandemic care home nurses have proven there is more than one front line

In a changed world, care home nurses have shown that they have the skills to care for people with multiple and complex needs

In a changed world, care home nurses have shown that they have the skills to care for people with multiple and complex needs

  • One of the challenges of COVID-19 has been to tackle peoples misconceptions about the care home sector and its role
  • The pandemic has given a platform to social care nursing, enabling it to show it is a specialism in its own right
  • Potential new era for care home nursing must not be stifled in future by those who want to revert to type

Anita Astle would be the first to admit

In a changed world, care home nurses have shown that they have the skills to care for people with multiple and complex needs

  • One of the challenges of COVID-19 has been to tackle people’s misconceptions about the care home sector and its role
  • The pandemic has given a platform to social care nursing, enabling it to show it is a specialism in its own right
  • Potential new era for care home nursing must not be stifled in future by those who want to revert to type
A nurse sits with a resident of Wren Hall nursing home in an area for those diagnosed with coronavirus Picture: Shutterstock

Anita Astle would be the first to admit it’s been a tough year. As nurse manager and managing director of Nottinghamshire nursing home Wren Hall, losing residents – she calls them ‘family members’ – to COVID-19 has been devastating.

There have been other challenges too, not least having to tackle people’s misconceptions about her sector and its role in people’s care.

She says: ‘At the beginning of the pandemic it was frustrating to hear constantly about “protect our NHS” and seeing everyone clapping “for the NHS”.

Anita Astle

COVID-19 has shone new light on the work of social care nurses

‘Just about everything was focused on what was happening in hospitals. As a provider, but also as a nurse working in social care, it was horrific trying to get personal protective equipment (PPE), for example, and being told by our usual suppliers that they had been told to divert supplies to the NHS. We were caring for people too, but that just wasn’t recognised.

‘As a last resort we went to the media, and as a result of that, care homes are being seen in a different light – people have seen what we do.’

COVID-19 has shone new light on social care and on the work of social care nurses.

As the year draws to a close, however, questions are being asked about how this momentum can be maintained – and what lessons from 2020 can be put to lasting positive use.

Deborah Sturdy Picture: Charles Milligan

Social care nursing is a specialism in its own right

These topics were discussed by Ms Astle and others at the Queen’s Nursing Institute (QNI) annual conference in October. A panel discussion on what has been learned in care home nursing during the pandemic found that while the year had been difficult, COVID has given a platform to social care nursing, demonstrating to other nurses, governments and the public that it is a nursing specialism in its own right.

Panel member Deborah Sturdy – who in early December was appointed the first-ever chief nurse for the adult social care sector – told the virtual audience that care home nursing offered ‘the whole package’ and that it required skills and expertise, including leadership, to care for people with multiple and complex needs.

Ms Astle, speaking to Nursing Older People after the event, described her pride in how care home nurses and other staff had stepped up during the pandemic, and her worry that this new momentum might not be maintained.

‘I have huge respect for absolutely everything that care home nurses have done,’ she says.

‘Turning up for work, giving their all, communicating with families in the most difficult circumstances– going above and beyond to keep people informed. And it’s not just the registered nurses, it’s all staff in social care. I’m so proud of all our team. They’ve worked through challenges, they’ve given their best.’

Staff stepped up and expanded their scope of practice to meet the extraordinary circumstances, Ms Astle adds.

Nurse watching CPR training on a computer monitor Picture: iStock

They showed willingness to be trained to do things they had never done before, such as verifying deaths, supporting people with subcutaneous fluids and oxygen therapy, and end of life medication.

Support for care homes’ new roles must be allowed to continue

Ms Astle had hoped this heralded a new era for care home nursing, and that the expansion of practice would continue beyond the pandemic, but now fears this might not be the case.

‘Social care and social care nursing can offer a lot better quality of life and an alternative to older people rather than having them yo-yo in and out of hospital’

Anita Astle, nurse manager

She worries that local authorities and clinical commissioning groups who had been supportive of care homes’ new roles might not wish them to continue once the peak of the first wave was over.

‘We stepped up, we innovated and care homes were praised for what we were able to achieve,’ she says.

‘But then we found that there were some who started to revert to type, and to want to tell us what to do. Any innovation or great practice is being stifled.

‘Times need to change. We need to say that actually, we have the knowledge and skills and experience, we can step up. We can offer a lot more – social care and social care nursing can offer a lot better quality of life and an alternative to older people rather than having them yo-yo in and out of hospital, and I hope that what we’ve learned through COVID can be showcased and we can put that in place.’

Change the perception of social care nursing as a career

Sharon Aldridge-Bent

QNI director of nursing programmes (leadership) Sharon Aldridge-Bent, who was also on the panel, believes that more needs to be done to consolidate the experience of social care nursing.

‘There’s a real opportunity because they are in the spotlight, but we need to change the narrative around the role,’ she says.

