The Queen's Nursing Institute (QNI) and Royal College of Nursing (RCN) (2019) called for urgent investment in district nursing as they identified a dramatic 43% reduction in the number of district nurses working in the NHS! It is astonishing that, although 90% of all patient contacts are in the community (QNI, 2012), there is a fierce concentration on ‘front door’ (emergency department) activity, rather than the activity at the patient's front door.
Our local universities have seen a recent increase in the uptake of nurse training positions, which might be a positive from the pandemic, when the NHS staff were hailed as heroes. However, the gaps in our day-to-day establishment remain. What can we do differently to attract nurses to work in the community? I have thought long and hard about this over the past few months and, of course, have written a strategy for recruitment, but I still yearn for those innovative strategies that make community nursing stand out from the rest!
Any nurse or allied health professional working in the community will tell you of the complexity and acuity on their caseload, but the myth of nurses becoming deskilled when they leave a hospital setting to work in community persists-this is one of the queries my colleagues and I have had to fend off during a recent community awareness week and virtual recruitment event for community nursing. Another myth was that newly qualified nurses need experience in a hospital setting before coming to work in community. Although I agree that a range of post-qualification experiences would be ideal and learning from training is consolidated, there is a place for these newly qualified nurses to work in community services and gain the requisite knowledge and experience to fulfil their role. Our practice development nurse has recently reintroduced the learning opportunities available to student nurses who are hospital based to come to community services, to follow their patient on discharge. We can use the same principles to give newly qualified nurses experience in hospital services if required.
Our hospital services have excelled with international recruitment for staff nurses, but there is a reluctance within community nursing to follow this path. Yes, there are challenges to overcome, but a lot of foreign nurses have vast amounts of experience in their own countries; if we can hire newly qualified nurses, the surely, we should open the doors to international recruits also. And where do we stand with introducing other professionals into the community nursing teams? We are considering trialling the inclusion of paramedics within our teams. There is some reluctance to accept this diversion, but we must continue to investigate all the available options before we can say something doesn't work!
We are very fortunate to be able to second at least six nurses annually to undertake the Specialist Qualification in District Nursing, and, this year, we are seeking to increase this number. However, with the Health Education England (HEE) funding at band 5 level, it remains a cost for the trust to fund at the current band so that we can continue with a definite stream of newly qualified district nurses. With this specialist qualification, we should be looking at recompensing our nurses with a band 7 on qualification. I understand the cost implications and the reorganisation of the team structure that would result from this change, but these professionals are highly qualified to look after the complex and acute patients in the community, and a reward for their years of study would be a worthwhile investment.