District nursing: how to launch and maintain a successful night service

A community night nursing service is helping ease pandemic pressures on a local healthcare system

Our new community night nursing service is playing a vital role in supporting acute care colleagues through COVID-19.

These fantastic night nurses are helping more people stay out of hospital, facilitating early discharges and supporting patients to remain at home, at a time of unprecedented strain on the healthcare system.

With nearly 40 years’ experience as a nurse, I’m clinical lead for a new night nursing service that started last September as part of a community service contract between Frimley Health NHS Foundation Trust and Virgin Care, my employer.

COVID-19 caseload has been overwhelming at times

Launching a new service in the pandemic hasn’t been easy – recruiting staff has been challenging, for example, but it’s also making a difference to patient care.

Between 8pm and 8am our band 6 nurse team is responsible for patients across north east Hampshire and parts of Surrey. Much of our workload is supporting palliative patients and providing end of life care at home, in care homes and at our local hospice.

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There has been an increase in the number of people we are supporting who have all types of conditions, including COVID-19. I estimate we are seeing about one third more patients above what we would normally see who are older, often with frailty, living with cancer and in need of palliative care, also with a range of co-morbidities.

We have also been supporting a number of COVID-19 positive patients who are at the end of life. It has been overwhelming at times, because every day there are people on the caseload who are at the end of life and on syringe drivers, which is draining for all community staff on day and night teams.

What makes a successful night nursing service

• If it is a joint arrangement between two organisations, ensure information sharing agreements are in place from the start
• Recruit band 6 nursing staff with palliative care experience to the team
• Appoint a team leader
• For the first month, have a clinical lead available for on-call support at any time during the night
• Make sure there is time and opportunity for clinical supervision
• Make sure the clinical lead touches base in the morning with the staff who have worked overnight, to sort out issues that may have arisen
• Use video conferencing for meetings and to share information with staff

The community nursing teams are also exhausted as the workload has been relentless over the past year. The resilience of the nurses continually amazes me.

We provide palliative support, intravenous antibiotics and admission avoidance support, as well as taking on referrals from our local out-of-hours GP service. If a patient is discharged from hospital late in the day we can make sure they are safe and comfortable.

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We also troubleshoot, dealing with issues such as catheter problems and other clinical needs, which means people can avoid having to go to an emergency department during the night. Equally, if the day staff have particular concerns about a patient, we are able to monitor their condition overnight. All patients are given a direct number to call us if help is needed.

Support for people in their choice of care

The great benefit for patients is that they now have continuity of care. Having this 24-hour community service means the most clinically unwell patients are supported at night, a time when people often feel at their most vulnerable.

This helps to reduce hospital admissions and supports people in their choice of care, so those patients who want to stay in their own home are able to do so. It is particularly important for our end of life care patients and their families, who want to be in familiar surroundings with their loved ones.

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The team is doing fantastically well, with colleagues from both organisations joining forces to develop the service. Information-sharing agreements offer the team access to patients’ full clinical records, which informs nurses’ clinical decision-making and overcomes geographical boundaries.

‘Recruiting nurses during the pandemic was difficult as we found there were few people applying and those who did felt guilty about leaving their organisations in the middle of a pandemic’

There have been challenges. The area we cover is physically large, and in a small team the impact of a sudden increase in referrals makes a big difference. Visits are mostly unplanned, so we have become flexible and adaptable, with the team supporting each other.

We have a motivated team working shifts that give them the work-life balance they sought

Recruiting nurses during the pandemic was difficult as we found there were few people applying and those who did felt guilty about leaving their organisations in the middle of a pandemic. However, we deliberately sought and employed people who wanted to work nights.

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This approach paid huge dividends, as now we have a motivated team working shifts that give them the particular work-life balance they want. As we continue to fight the COVID-19 pandemic, it is often acute healthcare services that make the news for their commitment and dedication to care.

But nurses in community settings are working away quietly in the background, providing an incredible but too often invisible service, one that makes such a difference to patient outcomes. This is why I am passionate about community nursing and initiatives such as our night nursing service.

Mandy Gundry is a clinical lead for community and specialist nursing at Virgin Care, @VirginCare