‘In the past the perception has been that nurses who work in care homes go there at the end of their careers or because they can’t get a job anywhere else. I can’t stress enough that it’s completely the opposite to that. We need to change the narrative, not just for the wider public and outside, but also for within the profession, so nursing in care homes is not seen as the poor relation.

‘Nurses in training should have the opportunity to go for placements – and it should be a good placement, where the right learning outcomes are achieved. But it’s also about education. It’s about putting care homes and adult social care on the map, which is about educational standards, and it’s also about research, because you need a good evidence base.’

There is also work to do around career progression in social care nursing, she says, and a need to maintain the momentum and promote care home nursing as a good career.

Standards for nurses new to care home nursing

The QNI is contributing to this – its care home network has 700 members, and has developed voluntary education and practice standards for nurses new to care home nursing, due to be published soon.

The RCN has developed an independent health and social care strategy and transformation plan to help it meet the needs of members working in settings including care homes, and has its Care Home Network.

Other developments include a new postgraduate diploma in person-centred advanced care home practice launched by Queen Margaret University in Edinburgh.

New course aims to advance professional practice in care homes

A course that aims to improve care and advance professional practice in care homes has been launched by Queen Margaret University in Edinburgh. The postgraduate diploma in person-centred practice: advancing care home practice is multidisciplinary and open to a range of experienced practitioners, including nurses and care home managers.

The aim is to help individuals advance their own practice and improve the experience of care home residents and staff.

Head of the university’s nursing division Brendan McCormack says it is much needed: ‘Education provision that is specific to the care home sector is an area of learning that has been sadly neglected. There’s a general lack of appreciation of the knowledge, skills and expertise of registered nurses in the care home sector – the dominant attitude prevails that “anyone can do it”.

Postgraduate course has two strands

‘Although there have been a number of studies, including my own, that demonstrate the complexity of care home nursing and the range of skills needed, including autonomous decision-making, there has been a failure to recognise this in nursing itself, and this seeps into the public’s view that care home nursing is unskilled work. We see this new course as part of the jigsaw in changing that perception.’

The course has two strands – one around person-centred, human rights-based care and decision-making, and the other around management and leadership.

Professor McCormack says: ‘We hope it will have an impact on the way that nurses in care homes are engaged in their own work, but also on how they lead other parts of the workforce in their day-to-day practice.’

The pandemic has helped to make the case for care home nursing as a vital part of the wider health and care service, says Ms Aldridge-Bent.

‘There were some amazing acts of compassion, such as people leaving their own families to go and live in care homes to keep residents safe’

Sharon Aldridge-Bent, QNI director of nursing programmes (leadership)

She moderates the QNI care home nursing network’s closed Facebook group, and has been enormously impressed by the experiences shared by members.

‘Nurses absolutely wanted to get things right for the residents,’ she says. ‘There were some amazing acts of compassion, such as people leaving their own families to go and live in care homes to keep residents safe. I was astounded.

‘There was lots around end of life care, keeping people in the home rather than sending them to hospital. I can’t stress enough that these are nurse-led units, with nurses leading the agenda with high levels of clinical decision-making, just getting on with it.

‘And not just clinical issues – there were examples of real acts of compassion and kindness, and thinking about their residents and how they could make the whole visiting thing work. That’s still going on today.’

Many care home nurses were aware they were reaching burnout

Losing residents to COVID-19 was the low point for care home nurses, she says. ‘It was particularly difficult for those who had a lot of deaths in their homes.

Picture: iStock

‘If you look after someone in hospital, the amount of time you have to get to know them is six to eight weeks maximum. And you might not necessarily have got to know them before they got ill – you just know them sick. But care home nurses have built up a long-term relationship with their residents. They are almost like members of the family.’

Care home nurses were also calling the QNI Talk to Us helpline, she says, knowing they were approaching burnout. ‘They’ve got COVID all day at work and COVID in the evenings when they come home because of fears for their own families. And having a huge sense of guilt and not wanting to give any time to themselves. Terrible to listen to.’

Nursing leadership and truly compassionate care

She hopes the role of care homes as places of nursing leadership and truly compassionate care will continue to be recognised beyond the pandemic.

‘During COVID-19, care home nurses have proven that there is more than one front line,’ she says.

‘If you listen to the media, everyone keeps talking about intensive care units (ITU) as if that’s the only place that COVID has been managed. Actually, for me, it’s more about the nurses who have kept people safe so that they haven’t ended up in ITU.’

Help and support for care home staff

  • Communication is key: if you bottle things up they may overwhelm you. Talk to colleagues, family or a trusted friend, bearing in mind confidentiality issues
  • Recognise how you are feeling and seek support, for example from the Queen’s Nursing Institute’s new listening service Talk to Us
  • Try meditation or other relaxation techniques, apps available such as Headspace can help support you to do this. Your employer might provide some of these, but don’t feel pressured to engage with apps – everyone is different
  • Ask your colleagues how they are feeling, and encourage people to do the same for you. When you talk about your feelings you rationalise them and get things in perspective. That’s why it’s good to talk

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