There is ‘very little strategic workforce planning’ for district nursing and services are ‘not very well coordinated’, a workforce academic has warned.
But Professor Alison Leary, the chair of healthcare and workforce modelling at London Southbank University, hopes the community nursing workforce standards she is drawing up with the International Community Nursing Observatory (ICNO) at the QNI will help manage workloads and support district nurses.
The standards, expected to be published in early 2022 following months of research including feedback from healthcare professionals, will draw ‘red lines’ for safety – such as the time allowed for visits, criteria on what constitutes an appropriate district nursing referral and unpaid overtime.
Professor Leary explained to Nursing in Practice there has been a ‘vacuum’ around what safe workloads for district nurses should look like. But the standards should support nurses in escalating issues with employers, and employers to do the same with commissioners.
‘For example, there’s currently no consensus on issues such as referral criteria,’ she said. ‘This means district nurses are just seeing everything and everybody. It’s ridiculous.’
Not only are there ‘not enough people with the right skills in community nursing services’, but some work is duplicated while other important work does not get done, she added. In addition, it is often left to ‘district nurses to pick up the work’ and ‘being a failsafe for everything else.’
Professor Leary also raised concerns about poor employment practices, such as staff not being refunded for travel. Likewise, she has found time allowed for visits is diminishing, citing one nurse being allocated seven and a half minutes including travel time to give someone insulin.
‘Services are not very well coordinated,’ she concluded. ‘There’s very little strategic workforce planning and many commissioners are missing the safety critical aspect of nursing care.’
Professor Leary’s comments follow an ICNO report last month that found the NHS is failing to capitalise on the expertise of district nurses by instead focusing on specialist teams delivering single-task care such as managing exacerbations and delivering intravenous antibiotics.
It also comes amid rising pressure on district nursing services, with a 37% rise in patients dying at home in England and Wales during the pandemic compared to the 2015-2019 average.
Yet district nurse numbers have significantly fallen – with 4,262 working in England as of July 2021, the latest figures available, down from 6,872 in July 2011, official figures show.