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The evolving role of the district nurse

I'm really passionate about being a district nurse and I feel strongly we need to raise the profile of district nurses and working in the community.

I have been a district nurse for 26 years and in that time community nursing has changed beyond recognition for the better.

My role has evolved with the development of expanding diagnostic and treatment skills, which has meant a huge advance for both the nursing profession and in turn the patients and families we care for. 

When I started I would be bathing stroke patients and applying wound dressings. Now we manage conditions that only a few years ago would have required a patient to stay in hospital.

I have a young man in my care who is having intravenous antibiotics at home. It takes us an hour and a half to administer the medication once a day. But if he was in hospital he would be there around the clock for at least a month. If we administer them for him at home he can then get on with his day. We have had patients like this for five-to-six months and they benefit greatly from being able to receive their medication at home.

We do this for patients with orthopaedic and neurological infections. These are quite nasty infections in the bone or a deep wound. It is a huge part of district nurses' case load as it takes two nurses to keep up with our competencies via observation as well as treatment.

The benefits are preventing an unnecessary stay in hospital for the patient, who could be there for months and enabling them to come home and have care that fits around him.

Advances in technology are also helping patients to recover at home. In the community we are now using a vacuum system, which is used in the Trust's general hospitals at North Tyneside and Wansbeck to clear the liquid from a patient's wounds.

It creates the optimum environment for the wound to heel and is now used by patients at home who carry it round in a shoulder bag.

My role expanded to include prescribing medicines in 1999 when I became a community nurse prescriber and I went on to study advanced clinical skills at Sunderland University followed by independent nurse prescribing at Northumbria University. I was lucky enough to be one of the first district nurses to get this qualification in North Tyneside. I can prescribe on the same level as a doctor, however, I always stay within my sphere of expertise.

Last year I was honoured to receive the honorary title of Queen's nurse, which is awarded by the Queen's Nursing Institute (QNI) to individual community nurses who have demonstrated a high level of commitment to patient care and nursing practice.

There is definitely a stronger emphasis on raising awareness of the profession as a whole and having networks in place like the QNI gives us a platform to share best practice with fellow teams, which is key for our development and the evolution of the services nationwide.

I work for Northumbria Healthcare NHS Foundation Trust which is unique because it is one of the few trusts in England delivering adult social care in Northumberland in partnership with Northumberland county council. The strong links are key for joining up care for patients and reducing unnecessary hospital admissions.

While I am based in North Tyneside where the local council has sole responsibility for adult social care, we have strong links and my work crosses many professions to ensure the best-tailored care for patients while maintaining compassion, empathy and respect.

One example of collaboration is a new partnership Marie Curie at Northumbria that is supporting palliative and end of life care patients across hospital and community. The aim is to make care more responsive and patient centred. We have a new matron overseeing the Trust-wide service and a specialist liaison service working with patients across general wards and in some cases accompanying patients home, to hand over to district nurses and support the family. There will also be a rapid response service in the community that is being developed. This is another example of how district nurses are playing such a key role in helping to deliver patient choice and patient centred care.

I find I still get emotional caring for people who may be reaching the end of their life. If it stops being emotive I would have to stop district nursing. In terms of paliative care helping someone die with dignity is what we are ultimately aiming for.