New course boosts care and district nurses’ morale

A leadership training programme devised and delivered by a team in Surrey is improving patient care and boosting the morale of district nurses

A leadership training programme devised and delivered by a team in Surrey is improving patient care and boosting the morale of district nurses.

The District Nurse Development Programme at Virgin Care’s Surrey adult community nursing service has enabled participants to develop leadership skills and empowered them to champion quality, compassionate, patient-centred services.

RCNi Nurse Awards 2016 Leadership Award winners Ruth McCarthy, Kim Geraghty and Tracy Harman. 
Picture credit: Nathan Clarke

Virgin Care launched a community nursing innovation programme to improve its services after clinical lead for professional development Tracy Harman and her team decided they had to address the considerable challenges facing them. These included internal changes such as the drive to implement new mobile clinical management technology to the pressures of the constantly evolving role for district nurses.


‘Our vision was to create a 21st-century community nursing service that serves its patients by providing the best possible care, and is highly respected by patients, carers and professional partners,’ says Tracy. ‘But we had to give our nurses the skills and knowledge to do the job.’

The programme was devised by Tracy, a district nurse and practice teacher, and supported by Ruth McCarthy and Kim Geraghty. The team was last month named winner of the Leadership category at the RCNi Nurse Awards, one of nursing’s top accolades.

Leadership training was seen as especially important for district nurses as the isolation and daily workload mean there is much less opportunity for reflection and peer support.


‘There are so many barriers to supervision in the community,’ Tracy says. ‘District nurses are spread out and work autonomously. There is a huge amount of complex care but our nurses have to grow and develop on their own. Nurturing and developing nurses is where my heart lies. I’ve been there, I know how it feels,’ she adds, having been a community staff nurse for ten years before becoming a district nurse 14 years ago.

‘There was a gap between theory and practice, and I wanted to give our nurses the skills to bridge it.

‘Even though they were doing a fantastic job out there, morale had gone and I wanted to help them do it better.’

Repeat themes

A brainstorming session with Kim established repeat themes around professional development that later became module headings: visions, values, roles and responsibilities, leadership behaviours and managing people, driving improvement and handling challenges. These were linked into the NMC Code.

The team used existing resources; the four clinical leads were module leads and internal experts were drafted in for specific subjects. The four modules were delivered to four cohorts in four months at a cost of £100 per head.

All practice teachers, district nurses and senior community nurses at Band 6 or 7 took part and received a certificate for revalidation at the end.


Modules were evaluated and feedback used to improve them for the next cohort. In an online questionnaire, nurses rated their competence and confidence. The percentage of participants’ who scored themselves four out of five on a range of learning objectives were compared before and after the course.

These scores improved from 11% to 89% in handling complaints, from 25% to 91% in handling challenging behaviours, from 18% to 92% in awareness of key human resources policies, and from 34% to 98% in awareness of vision and objectives for the district nursing service.

‘We put 56 district nurses through the programme and it made a huge difference,’ Tracy says. ‘Everyone said they felt more confident managing their teams afterwards.’

Driven and enthusiastic

The reason for its success? ‘I was driven and enthusiastic as I had had the idea for a long time,’ says Kim. ‘The practice teachers on the front line could see it was needed and were part of the programme’s development. And I had high-level buy-in, which was paramount.’

Budget was made available so bank nurses covered shifts to enable others to take part.

‘I am so proud of what we achieved with the development programme, of our practice teachers for the work they did in designing the content of the sessions and the energy and commitment the whole team gave. The feedback told us not just how enjoyable the district nurses found the sessions, but also how their learning has contributed to the delivery of a high quality, responsive service.’


District nurse team leader and practice teacher Bethan Garner found it helped her as a manager and in supporting new district nurses through their qualification. ‘I covered leadership in my district nurse training and in my practice teacher course, but this was a while ago,’ she says.

She found all the modules relevant and thought-provoking but thought the leadership behaviours and managing people modules especially useful. ‘It helped me identify colleagues’ personal styles and approaches, and how best to work with each other. It’s easy to forget that everyone approaches work differently and this is not something I had covered before.’

The course feedback from district nurses revealed that their learning has contributed to the delivery of a high quality, responsive service

Role models

Ms Garner says senior nurses are now even more aware they are role models who set the standard: ‘By having the opportunity to take time out of our daily practice to work with and reflect with colleagues, we can now lead our teams more effectively.

‘The part of the programme looking at customer service training has directly improved how we interact with patients.’

The RCNi Nurse Awards judges thought the development programme had national and international potential and praised the team’s energy and commitment.

Virgin Care chief nurse Matthew Hodson, a former RCNi Nurse of the Year, agrees: ‘Tracy has demonstrated exceptional skills and having identified a problem, found a solution. Her team has empowered nurses to champion high quality, patient-centred services and the feedback from the nurses who took part speaks for itself.’

Easily adapted

Tracy hopes others will use the programme, too. ‘It’s easily adapted,’ she explains. ‘We’ve talked to community rehab teams, rapid response teams, children’s services and teams in community hospitals – anyone who will listen. I hope it becomes a rolling programme.’

Course participants helped create a book of service standards called The Boss and the team has also developed the Passport to Practice six-month preceptorship.

Going mobile

District nurses have embraced the new technology, Tracy says. ‘Now district nurses spend more than half their time with patients. Before going mobile they spent a quarter of their time with them.’

Ms Garner thinks every district nurse should have access to the programme: ‘If the team around you is happy, and if you are happy leading your team, you will deliver a better service. This training improved our leadership skills and the building of strong relationships with our teams.’

Tracy adds: ‘District nurses are a hidden workforce, out there doing it day in day out, from a block catheter to end of life. But we are rubbish at shouting about how good we are. The leadership programme has boosted our district nurses’ confidence. And you can feel the difference.’

The other leadership awards finalists

Victoria Thorne, Pennine Acute Hospitals NHS Trust

Victoria drove forward a new holistic service giving better access for cancer patients to palliative care. The North Manchester Macmillan Palliative Care Support Service co-ordinates care with district nurses to improve communication and share knowledge for patients in their last year of life.

Ann Simms, West London Mental Health NHS Trust

Ann devised a nurse development pathway to try to address difficulties in recruiting clinical nurse specialists to child and adolescent mental health services. It offers Band 5 and 6 mental health nurses interested in working with children and young people a tailored development package. Nurses hold a caseload in size and complexity appropriate to their experience.

Delirium Care Group, St George’s University Hospitals NHS Foundation Trust

A two-week audit showed that 26% of patients on the cardiothoracic intensive care unit had delirium, but 66% were undiagnosed. Team leader Siby Sikhomi researched the evidence then embedded a new validated screening tool called confusion assessment method for ICU (CAM-ICU) into daily practice to improve patient care. The Delirium Care Group then delivered training.

Gloria Rowland, West Hertfordshire Hospitals NHS Trust

Gloria transformed the maternity department at James Paget University Hospital in Norfolk in her previous role. Staff morale was low and sickness rates high, while the service for mothers and babies needed improvement. Gloria improved safety, ensured service user feedback was collected and developed effective arrangements for vulnerable women. The service is now rated ‘good’.

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