Queen's Nursing Institute Research Articles

The state of district nursing today

District nursing services are critically-under resourced, teams are struggling with capacity, and team leaders are carrying more responsibility than ever before, a new report by the Queen's Nursing Institute (QNI) reveals. Kathy Oxtoby reports

The Impact of the Introduction of the Additional Roles Reimbursement Scheme on the General Practice Nursing Workforce in England.

To understand the impact of introducing Additional Roles Reimbursement Scheme (ARRS) on the General Practice Nurse (GPN) workforce. A workforce/people impact assessment designed as a cross-sectional survey of a stratified sample of 900 GPN on the Queen's Nursing Institute mailing list. A workforce/people impact assessment was designed based on the UKCS 2014 piloted and distributed as a cross-sectional survey via a survey platform. This included questions on level of impact, kind of impact and perception of prior engagement. Data were analyzed using descriptive statistics and content analysis. The survey consisted of 21 questions (531 responses, response rate of 60%). ARRS deployment appears to have impacted the GPN workforce in several ways. There was positive impact on workloads from ARRS roles working in original scope, for example pharmacists medicine reviews. However, any benefit was offset by the increased workloads created by those new to general practice and/or working outside of traditional scope. This ranged from a lack of resources to provide the support those new to primary care require to practice safely, the expectations of others-that GPN will fill the gap in support and teaching to GPN directly safety netting the work of others. There was a lack of consultation regarding a major workforce change, leading to feelings of devaluation. There are some significant equity issues highlighted particularly around pay and opportunity. The introduction of ARRS has had some positive but mostly negative impact on the workload and introduced pay inequity issues on GPN.

Why were nurses snubbed at Rishi Sunak’s summit on NHS pressures?

The Queen’s Nursing Institute (QNI) mantra is: ‘Be at the table – or you (as nurses) will be on the menu’. Nurses make up the largest part of the clinical workforce, spend the most time with the people they care for and know what needs to change. It was therefore inexplicable that no nurses were invited to a recent summit at Downing Street to discuss current NHS pressures.

'A journey of self-discovery and transformation': A theoretical and comprehensive evaluation of the Queen's nursing institute Scotland community development programme.

To evaluate adoption, implementation and maintenance of the Queen's Nursing Institute Scotland development programme. A comprehensive, longitudinal, qualitative evaluation. Participants from the first two cohorts were interviewed at different stages to explore adoption, implementation and maintenance. Managers of participants engaged in interviews to explore service changes. Facilitators took part in a focus group exploring delivery. A member-checking event was held. Data collection was between March 2017 and October 2019. Data analysis was thematically followed by the application of Normalization Process Theory. Ninety-four interviews, two focus groups and a member-checking event were conducted. Prior to the programme most participants were burnt-out and considering leaving. Engaging led to a journey of self-discovery and transformation. The programme was perceived to change their way of thinking, personally and professionally, unlike any training and development previously experienced. Participants were rejuvenated and reinvigorated, sharing their learning with colleagues, service users and family, implementing new working practices and furthering their careers. They developed communities of practice amongst their cohorts with strong bonds; enabling them to build and sustain learnings. Participants experienced a journey of self-discovery and transformation unlike anything before due to the personal investment in them. Participants were rejuvenated and reinvigorated with many moving into new roles. The programme equipped them with a range of leadership and resilience skills. The Queen's Nursing Institute Scotland Development Programme had a profound impact on participants, personally and professionally, which was perceived as lifelong. These findings and programmes are transferable beyond Scotland and to different professions.

Achieving congruence in 'being and doing' community nursing.

Conceptual and theoretical frameworks for person-centred community nursing practices have not yet been fully developed. There is a need to explore this further in order to guide future district nursing, which forms part of the community nursing discipline in the UK. The contemporary district nursing role is undergoing change, although there appears to be little consensus about the district nurse's (DN) vision across the UK, and little indication of the theoretical position underpinning this change. Meeting strategic requirements (National Health Service (NHS), 2019; Scottish Government (SG), 2017a&b), DNs have advancing clinical expertise and are recognised for their technical skills. However, one may contend that this emphasis on 'doing' in practice contributes to practice decisions made exclusively on task performance by strategic decision-makers, and DNs continually viewing themselves as invisible (National Assembly for Wales,, 2019; Queens Nursing Institute (QNI), 2006; Dickson 2018; 2020). District nursing education may contribute to this lack of clarity as curricula are based on borrowed theory from other disciplines that continue to focus on 'how to do', with little emphasis on 'how to be' a DN, and the continued decrease in DN numbers across the UK may be a consequence. In this paper, I explore current evidence that underpins district nursing practice, education and research in the UK, and advocate the use of the Person-centred Practice Framework (PCPF) (McCormack and McCance, 2017) as a means of unifying and guiding 'being a person-centred DN.' This will enable practitioners who can draw on multiple forms of evidence to inform their advancing practice. This article offers philosophical and pedagogical principles to underpin person-centred education going forward. I argue this will promote congruence between 'doing' and 'being' a DN, giving a voice to DNs, and direction to their specialism.

A business case for district nurse resources that no one should ignore

Every week I receive emails asking the Queen’s Nursing Institute (QNI) to point to the national guidance on how to configure the district nursing service locally. Questions are focused on patient safety and ensuring that communities served have the right nurse with the right skills – at the right time and place.

