Developing a district nursing workforce with advanced skills, for care at home

Abstract

The NHS continues to move towards primary-led care, with an emphasis on care closer to home. Despite this transition, independent health charity the King’s Fund’s report, Older People and Emergency Bed Use (Imison et al, 2012), identified variation across NHS trusts, with respect to emergency admissions of people aged 65 years and over. While this variation has implications for planning secondary care and the finances of healthcare delivery, it is imperative that the impact on the quality of life of people aged 65 years and over is considered. At a time when the number of older people in the population is not only increasing but also becoming more diverse (Blood and Bamford, 2010) the district nurse is well placed to play a pivotal role in healthcare delivery. It is of interest to note that availability of community services and the integrated service model has reduced emergency bed use, despite this 68% of emergency bed days are filled by the elderly (Imison et al., 2012). District nurses and their teams should be well placed to influence care delivery and reduce emergency bed use. The Queens’s Nursing Institute (QNI) (2011) highlights the complexity of district nursing including; assessing complex needs, risk management, application of specialist knowledge and skills and working across organisations. When this is considered within the context of those receiving care at home; housebound and frail, reliant on others for help and often isolated and alone (Queen’s Nursing Institute (QNI), 2011) it is crucial that district nurses are supported and empowered to act as an advocate and, in the context of the King’s Fund Report those aged 65 years and over. Elderly people that receive care from the district nursing service, value the service and the contribution it makes to supporting them to stay at home. Ohman and Soderberg (2004), reported on a study of 10 district nurses with an average of 15 years district nursing experience. The findings identified that district nurses, by the nature of the ongoing involvement with patients, are able to nurture a close relationship, which enables them to develop a shared understanding of the needs of the patients and thus weave a web of protection. Based on the complex knowledge and skills identified by the QNI (2011) and the emotional labour, which accompanies this complex knowledge, it is evident that district nurses require an advanced skill set to fulfil the role effectively. Despite evidence that district nursing is valued by the population with which it works and can make a difference to emergency bed days, it would appear that it is in danger of becoming a Cinderella service. The QNI Right Nurse, Right Skills campaign was started as a result of concern regarding the increasing need for skilled home nursing and this remains a major concern. The Nursing and Midwifery Council (NMC) standards for specialist practice (district nursing) have not been revisited since 1994 and it has been argued that they are no longer fit for purpose (Edwards, 2012). Anecdotal evidence from students undertaking pre-registration nursing programmes suggests that district nursing is generally not considered as a career option as it is felt that opportunities for development are limited. When this is set within the current context of a high profile Government campaign to train and recruit health visitors, it is little wonder that recruitment to district nursing programmes is struggling. District nurses are engaged in a range of professional development including advanced assessment and independent prescribing to meet the demands of the changing health service and population. However the development of the future district nursing workforce also needs to be fit for purpose. Following ongoing discussion with the NMC a new MSc advanced practice nurse practitioner – district nursing programme has been validated at King’s College, London. In addition to providing the successful student with district nursing and community practitioner prescriber (V100) qualifications the programme also includes independent/supplementary prescribing (V300). This programme will prepare district nurses of the future to meet the increasingly complex needs of individuals receiving care at home. It is hoped that by providing a district nursing programme which develops advanced practice and provides a clear career trajectory it will be possible to consolidate a district nursing workforce with advanced skills to play a key role in care closer to home. BJCN