A striking nurse’s shift diary lays bare the reality of working in today’s NHS

Dear diary, that was one hectic shift

One day in December 2019

• 7.45am My shift should start at 9am but I receive a phone call from duty sister that colleague has phoned in sick, so my day starts now.
  Carry out home visits for three patients with diabetes who require assistance with insulin. Care staff are running late for one patient, so I make breakfast, help the patient to sit, and ensure they eat breakfast before leaving.

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• 10am Head to the office and check call allocations for the day, assist with re-allocation of calls, and contact staff with extra visits.
  Spend time at base triaging referrals from care staff and answering multiple calls from staff nurses and healthcare assistants. These calls are mostly about patient updates, access issues to patients’ homes and identification of patients requiring reassessment due to changes or deterioration of their needs.
  A colleague calls to say they are having difficulties with a key code for access to a patient’s home to take urgent bloods. We manage to resolve after multiple phone calls to the patient's GP and social care staff.

‘A patient with palliative care needs has deteriorated. I spend some time with the patient and carers, ensuring they have team’s contact details and adequate medication’

• 11.15am Out again on visits. Am contacted by a care agency about a patient who needs an urgent moving and handling assessment. The patient has had two falls in the past 12 hours; care staff report multiple previous falls and that the patient has some difficulties with standing at night.
  Following assessment, I contact the falls team for specialist support and advice and refer the patient to the district nursing evening service. The nurse on the evening team is going to reassess moving and handling to gain a complete picture of the patient's needs.

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• 12.30pm Second moving and handling referral, this time for a patient with a urinary tract infection who was previously unknown to the district nursing service. 
  Meet up with a colleague to undertake assessment; the patient requires an admission, but is very upset as they have a dog and live alone.
  Liaise with social care staff, care staff and her GP, and appropriate placement is found for her dog. The patient is admitted for acute care.
• 1.30pm A hospice nurse contacts me to advise the condition of a patient with palliative care needs has deteriorated and they need breakthrough sub-cutaneous medication.
  I spend some time with the patient and their carers, ensuring they have contact details for the team and adequate supplies of medication.

‘Over the past few years I frequently started my shift early and finished late’

• 3pm Arrive back at base and have a working lunch at my desk.
  I spend the rest of the afternoon reviewing call allocations, scheduling patient flu vaccine visits, receiving handover from Band 5 staff nurses for patients seen today, and activity recording.
  I return multiple calls from hospital staff to discuss new referrals, including a call for palliative care assessment and equipment provision for tomorrow.
• 5pm Leave base to visit patients requiring evening insulin.
• 6pm My working day finally finishes, 10 hours and 15 minutes after it began.

Reflections on the challenges, and why I love my job

Reflecting on today, I have always enjoyed the varied role of a district nurse as every day is different, however over the past few years I frequently started my shift early and finished late. Recruitment and retention of staff in community nursing has also become increasingly challenging.

Community nursing may not be for everyone, but it is definitely for me. I have recently taken up the role of teacher practitioner as I am committed to supporting other nurses to specialise in district nursing and I want to share my knowledge and experience.

*Name has been changed