Abstract
ObjectivesMany countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England.MethodsA qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development.Findings: All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development.ConclusionThere is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.
Highlights
Many health care systems are increasing ambulatory and primary care services to address population changes and contain rising health care costs.[1]
Home visiting nurses represent a small percentage of the nursing workforce, with figures ranging from under 7% of registered nurses (RN) in Australia (2015),[5] about 9% in the National Health Service (NHS) in England (2017)[6] to 13% of employed
The methodology drew on the interpretivist tradition and data were collected through semi-structured telephone interviews in 2014.18 A purposive sample was identified of senior nurses in 8 organizations providing district nursing services in the 12 Clinical Commissioning Groups (CCGs) in the metropolitan area of South London
Summary
Home visiting nursing services feature in many, but not all, health care systems. RNs in the USA (2016).[7] In the UK, home visiting nurses, commonly referred to as district nurses provide services to housebound, mainly older people with longterm conditions or those who are terminally ill. In England, recent moves to increase self-management among people with long-term conditions, the provision of palliative care at home, along with a desire to reduce unplanned hospital admissions[8] point to the need for more and differently skilled district nursing. These developments appear to run counter to the policy aims of enhancing care in the community
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