Seven-point plan focuses on older people
A ‘radical shift in resources’ is required to meet the needs of older people in remote and rural areas, according to a report published by the RCN with support from Age Scotland. The report, Going the Extra Mile, is drawn from interviews with community nurses and survey responses from more than 170 older people
A ‘radical shift in resources’ is required to meet the needs of older people in remote and rural areas, according to a report published by the RCN with support from Age Scotland. The report, Going the Extra Mile, is drawn from interviews with community nurses and survey responses from more than 170 older people.
RCN Scotland says that if the Scottish government’s ambition to bring care closer to people’s homes is to be realised, the community workforce in remote areas needs to be more flexible and accessible to patients.
Rural areas are disproportionately affected by the nationwide challenge of an increasingly ageing population and nursing workforce, with 60% of community nurses in Western Isles aged 50 or over.
The report lists a seven-point plan for improving older people’s care in the community. One recommendation is to develop and support the advanced nurse practitioner (ANP) roles for the long term in remote and rural areas, including a focus on succession planning, ensuring nurses have the time and support to undergo the training needed, and developing an effective recruitment strategy.
RCN Scotland's recommendations
- Shift resources to the community with adequate long-term investment
- Implement a whole-system approach to recruitment and retention across all sectors
- Develop and support the advanced nurse practitioner role
- Enable nurses to feel confident in using technology and promoting telehealth in the community
- Significantly improve broadband infrastructure to connect services with patients and support a mobile workforce as a matter of urgency
- Change attitudes and improve digital participation, particularly among older people
- Support older people to live independent and active lives
RCN Scotland director Theresa Fyffe says: ‘ANPs must not just be seen as urban roles as they have a very big part to play in rural areas and out of hours care, particularly on the islands where there might be no GPs.
‘We want the government and the NHS to understand the requirements of the role and that they will need support supervision and mentorship because they often work remotely and independently so they need to stay up to date professionally and stay competent.’
RCN Scotland is working with chief nursing officer for Scotland Fiona McQueen to create a national framework for ANPs to outline and standardise the level of competence and experience required for that level.
'We believe ANPs are the linchpin of rural care,’ she says. ‘We want to bring to the attention of policy makers that without these roles older people would not get the care they need.’
NHS Grampian associate nursing director Linda Harper has created in partnership with Robert Gordon University in Aberdeen an ANP master’s degree, accredited by the RCN. The course includes modules in clinical examination skills, physiology and prescribing.
Ms Harper says ANPs are often recruited to work in areas where GP recruitment is difficult, but she adds that ANP retention can also be an issue, with ‘brain drain’ occurring a few years after investing in their training.
‘In 2004, ANPs would have stayed with me for an average of seven years but now it’s averaging three to four years,’ she explains.
She says health boards need to consider the infrastructure and any resources such as training and support that could be put in place to boost the retention of ANPs.
She adds that many older people are grappling with 40-mile trips to travel to their nearest hospital. Diagnostic care and investigations could be carried out closer to home by using more telemedicine or cottage hospitals, she explains.
‘For example, if someone had a fall we could use telemedicine to link it to a hospital in Aberdeen so we can get the opinion of a consultant. From there, we can decide whether to book travel for the older person to the hospital, treat them in the community or arrange for the consultant to travel to them.’
Access to IT
Ms Harper says nurses in the community would benefit from having better access to IT and technology, such as handheld devices or laptops, to record case notes and care plans.
The RCN’s report calls for nurses to become confident users of technology, supported by an improved broadband infrastructure, as well as a greater focus on supporting older people to live independently.
Ms Fyffe cites best practice from NHS Grampian, whereby older people are shown how to use digital services to manage their conditions at home prior to being discharged from hospital: ‘It means that a family member could go out for the day knowing that the older person is hooked up to make a call if they have a fall. It could really help reduce anxiety.’
Christopher Rice, who is the only ANP working on the island of Bressay in the Shetland Islands, says healthcare on the islands has become nurse-led as there are too few GPs being trained.
‘ANPs are increasingly taking on the workload of GPs,’ he says. ‘We also have a high staff turnover rate because remote and rural practices are not for everyone. The ANP role needs recognition. We are autonomous in what we do and we make clinical decisions to get the most effective outcomes.’
Jennifer Sprinks is assistant editor, RCNi