As a community nurse lecturer, Una Adderley doesn't spend much time at the coalface. She explains her shock at current working conditions for Nursing in Practice
One of the challenges of being a lecturer in community nursing is trying to make sure that I don’t lose touch with the coalface of clinical practice. I am all too aware that it could be very tempting to retire to safety of the ‘ivory towers’ of academia. (Admittedly the ‘ivory towers’ can also be fairly demanding places but, in my experience clinical practice consistently trumps academia in terms of stress.) So in the last few weeks I have been catching up with clinical colleagues working in the community and frankly, I don’t know how they are staying sane!
Everyone I speak to is telling me that their patient caseloads are increasing while their staffing levels drop, or experienced and highly trained staff are replaced by novices. Nothing against novices – we have all been novices at some stage in our careers – but I know I was really grateful to have enough senior nurses around to support me and to learn from.
I wondered whether community nurses have always complained about staffing levels but when I went looking for some literature I found the figures supported what nurses in practice are telling me. Last year, the Royal College of Nursing, in response to the Francis Report, commissioned a report into qualified nursing staffing levels(1). The report found that between 2002 and 2012, the qualified community nursing workforce had slightly increased but the number of health visitors and district nurses (i.e. the community trained nursing work force) had steadily decreased.
This is worrying. The research evidence is increasingly suggesting that a highly educated workforce is associated with better patient outcomes so why is the proportion of nurses with specialist community education and employed in community leadership roles shrinking? The Francis Report noted the need for good nursing leadership so why are we reducing the number of nurses who have been trained to take this leadership role in community nursing?
The irony is that community nursing’s loss may be practice nursing’s gain. Most of the senior nurses I know who have been forced out of community nursing by unrealistic workloads or service reviews have been welcomed into senior roles within practice nursing. GP practices seem to recognise a good thing when they see it! But I do wonder how many patients and junior nursing staff will have to manage without the advanced knowledge and skills of a well-trained and highly experienced senior community nurse? And how long will it be before we see a ‘Francis Report’ equivalent in a community setting?
1. RCN (2013) RCN Labour Market Review: Safe staffing levels – a national imperative - The UK nursing labour market review
PhD DN RGN
Lecturer in Community Nursing
School of Healthcare, University of Leeds
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