A district nurse's reflection on pre-registration nursing education: a troubling position
This article explores the author's observations as a qualified district nurse and senior lecturer in pre-registration nurse education. Perceived ‘troubling’ reflections suggest pre-registration nurse education appears very hospital focussed. Additionally, the role of the district nurse has become synonymous with the term ‘community nurse', hiding the historical specialism it represents. Media representations of the term ‘frontline’ was particularly noted in relation to COVID-19, suggesting a heroism of nursing that only happened in hospital. More discussion will take place around how nursing is viewed within education by students, such as what we do to patients (catheterisation, blood sugars etc) rather than how we can work with them. All these areas appear to strengthen lingering historical myths around district nursing and student perceptions of this specialist profession.
Historically in England, the district nursing service was developed by the Queens’ Nursing Institute (QNI) (2022). Initially founded by William Rathbone, there was a need for nurses to care for people in their own homes. The title of district nurse (DN) is often used interchangeably with ‘community nurse’, which is a collective term for a nurse (qualified or not) who cares for patients outside of the hospital setting. This collective term now encompasses areas from nursing care homes, general practitioner (GP) surgeries, hospices, prisons and in more recent times, a focus on those who nurse the homeless (QNI, 2022). Nursing and Midwifery Council (NMC) standards (2022) for the proficiency of community nursing specialist practitioner qualifications acknowledge this variety of roles and the ever changing context of community nursing to which further specialist qualifications may be needed. For this article, the role of the DN will largely refer to a registered adult nurse who has completed an additional year of the professional body NMC-approved training in this specialist field. The qualified DN is registered and regulated with the NMC (2022), and thus, district nursing is established as a profession in its own right (Allsop and Saks, 2003). In response to a 21-year gap, the proficiencies for specialist practitioner qualifications are now under review (NMC, 2022). It is highly appropriate that these are reviewed, when considering that the DN often is a lone worker, making autonomous decisions, diagnoses and directing the holistic care for their patients. As a profession, district nursing upholds the provision of high-quality care to the local community of patients, both in their own homes and part of local community clinics and GP practices.
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