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Becoming an assertive district nurse in a challenging environment

It’s essential that district nurses are inspirational managers, who lead their teams in an effective and confident manner.
Assertive district nurses

District nurses traditionally see patients who are housebound and holistically manage a range of complex clinical conditions.

Over recent years the delivery of nursing care in the community has undergone considerable change, which has expanded the remit of district nurse teams.

In addition to increasingly acute demands, each district nurse has day-to-day responsibility for the care of many patients with multiple, debilitating, long-term and palliative conditions.

Balancing these competing demands, often accompanied by diminishing staff numbers, presents every district nurse team with daily challenges which can result in delayed visits, hurried consultations and the potential to compromise care (Queens Nursing Institute 2009).

Such increasing pressures intensify the challenge of allocating and managing this daily workload and the ability to deliver high quality care to all.

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District nurses traditionally see patients who are housebound and holistically manage a range of complex clinical conditions. 


Keele University is leading a research study into the day-to-day demands of district nurses
Picture: iStock

Over recent years the delivery of nursing care in the community has undergone considerable change, which has expanded the remit of district nurse teams.

In addition to increasingly ‘acute’ demands, each district nurse has day-to-day responsibility for the care of many patients with multiple, debilitating, long-term and palliative conditions. 

Balancing these competing demands, often accompanied by diminishing staff numbers, presents every district nurse team with daily challenges which can result in delayed visits, hurried consultations and the potential to compromise care (Queen’s Nursing Institute 2009).

Such increasing pressures intensify the challenge of allocating and managing this daily workload and the ability to deliver high quality care to all. 

Leading effectively

In this challenging environment, it is essential that DNs are assertive and inspirational managers, who lead their team effectively, ensuring prioritised allocation of visits and successful negotiation with the wider multidisciplinary team.

A 2016 RCN Congress resolution, supported unanimously, stated that all district nurse caseload holders should hold a Specialist Practice Qualification (SPQ). The resolution emphasised the importance and impact of this NMC recordable qualification, achieved following an intense clinical and academic programme delivered in partnership between employing Trusts/Health Boards and Higher Education Institutions (HEIs). 

Many SPQ students reflect on the ‘transformational’ nature of the course, which equips them with the knowledge and skills required to be effective caseload managers and team leaders across the diverse community settings in which they practice.  

Several questions surround the SPQ: Is it necessary to be an effective DN caseload holder? What difference does the qualification make to the practitioner? What impact does a DN with the SPQ have on teams in terms of clinical performance, patient experience, prevention of admissions, clinical decision making and effective caseload management?

In a direct attempt to explore one area of impact of the SPQ and to provide some ‘evidence’ of the impact of course completion, a two-year study was proposed.

Assertiveness study

The research study Enhancing assertiveness in district nursing specialist practice is being led by Keele University (September 2016-2018) and involves a further 11 HEIs who deliver the DN SPQ programme and 130 SPQ student participants.

This study aims to establish whether educational interventions and supported clinical practice have an impact on the assertiveness of DN Specialist Practice students during their course and in the year following qualification.

This mixed methods study will provide quantitative evidence about assertiveness levels while providing a deeper, qualitative insight. Study participants will complete the validated Begley and Glacken (2004) assertiveness questionnaire at four points during their 12-month full time course to provide a numerical estimation of assertiveness. 

A subsample of participants will also undergo a semi-structured interview at the end of the course to explore their views around their development of assertive skills.

Exploring pressures

One year following completion of the course, participants will again complete the assertiveness scoring and the subsample of participants will undertake a further interview to explore the pressures experienced by newly qualified DNs.

Quantitative and qualitative findings will triangulate the impact of educational interventions and supported clinical practice on assertiveness scores.

In addition, the study will also provide a deeper insight into the experiences of the application of assertiveness skills in clinical practice while both a specialist practice student and as a qualified district nurse.   


References

Begley C M, Glacken M (2004) Irish nursing students’ changing levels of assertiveness during their pre-registration programme. Nurse Education Today.

Green J (2016) Enhancing assertiveness in District Nurse Specialist Practice. British Journal of Community Nursing.

About the author

Julie Green is director of postgraduate studies, lecturer in nursing and award lead for specialist community nursing (district nursing). A Queen’s Nurse, Dr Green is also a member of the Association of District Nurse Educators and interim chair for the RCN District Nurse Forum Steering Group.

                                                                                                  

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