Features

Community nursing is at a crossroads

Distinct cultural change is opening up new styles and ways of working centred on technology and maintaining good health  
Telehealth

I graduated from University of Barcelonas School of Nursing in 1997. As a young male nurse, I loved action and technology, so the emergency care environment was a good fit. Work was intermittent in Spain, so in 2000 I moved to England.

As the years went by, I felt constrained by the hierarchic, task-orientated system and felt that I could not be myself or express my ideas properly in the hospital environment.

Frustrated, I finished shifts demoralised, deflated and sad. My nursing career began to drift and I ended up working on the nurse bank. I felt undervalued and unable to make a difference.

Patient-centred care

In 2012 I decided to give nursing one last chance and applied to be a community nurse. I had found my perfect role. A community nurse experiences all the thrills of working in emergency care.

Watch the video

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I graduated from University of Barcelona’s School of Nursing in 1997. As a young male nurse, I loved action and technology, so the emergency care environment was a good fit. Work was intermittent in Spain, so in 2000 I moved to England.

As the years went by, I felt constrained by the hierarchic, task-orientated system and felt that I could not be myself or express my ideas properly in the hospital environment.

Frustrated, I finished shifts demoralised, deflated and sad. My nursing career began to drift and I ended up working on the nurse bank. I felt undervalued and unable to make a difference.

Patient-centred care

In 2012 I decided to give nursing one last chance and applied to be a community nurse. I had found my perfect role. A community nurse experiences all the thrills of working in emergency care.


Watch the video

Read the transcript of the video (PDF)


Every day is different. You never know what you are going to find at a patient’s home. It is challenging, exciting, makes use of all your nursing knowledge and is incredibly varied and rewarding.

The best part is that you get to forge a better relationship with patients and their families. I was now able to provide holistic care, focused on the individual. Care became patient centred and I could see the impact I was making – something I missed while working in emergency care.

Golden opportunity

Six months into my new role as a community nurse a combination of three factors transformed my nursing career: the 6Cs, NHS Change Day and social media. The 6Cs gave me back the values I had lost on my way, NHS Change Day gave me the license and approval to peruse my ideas and try to change things for the better, and social media has given me a voice.

These three factors, combined with finding my ideal role, helped me fall in love with nursing again. I now look forward to a future in my nursing career where community and practice nurses will play an increasingly vital role in the healthcare system.

Community and practice nurses have a golden opportunity to shape the future of the NHS. Questions over quality, services, technology and funding make it hard to imagine what the NHS might look like in ten years’ time, but one thing is sure, we are going to play starring roles.

With increasing financial pressures and soaring demand, the NHS is changing. The Five Year Forward View emphasises that the healthcare system needs to break down the existing barriers of how care is provided between family doctors and hospitals, between physical and mental health, and between health and social care. The future will see far more care delivered locally and in the community, increasing the pressure on primary care.

Leading partners

Our roles as community or practice nurses are changing. Critical to the future of the NHS is that people take greater responsibility for their own health and wellbeing. Health professionals must support them to do this.

Patients must feel involved to prevent them being passive consumers of care and become active and leading partners in their own health. Individual responsibility and lifestyle choices are as important to the success of our health system as is the quality of the care we provide.

There is one solution to ensure that the NHS continues to be the best health system in the world. We need to turn the NHS upside down and empower frontline staff and patients. If we want to deliver patient-centred care we need to give more control to our patients.

Cultural shift

For this to happen, a distinct cultural change needs to take place in healthcare professionals’ outlook. Many of us become nurses, doctors or physiotherapists to make people better. This mentality needs to change to encompass prevention alongside treatment. Our role needs to move towards preventing illness in the first place and many are not ready for this change. Our mentality needs to shift towards thinking how we can help people to remain healthy in their community for as long as possible. A useful comparison is telling firefighters their main role now is not to extinguish fires but to prevent fires.

The benefits are obvious. However, resistance is unavoidable and the future is peppered with questions and perceived barriers. The solution will be in enabling prevention.

Benefits made available to us via technology must be maximised (see Box). Better use of technology will play a major role in ensuring a ‘healthy state’ NHS. We are living in a 21st-century society where communication is fast and accessible, but the NHS is still using technology from
25 years ago.

Agents for change

Frontline nurses know what works and what does not, but too often they are not involved in decisions affecting the future of the care they provide. That needs to change. We need frontline nurses to take the first steps to try to improve the place they work.

NHS Change Day will happen again this year in October. Let’s start the revolution together. If each of us makes a small change, the sum of all of those changes will have a huge positive impact on the whole system.

We are at a crucial crossroads and it is paramount that we get the next steps right. We cannot sit down and wait. We need to take control, connect with each other and embrace our new role with open arms. As cultural anthropologist Margaret Mead said: ‘Never doubt that a
small group of thoughtful committed people can change the world. Indeed it is the only thing that ever has.’

Telehealth revolution

Technology enables us to work more efficiently and effectively. Telehealth is emerging as a critical component of the solution to the healthcare crisis. Telehealth can change the current model of care and allow improved access and better health outcomes in more cost-effective ways. It can increase access to health care while reducing healthcare costs and improving support for patients and families. What’s not to like?

For these reasons my local clinical commissioning group funded a telehealth clinical lead role focusing on expanding the use of Florence Simple Telehealth (getflorence.co.uk and www.simple.uk.net/home). I felt this was the ideal role for me and was over the moon when appointed. Now I spend my day visiting frontline clinicians introducing this new way of working. I am still in contact with patients and help them to manage their conditions better by empowering them via the support that the service can give them 24/7.

Technology can also help us to thrive as nurses. The world is open to you via social media. It used to be difficult to keep up to date with what was happening outside your workplace, but Twitter has changed all that. Social media offers a huge opportunity to connect with other nurses. The amazing people I have connected with have supported and encouraged me on a daily basis. The power of social media lies in the community behind it; it has connected me with amazing people and given me fantastic opportunities.

Joan Pons Laplana is Telehealth FLO clinical lead, NHS Arden & Greater East Midlands Commissioning Support Unit, Scarsdale Hospital, Chesterfield


Further information

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