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Red light for district nurses?

The number of district nurses is decreasing and there are not enough newly-qualified professionals to take their place, according to Queen's Nursing Institute director Crystal Oldman.

In June 2013, the Queen's Nursing Institute (QNI) published a report on district nursing education. The report was based on research into the number of district nurse students in England, Wales and Northern Ireland studying for their community nursing specialist practice qualification in the academic year 2012-13. It also reported on issues the universities had experienced with the number of commissioned places in recent years. 

The research was prompted by concerns about the declining numbers of district nurses identified as part of the QNI's Right Nurse Right Skills campaign. This decline is completely counter-intuitive when there is a pressing need to use hospital beds more efficiently and to move patients into the community more quickly when recovering from illness or after surgery.

In order for this to happen, highly skilled, educated and experienced district nurses are needed to lead teams in the delivery of high quality complex nursing care.

It seems logical then that there will be more nurses being selected and supported to train to become qualified district nurses. This is a highly specialist role requiring the nurses to become autonomous practitioners capable of managing large caseloads of patients who need increasingly complex care in their own homes. 

It is astonishing therefore that the decline in district nurse numbers continues unabated. In the summer of 2013, approximately 250 district nurses will qualify in England, Wales and Northern Ireland. This number will not be sufficient to replace those who are retiring, let alone the number needed to cope with an increased demand in home-based care. 

The QNI is however heartened by the response to the report of NHS England, Public Health England and Health Education England. There is a real determination by our senior nurses to address the issue and to reverse the trend of disinvestment in district nursing. There is recognition that there is a need for considerable joined-up thinking, strategic planning and a focus on the best outcomes for patients and carers. 

First, there needs to be a clear understanding of the need for the district nursing service and the skill mix within the teams. Clinical commissioning groups (CCGs) require evidence on which to base their commissioned numbers and to plan for the shift of care from the hospital into the community.

Secondly, there needs to be an investment into the education of the team leaders of the service. I am often heard to say that it would be unthinkable to take a qualified doctor out of a hospital environment and ask them to lead care in the GP surgery without substantial additional education. In the same way, nurses who are to lead the teams delivering care in the home require the extra qualification as part of their preparation for this highly skilled and responsible role. 

Thirdly, there needs to be an improved exposure to the community nursing role as part of pre-registration nurse training. This is not without substantial challenges, but is essential to 
raise the profile of district nursing as an exciting and rewarding career option.

Lastly, I call on all ward managers to refresh their knowledge of community nursing by spending a day with a district nurse in the local community. I guarantee they will both learn something new and that patients will benefit from these experiences. I'm sure this will lead to more applicants for district nurse programmes as once the ward sisters and charge nurses renew their knowledge of this exciting and stimulating area of our profession, they too will wish to become active participants.