Whenever the NHS is mentioned in the media, we hear that the number of nursing vacancies is rising, the number of beds in acute hospitals is falling, and the wells of hospital budgets are drying up, but is the situation better for community nurses?
Many nurses working in hospitals are being forced to work on wards with unsafe staffing levels – Scotland and Wales have made efforts to resolve this, but England is still behind in this regard. It is perhaps no wonder that burnout among nurses is on the rise.
While some nurses have opted to jump ship entirely by dipping into another profession, others have sought refuge in the community sector. But is the grass greener on the other side of the hospital doors?
Moving into the community
The community came calling for Susie Wellings after a lengthy hospital nursing career. She spent two years in the community before returning to hospital care. Working in a specialist community role provided her with the opportunity to increase her skillset, and she says that the move away from community nursing was motivated purely by her subsequent role rather than a dislike for community care. At the time, her transition into the community was based on a decision to change specialty. The move would see her visiting patients at home as a clinical nurse specialist in palliative care. ‘I chose to move specialty from elderly care to palliative care, and the job going at the time was a community one,’ she says. ‘This made it a double change for me, and I had lots of discussions with the community team before applying so as to make sure I would be able to do the job before considering it.’
The transition for Ms Wellings did not come without some trepidation. Having worked for most of her nursing career in the acute sector, she was conscious of how lone working might be a challenge. ‘I was nervous about being away from a ward environment and felt that being completely alone may highlight the bits of nursing I wasn’t so sure of,’ she explains. ‘I was worried about how this may affect the care I gave my patients.’
Samiira Mohamed went straight into practice nursing after graduation, something which she admits is quite rare. ‘I found that during my nursing course, the university often didn’t give out practice nurse placements,’ she says. ‘But I was lucky enough on my final placement to request this.’
Although she has always been interested in community nursing, it was her final placement in a GP practice that set her on a path to starting her nursing career there. ‘I was excited about the progression and depth of knowledge that comes with a practice nursing role,’ she explains of the opportunities available to nurses working in GP practices. Much like Ms Wellings, Ms Mohamed was also ‘apprehensive about the work environment’, given that most graduates still begin their nursing careers in the acute sector.
There are many nurses thinking about changing lanes but who are yet to make the leap. For Hattie Wilson, the community is ranked high on her career wish list. After almost two years in the acute sector, she has been thinking about leaving. ‘Although I have learned a lot, moving into primary healthcare could be the next step for me,’ she says. ‘As well as hoping it will provide a better work-life balance, it’s a different type of nursing and will allow me to grow as a nurse.’
The idea of having more balance is something that is shared by Ms Wellings and Ms Mohamed, who both agree that being able to manage their own time is a benefit of working as a nurse in the community.
The variety of community working
Ms Wellings believes that being able to take advantage of ‘fresh air between patients’ makes the community a more positive working environment. She says that ‘not being stuck in an office or on a ward all day’ adds to the variety of community shifts and keeps nurses motivated during the day.
The public health and health promotion aspect of this role is another advantage, according to Ms Mohamed. ‘Working on prevention and not just treatment of long-term conditions, as well as health promotion, is just one of the positive aspects of practice nursing,’ she says. As an adult registered nurse, she also feels her role enables her to look after patients from different age groups, including young children and babies, something she would not have been able to do working on an adult ward in a hospital. Working at the heart of her local community means she sees patients ‘from different walks of life’, adding to the variety of health and social care needs she comes across during the day.
Ms Wilson thinks the future of nursing will likely be very different to how it is today, with perhaps more focus on looking after patients outside of the acute sector. Moving into community nursing, she thinks, might be a new area for nursing career development. ‘There is a shift and active push for patients to be cared for in their own environment,’ she says. ‘By working in the community, you’ll be able to care for and treat those who require help, while allowing them to stay in their own homes.’
While working in the community might have some perks for nurses, it is fair to say that community nursing is not always plain sailing. ‘Patients’ home environments are not always the cleanest,’ Ms Wellings says of comparing her hospital and community workplaces. She also admits that being out on the road all day results in her needing to be more vigilant of where to stop for a comfort break – something which she did not have to consider while working in the acute sector.
She argues that ‘working alone for most of the day’ is part of the negative aspects of being a community nurse. This is also a challenge that can be faced in some GP surgeries, as Ms Mohamed describes: ‘I am the only nurse in my GP practice, so at times I miss working as a team.’
Ms Wilson agrees: ‘I think getting used to more independent and lone working is challenging; it is a big adjustment from an acute setting. In the community, it seems as though you are on your own much more and have to work independently, which can be scary.’
During previous workplace challenges, Ms Wilson had been supported by a team in the hospital and, thanks to them, has built up confidence and become more resilient. She feels this is something she would leave behind in a transition into the community. ‘I’d miss working in a close-knit team. There is always someone there to support you when you are struggling, or to lend an ear when things get tough.’
Could the community help retain nurses?
The pressures faced by the NHS acute setting seem to be making headlines on a weekly, if not daily, basis. Nurses on the frontline find themselves caught between an ageing population, with a growing number of medical and social needs, and a reduction in resources to care for their patients. Just under one third of nurses and midwives who left the register in 2018-19 did so due to stress and poor mental health, according to a report released by the Nursing and Midwifery Council. And 20% of those surveyed said they were ‘disillusioned by the quality of patient care’.
But could the community be the answer for nurses who find themselves stressed and burnt out in the acute sector? ‘I hope that a move to the community would allow for better working hours, creating a healthier work-life balance, which obviously would make for a happier life,’ argues Ms Wilson. She says she feels ‘extremely stressed’ in her current ward-based job. ‘The pressures and the expectations of patients is building, and staffing shortages are increasing.’ And the long shift hours, she says, leave her feeling exhausted.
She also believes she will reap more rewards from a community-based nursing role, which in turn will motivate her professionally. ‘I’d like to think I will feel professionally fulfilled working as a nurse in the community, as you have contact with more people, and can disseminate knowledge and advice to those people,’ she explains. ‘You will also have more of a bond with your patients as you will see them possibly over several months, or years, rather than just a few weeks on a ward.’