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District nurse caseload: the red flags that no one should ignore

Evidence-based district nursing workforce standards from the QNI outline what to look out for when deciding whether you and your team can deliver safe care
District nurse on a home visit

Evidence-based district nursing workforce standards from the QNI outline what to look out for when deciding whether you and your team can deliver care safely

A caseload of more than 150 patients per district nurse could lead to a ‘red flag’ situation that hinders nurses’ ability to provide safe patient care, say new standards.

Expecting district nurses to cram in as many as nine or ten visits per day also risks compromising care, according to new standards published by the Queen’s Nursing Institute (QNI). The document recommends visits last at least 30 minutes – and that’s not including travel time.

‘Patients are being referred to district nursing because other services are short-staffed or not offered 24/7’

Alison Leary, director of

Evidence-based district nursing workforce standards from the QNI outline what to look out for when deciding whether you and your team can deliver care safely

District nurse on a home visit
Picture: Neil O’Connor

A caseload of more than 150 patients per district nurse could lead to a ‘red flag’ situation that hinders nurses’ ability to provide safe patient care, say new standards.

Expecting district nurses to cram in as many as nine or ten visits per day also risks compromising care, according to new standards published by the Queen’s Nursing Institute (QNI). The document recommends visits last at least 30 minutes – and that’s not including travel time.

‘Patients are being referred to district nursing because other services are short-staffed or not offered 24/7’

Alison Leary, director of the International Community Nursing Observatory

When urgent action is needed: what managers should look for

The standards, developed by the QNI’s International Community Nursing Observatory, set out areas of risk and ‘major red flags’ that require urgent action from managers.

Workload is far exceeding the capacity of services, with district nursing teams acting as fail-safes for other NHS and social care services, said observatory director Alison Leary.

‘Patients are being referred to district nursing because other services are short-staffed or not offered as a 24/7 service,’ she said.

The standards, which are based on the latest research evidence, do not specify maximum caseload, but urges ‘caution on caseloads per whole-time equivalent of over 150 as this seems to be a tipping point into more work left undone, and deferral’.

4 red flags in district nursing

  • Nurses needing to put off work every day or most days
  • Deferral of any high-priority work such as end of life care or a blocked catheter
  • High staff turnover and sickness absence
  • Services are unable to close caseloads

Source: QNI Workforce Standards for District Nursing Service

District nurse workforce planning

QNI chief executive Crystal Oldman hoped the standards would prove useful for providers and commissioners of district nursing services and nurses themselves.

‘The standards explain the key factors to consider when planning workforce to meet demand and the overriding requirement to always apply the professional judgement of the expert nurse,’ she said.

The publication of the standards comes amid concern about spiralling caseloads and time limits for appointments that put pressure on nurses to complete tasks as quickly as possible.

An RCN survey of almost 500 district and community nurses last year found teams were under immense pressure, with just 1% of respondents able to leave work on time at the end of their shift.

Read the QNI district nursing standards


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