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Working collaboratively empowers the nursing profession

Marilyn Eveleigh
Consultant Editor

Family circumstances have recently jettisoned me into the world of nursing homes - and an interest in the nurses working within them. On the one hand, I find myself in awe of these nurses - and yet, I'm more than a little anxious too ...

These days, the level of responsibility and clinical expertise required by nurses working in nursing homes is huge. Hospitals under pressure to provide acute beds and the national tariff that governs their contract, are eager to discharge patients when they are clinically suitable. Indeed, most patients and their carers want to be out in the comfort and familiarity of their own home. For an increasing number of the most vulnerable in the population, this "home" will be a care home with  nursing support.

Technological advances, evidence-based assessment tools and improved medication regimens allow earlier hospital discharge. Percutaneous endoscopic gastrostomy (PEG) feeding supports those with swallowing difficulties, sophisticated catheter design improves continence care and end-of-life pain management can be assessed and tailored to maximise dignity for the dying.

Such sophisticated clinical options require a new set of competencies for nurses. We need updated scientific skills to manage digital pumps and indwelling lines, underpinning knowledge if they break down and good communication links with GPs and specialists to effectively monitor treatment regimens.

Where do these competencies come from? Ideally, from well designed and timely training - but in reality, from a hospital ward nurse as they outline the patient care plan on discharge to the nursing home nurse. Assimilating patient clinical information, as well as their social and emotional needs, this nurse must make an informed judgement that the team will be able to provide appropriate levels of care over 24 hours from now on, with sporadic medical input that they may need to initiate. It needs time, clarity and demonstration for this crucial handover; with ward pressures many nurses report these are often lacking. A missed opportunity: a potential risk for readmission.

Nursing homes vary widely in their reputation for standards and care and the status of nurses working in homes reflects this position. Many homes report difficulty in recruiting nurses - but nurses report poor remuneration and training for their role, high staff turnover, an imbalance and dependence on unqualified staff, and few governance structures and supervision to support safe and consistent practice, as required of NHS organisations.

Despite regulatory bodies such as the Health and Safety Executive and the Care Quality Commission who have a responsibility to ensure the public are cared for safely, time and again, the press, the public and internal whistleblowers reveal poor standards and practice. Unfortunately, the few high-profile shocking cases overwhelm the vast majority of kind, caring environments. To my mind, the increasing number of formal reports and investigations into social care and nursing homes are to be welcomed - they send a clear message that as a society we safeguard our most vulnerable and will punish perpetrators of neglect.

National cases of neglect of vulnerable adults in nursing homes make harrowing reading. Every time a "nursing" home is exposed as lacking, nursing as a profession is tarnished. Nursing holds a public expectation and has a responsibility to protect the vulnerable: a Code that charges us to root out poor practice and report for the greater good. Ironically, the high clinical level of dependency of residents and the nursing skills needed to manage them, has seen an anecdotal increase in complaints against care home nurses for medication errors, palliative care management and poor judgements.

Can nurses do more to support colleagues in the private nursing home sector? Can we share training opportunities - infection control and anaphylaxis? Can we share workloads - they undertake seasonal and swine flu immunisations for starters? Can we partner better - as 16% of deaths take place in care homes, can we proactively ensure ALL care plans and last wishes are in place? Ensure better and protected discharge handovers? What of chronic disease management?

Working collaboratively and supporting nurse colleagues in nursing homes strengthens us as a profession, and empowers nurses to the benefit of present and future care home residents. Make a resolution to contact such a nurse. It is the very least we can do in support of our vulnerable population.

Your comments (terms and conditions apply):

"I too found myself having to take a position in a nursing home due to family commitments. I have been there for 5 months now. I take my hat off to anyone who works long term in such places. It is hard work with little support and training. The residents are increasingly dependent, GPs increasingly uninterested and the staff sickness and turnover is huge. I am doing my utmost to get back into the NHS but I will not forget the hard job my colleagues have to do when I eventually leave" - Louise Thomasson