New workforce standards for district nursing launched.

The Queen's Nursing Institute has published workforce standards for district nursing services in the UK. The standards are intended to provide top-level guidance to commissioners, service planners and managers about the key considerations when deciding on the number of staff, skill mix, and workload management tools needed to provide healthcare in the community setting. The standards are intended to support the evidence base around the number of suitably qualified and experienced district nurses needed to provide a service to a given population. The standards include 'red flags' that indicate when a service is at increased risk of deferring care due to lack of staff capacity.

Homelessness during the pandemic: helping the most vulnerable.

Sam Dorney-Smith, Nursing Fellow, Pathway, and Specialist Advisor, Homeless Health Programme, Queen's Nursing Institute, London (samantha.dorney-smith@nhs.net), runner-up in the Nurse of the Year category of the BJN Awards 2021.

Nurse-led projects for people experiencing homelessness and other inclusion health groups: a realist evaluation.

Nursing service development or innovation projects, even small-scale ones, can be difficult to deliver and evaluate, due to a lack of resources and support. Results can also be difficult to disseminate, limiting transfer of learning. This paper presents findings from a realist evaluation of 10 small projects supported by the Queen's Nursing Institute Homeless and Inclusion Health Programme to deliver innovation in health care for people experiencing homelessness and other marginalised groups. These nurse-led projects were funded by the Queen's Nursing Institute and the Oak Foundation, and were largely successful in achieving outcomes to support the improved health of people experiencing homelessness and other marginalised groups. This realist evaluation explores the factors that contributed to the delivery of positive outcomes. All were impacted by the context and the response (mechanisms) of people experiencing homelessness and staff within these settings. It is hoped that the lessons learned will enable better support for nurse innovation projects in the future.

Making Legs Matter: A Case for System Change and Transformation in Lower-Limb Management.

This consensus document is endorsed by The Queen's Nursing Institute (QNI) and The Queen's Nursing Institute Scotland (QNIS).

Major new survey of care home leaders confirms severe impact of COVID-19

The Queen's Nursing Institute, the world's oldest nursing charity, has published a major new report on the effect of the COVID-19 pandemic on the UK's nursing and residential homes.

Verification of expected death in the community: role of the community specialist practitioner.

In 2019, the Royal College of Nursing (RCN) and Queen's Nursing Institute (QNI) recognised a significant reduction in the number of qualified district nurses (those who hold the Community Specialist Practitioner (CSP) qualification). Community nursing is an evolving role, and, with the role of community nurse expanding, the role of the CSP in supporting teams to adapt to the development of the role is more important than ever. As a leader, the CSP possesses skills in leadership and co-ordination of the team, alongside specialist knowledge of the provision of nursing care in community settings. This article seeks to explore the hidden practice of verification of expected adult deaths by registered nurses and how the CSP role is integral in developing and embedding this skill within a team.

From support worker to district nurse team manager: a narrative

As the general population ages, so too does the nursing workforce. A recent Queen's Nursing Institute (QNI) report (2019a) stated that 1 in 10 qualified district nurse positions have been lost in the past 10 years—without a trained workforce to replace those who retire. Workforce planning is central to ensure safe and effective care in the community setting. This article aims to provide a narrative account of one student who started her career at the University of Bolton as a trainee assistant practitioner and over time achieved her present position as a district nurse team manager. The account will include her journey from support worker to assistant practitioner, studying at the University of Bolton as a trainee assistant practitioner on a ‘work, earn and learn’ programme. It details the support she received from mentors in the trust, alongside her onward journey to registered nurse and specialist nurse practitioner qualifications.

Raising the voice of practice nurses in 2020

In a new quarterly column, Crystal Oldman explains how the Queen's Nursing Institute aims to make the voices of practice nurses heard in 2020

Valued impact of seniors working alongside clinicians in the Lindsay Leg Club network.

British Journal of Community NursingVol. 24, No. Sup12 Society UpdateValued impact of seniors working alongside clinicians in the Lindsay Leg Club networkEllie LindsayEllie LindsayE-mail Address: [email protected]Queen's Nursing Institute Fellow Life President, Lindsay Leg Club FoundationSearch for more papers by this authorEllie LindsayPublished Online:5 Dec 2019https://doi.org/10.12968/bjcn.2019.24.Sup12.S34AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 December 2019Volume 24Issue Sup12ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 5 December 2019 Published in print 1 December 2019 Information© MA Healthcare LimitedPDF download

The development of the general practice nursing induction template

Sharon Aldridge-Bent explains how she developed and wrote the Queen's Nursing Institute's general practice nursing induction template

The development of a district nursing caseload review tool.

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen's Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient's needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

The development of a district nursing caseload review tool.

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen's Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient's needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

Secondary care for people without a bed of their own

Penny Harrison, Senior Lecturer in Adult Nursing at De Montfort University, Leicester, looks at the Queen's Nursing Institute resource for homelessness

Why you should never be ‘just a nurse’

The Queen’s Nursing Institute (QNI) is encouraging all registered nurses to include ‘RN’ in their Twitter handle. Most nurses in the QNI network now include RN after their name.