Community nursing and COVID-19: when this is all over, I don’t think things will go back to how they were

Our teams have increased collaboration and enhanced rapid patient discharge
Community collaboration

Our teams have increased collaboration and enhanced our rapid discharge service for patients

Picture: iStock

As hospitals have been transforming in response to the COVID-19 pandemic, so too has community nursing.

Like the acute sector, we anticipated a surge in demand and workload, with increasing numbers of patients requiring our help in their own homes and in care homes, many of them near the end of life.

Benefits of changing the way we work during the COVID-19 crisis 

Preparing for this was – and continues to be – a huge task. And it might sound a strange thing to say given the terrible time we’re all living through, but there are positives that have come about as a result.

For example, we have enhanced our rapid discharge service to ensure people get home from hospital as quickly as possible unless they absolutely have to be there. We now aim to transfer people from hospital to home within three hours of them being assessed as medically ready to go home. 

This has obviously been a huge challenge, and it is one that has involved joint working and collaboration on an unprecedented scale. Everyone has been focused on making it happen, including hospital staff, the local authority, as well as the community nursing and therapy team.

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Joint working has enabled rapid discharges to be made safely 

I was asked to move into a new team to help make this happen. Norfolk Community Health and Care NHS Trust already has an established integrated admission avoidance team and associated processes, which we have built on and expanded to meet the need of rapid discharges. 

‘Colleagues’ positivity has been incredible – I’m in awe’

Essentially, if you are now told that a patient on the ward is medically optimised to go home, you have three hours to get them home.

In that time, the discharge hub has to sort out health, social care and other provision. It is also important to avoid complex admissions and reduce the need for some patients to go into hospital. 

Our trust is in a rural area. There are limited packages of care available from social care providers and we already have people on unmet care lists, so we knew we were going to have to think about different ways to get people out of hospital and managed safely at home. 

We have found innovative ways to meet patients’ needs

Another part of my role is managing messages to the workforce. I need to ensure that everyone is prepared to work flexibly, but not beyond their scope of practice.

So if a nurse was going in to do somebody’s insulin, they could also help with their breakfast and get them up and dressed. If there’s a patient with mixed social and health needs, we send the member of staff with the most experience to deliver all the necessary care.

There’s a recognition that we are trying to work in a patient-centred way and everyone from health, social and corporate services, as well as volunteers, have all been keen to help. 

These are not ideal times – of course they are not. And it’s tough for everyone to be working in these different ways. But when this is all over, I don’t think things will go back to how they were.

These circumstances have led to heightened collaboration, to conversations that we’ve never really had before, and to action – all in an extraordinarily short space of time. The positivity has been incredible and I’m in absolute awe of all my colleagues.

Rosy Watson is a Queen’s Nurse and clinical lead community nurse for Norfolk Community Health and Care NHS Trust



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