Advice and development

My motivations and first destination into a community staff nurse post

Following a 12-week placement as a community nurse, Hattie Domagala explains why team support can really matter in lone working
Hattie Domagala

Following a 12-week placement as a community nurse, Hattie Domagala explains why team support can really matter in lone working

In my final year as a student at Kingston and St George's University, London, I carried out a 12-week placement which involved working in the community in a district nursing team. I was given my own caseload of clients to see each day, allowing me to experience the reality of working as an autonomous practitioner.

It offered me a good insight into the highs and lows of day-to-day life as a community staff nurse (CSN) and helped me realise that when you walk into a house, it is not always a straightforward task but rapid decision making that is often needed.

People told me that being a CSN was an easy career choice, which made me doubt the role. What cemented

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Following a 12-week placement as a community nurse, Hattie Domagala explains why team support can really matter in lone working

In my final year as a student at Kingston and St George's University, London, I carried out a 12-week placement which involved working in the community in a district nursing team. I was given my own caseload of clients to see each day, allowing me to experience the reality of working as an autonomous practitioner.


Hattie Domagala

It offered me a good insight into the highs and lows of day-to-day life as a community staff nurse (CSN) and helped me realise that when you walk into a house, it is not always a straightforward ‘task’ but rapid decision making that is often needed.

People told me that being a CSN was an ‘easy’ career choice, which made me doubt the role. What cemented my desire to work in the community straight away, going against the ‘normal’ nursing career pathway, was the team support. 

Influences

One situation which was influential in my decision to become a CSN was my involvement in what initially seemed like a routine GP request to check a client’s blood pressure. This transpired to be a more severe situation. It was clear the client was unwell so I did a full set of observations.

The vital signs indicated the client’s condition was rapidly deteriorating so I called an ambulance. Being on my own in this high-pressured situation was overwhelming, but gave me confidence in my knowledge as I had recognised and acted quickly to achieve the best outcome. The skills which I had developed throughout my three years of training had been put into practice.

Although it may seem initially daunting to be on your own, the team is available on the telephone to advise in unexpected situations. This contrasts to my experiences on wards and on an emergency department placement where you can feel alone and unsupported as it is so busy.  

Care quality

On the first day in my role as a CSN, my district nurse team lead made me feel welcome. She informed me of positive feedback she had heard, which has boosted my confidence. Together we agreed the training I am aiming to complete, including venepuncture, catheter care and complex wound care. Weekly multi-disciplinary meetings at GP surgeries clarified what can be achieved for clients and enables the formation of good professional relationships, improving the quality of healthcare provided.

Rather than becoming de-skilled in the community, you are an autonomous practitioner who makes decisions independently. Each visit allows the provision of a different nursing skill. We have a client with a percutaneous endoscopic gastrostomy who needs daily medications administered and care of the tubing. I had only seen this device used a few times as a student so I was nervous at first. The team ensured I had someone with me for the first few visits until I felt confident. 

I was able to do my own clinic for staff flu vaccinations at a residential home and had basic life support and anaphylaxis training. I have gained skills in wound care and vac dressing and I hope to continue to develop new skills, my confidence and competence as the training continues.

Awareness of opportunities 

Developing rapport with a person at home and getting to know them on a personal level is one of the most important elements of nursing. The community may be a different route into a nursing career but if it is where your interest lies and you want a supportive and encouraging environment, it is important to know you can go there straight from qualifying.

There is not enough awareness of this possibility. More community placement opportunities are needed during training to allow lecturers and students to have a better understanding on this area of nursing.


After completing the placement, Hattie Domagala is now a community staff nurse for Your Healthcare in Surbiton, Surrey

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