District nurses' experiences with a caseload profiling tool: a service evaluation

Reflecting international trends, in all corners of the UK, changing demographics of the ageing population have resulted in a shifting pattern of disease, from acute illness to complex and multiple long-term conditions (Royal College of Nursing (RCN), 2014). Resultant policy drivers have shifted the balance of care to the community, with avoiding hospital admission being an international priority (World Health Organization (WHO), 2010; Northern Ireland Assembly, 2016; Scottish Government, 2016; Department of Health and Social Care, 2018; National Assembly for Wales, 2019). District nurses (DNs) are viewed as being ideally placed to deliver the policy agenda due to their position as the largest group of providers of nursing in the community (RCN, 2014).

These changes in demographics and political focus challenge district nursing at a time of increasing caseload size and complexity, with an ageing and dwindling DN workforce (RCN, 2014). This is further exacerbated by scarce additional resources to meet the demands, with district nursing caseloads described as a ‘ward without walls', where the caseload has no physical boundaries or limitations (Haycock-Stuart et al, 2008). These challenges have resulted in increasing pressure for active management, monitoring and evidencing of DN caseloads (Baldwin, 2006). However district nursing and the delivery of care has always been a difficult activity to quantify, with no ideal universal method available. Further confusion is evident in practice due to a plethora of methods, with interchangeable use of terminology and applications. The literature suggests that the principles of caseload management provide a range of methods to support DNs to manage caseloads (Bain and Baguley, 2012). Of these, two methods specifically focus on monitoring, managing and evidencing of caseloads-workload analysis and caseload profiling (Table 1) (Ervin, 2008).