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Profile: A day in the life of a health visitor

The role of the health visitor has evolved over the years, and todaythey form part of a skilled multidisciplinary team caring for and supporting families

Health visiting has undergone extensive changes over the past three years during 'Call to Action'. This has increased the workforce significantly through training an additional 4,700 health visitors (HVs). Health visitors are at the forefront of delivering high quality public health and health visiting advice and support. As a universal service, health visiting is the only service that is consistent in the lives of children and families from pregnancy to five years, and putting HVs in an ideal position to empower families to take the lead on reducing inequalities for our children. 

HVs are highly trained practitioners; all are qualified nurses who undertake a year-long specialist community public health nurse degree or masters degree.

As a practice teacher, over the last four years I have guided many professionals who have crossed over into our service. What advice would I give professionals considering a move into health visiting? Well, firstly you need a passion to improve the lives of children and to support families in those vital early years. Secondly, do your research. A good starting place is the Department of Health (2011) Implementation Plan and the new Public Health England (2014) six impact area document which set out the case for our service. These provide a comprehensive overview of our role from pregnancy through to age five. Also read the Healthy Child Programme (2009) and try completing the HCP e-learning core modules online. This e-learning offers everyone thinking of entering the profession an insight into the world of the health visitor.

Additionally, take a look at the Institute of Health Visiting (iHV) website. The iHV was established almost two years ago to promote excellence in practice through education and support to student and newly qualified health visitors in particular.

Through this website, and membership of the institute you will gain access to a huge amount of knowledge on current topics all supported by the latest research and practical experience from the front line. Then, if you are still keen to progress with a career in health visiting, why not contact your local HV team manager and ask about 'shadowing' a HV for a day. Alternatively pop into your local Children's Centre and speak with staff. Children Centres work closely with health visitors, providing a variety of group and one-to-one support with families. 

A typical day: real-life diary extract

9am: The start of the day

Admin and phone calls - a hectic part of the day. Answering phone messages that have come in over the weekend from parents looking for advice, messages from social workers with concerns about families, calls from the local hospital special care baby unit (SCBU) sharing information about a baby ready to be discharged home, and information about a baby born early over the weekend. A team liaison ensures the day's work is allocated fairly and support offered to junior staff.

The HV team can include a staff nurse (usually a developmental role, prior to commencing the SCPHN course), and nursery nurses who add invaluable experience to the team. Their role includes performing the two-year development check and providing support at baby clinics. Catching up with emails and planning the day's visits means this first hour passes very quickly.

10am: New birth visit

Today's visits begin with family who have just had their first baby. The visit encompasses an assessment of the baby's physical aspects, feeding preferences and giving support/advice with this; assessing emotional changes in both parents since the arrival of the baby. This is a critical area for discussion as the attachment (bond) between mum and baby and dad and baby is critical to the baby's wellbeing. The relationship between parents and HV can often help to cement the positive relationship with their baby. Postnatal depression is common, occurring in 10-15% of parents, including fathers. The HV will discuss this with both parents and will look for mood markers during this visit. The HV will also tell the parents what support is available in the local area; children centres, baby clinics and how and where to contact the HV. 

11.15am: Antenatal visit

The next visit is to a vulnerable mother-to-be who has a history of depression and anxiety. Evidence tells us1 that early intervention is key to improving positive mental health for families. This visit takes 90 minutes as the HV undertakes an in depth assessment. This assessment is a two-way dialogue between the mother-to-be and the HV. 

12.30pm: Team allocations meeting over lunch

A lively and focused weekly meeting where cases involving safeguarding concerns are allocated as well as families requiring follow-ups, antenatal visits, new birth visits, transfer into the area visits. Ten month and two-year developmental visits are aligned as well as planning for baby clinic cover. Team annual leave, study leave, updates on trust activities are shared, and the 'duty HV' cover is discussed. Work may come to the team directly from parents as well as from GPs, midwives, child health, safeguarding teams, police intelligence, social care, local hospitals and children's centres.

2pm: Core group meeting

Meeting with children's social care service regarding a family with two children, both on a child protection plan (section 47 of [2008] Children Act). The core group consists of lead social worker, health visitor, children centre team member, mental health support worker and drug/alcohol support worker. The mother is present with the baby while the older sibling is at pre-school. The plan for each child is fully discussed, any changes noted and the revised plan agreed with the mother. All agencies agree their input and visits and ensure that the mother is fully involved in the plan.

3.30-5pm: Record keeping

Back to the office for a much-needed cup of tea and time to input all the visits of the day onto the electronic record keeping system.

Career progression

The career path is expanding for HV and one such accolade is to become a fellow of the Institute of health visiting after five years of practice. Becoming a iHV fellow is a prestigious honour in its own right and an important part of any professional journey to enhance the role of the HV and its contribution to child health, well-being and development. This award is given to HVs who have made outstanding contributions to the service and show great leadership potential to take health visiting into the future. I was extremely honoured to be awarded this recently to become one of the first five health visitors in the country to become a fellow of the Institute.

Summary

The role of the HV is wide and varied but most importantly massively rewarding for the health and wellbeing of our children and the families who care for them. It encompasses not only a role in public health promotion, leadership, supporting a change in behaviours through empowerment but a role as communicator between many agencies involved in working with families who have children under five years.