Achieving congruence in ‘being and doing’ community nursing

District nurses (DNs) have an important role in person-centred practice within the community due to their involvement in assessing and caring for people principally in domiciliary settings, helping people live with long-term conditions and frailty, preventing deterioration and promoting health and wellbeing (Dickson et al, 2017). In the UK, DNs lead teams of community nurses who work within larger integrated teams. Similar roles exist in other countries (e.g. Australia, the Netherlands and Sweden), but most of these countries do not require a post-registration qualification. Despite the number of UK universities offering the Specialist Practitioner Qualification (the UK professional qualification) increasing from 33 to 43 since 2012 (Queens Nursing Institute (QNI), 2021), in the past 10 years, the numbers of qualified DNs has decreased by 43% in England (NHS, 2018; Royal College of Nursing and QNI, 2019) (data is unavailable in the other three UK countries). Anecdotally, there are increasing numbers of DNs leaving the discipline for other community roles, for example, advanced practitioners. This appears to be as a result of such roles being awarded a higher pay grade. However, there may be other contributory factors. The author's doctoral work revealed that DNs felt a ‘burden’ of responsibility for managing caseloads, teams and associated tasks, resulting in compromise to their wellbeing (Dickson et al, 2018; 2020). Maybin et al (2016) conducted a study for the Kings Fund which concurs. Their study sought to explore ‘good care’ from the perspectives of sservice users and district nursing staff; they found pressures of work, lack of resources, control and weak leadership as ‘getting in the way of good care’. They further suggest that it is contributing to reducing numbers of DNs. Another contributing factor may be the little attention being paid towards retention of nursing staff, as stated in a report by Buchan et al (2019). This workforce crisis is set within the backdrop of 40 000 vacancies in nursing across the UK, and the COVID-19 pandemic amplifying the problem (House of Commons Public Accounts Committee, 2020). Maybin et al (2016) suggest this decrease in the workforce has resulted in many community nursing teams becoming ‘task focused’, resulting in a negative impact on staff wellbeing and care outcomes. The perceived lack of visibility in district nursing, which is another factor (Goodman 1996; QNI, 2019; Dickson et al, 2020a), may be due to the little attention being given to the role/work of specialist practitionersin the literature. Most of the literature refers to DNs in general ‘community nursing’ terms, equating this role to a range of other roles being undertaken in communities. In the literature, the tasks performed by nurses ‘doing community nursing’, are given more privilege than the uniqueness of ‘being’ a DN. Therefore, it is challenging for DNs to build a body of knowledge that articulates their specialism.