The Queen’s Nursing Institute (QNI) has published a document outlining the factors that should be taken into account when considering what a “safe caseload” is for district nurses.
The report, Understanding safe caseloads in the District Nursing service, identified a “lack of robust data” on what a safe caseload actually entails.
The QNI said this has led to a level of uncertainty among commissioners, service providers and team leaders.
The new document, therefore, provides a thematic overview of the issues that should be considered when determining a safe caseload.
These include: patient need; complexity of care required; rate of hospital discharge; skill mix within the team; capacity of other health and social care services; use of technology; and local geographic factors such as housing.
The report says: “Many of the new models of care are exploring solutions to these challenges, including the transfer of funding and resources into community services, improved use of technology to release time to care, and greater support to enable people to manage their own health.
“Innovation must be balanced with the need to ensure a safe service for both patients and staff.
“In some areas the services may be dependent on staff working unpaid overtime each day in order to complete their work.
“In these circumstances, it is feasible that actions to increase productivity through the use of technology to support caseload management and mobile working, will result in relieving the burden of unpaid overtime, but may not result in the anticipated increase in the capacity of the existing workforce.”
Dr Crystal Oldman, QNI chief executive said: “The issue of safe caseloads is one that has been of growing concern to District Nurses in recent years and we receive more questions on this subject than almost any other.
“This is against a background of overstretched services that are struggling to cope with the number of patients being referred to them for the expert care that they provide.
“Frequently these are patients with complex long term conditions, who need specialist healthcare in the community for them to be able to live with dignity in their own homes.
“There is now general recognition among policy makers, commissioners and service planners that we need a stronger framework of principles and measures in order to meet individual and population need.
“The QNI is committed to excellent care for all patients, families and carers in their homes and communities and understanding all the elements on which a well-resourced District Nursing service can be built and managed is critical to this.
“It is intended that this paper will be the catalyst for a wider discussion on safe caseloads in the District Nursing service and the QNI welcomes feedback on the issues covered in the paper.’
The document follows a publication from The King’s Fund, which last week said that the district nursing profession is at breaking point as a result of high patient demand and fewer district nurses.
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