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District nurses facing rising workloads with increased administrative pressures

District nurses facing rising workloads with increased administrative pressures

The RCN’s District and Community Nurse Forum has echoed concerns that community nurses are facing unpaid overtime alongside rising clinical and administrative pressures.

The comments come after The Queen’s Nursing Institute (QNI) released its ‘District Nursing Today’ report this week, which follows on from previous findings in 2019.

The QNI’s report showed that district nurses are facing rising workloads, amongst other challenges.

Based on a survey of 1,500 district nurse leaders – the analysis found that the proportion of district nurse caseloads of 101 to 200 had fallen by almost 5% (to 20%) compared to the findings of a previous QNI survey in 2019. In contrast, caseloads of 600 plus had risen to 16.2% in 2023, from 11.5%.

Commenting on the findings, District and Community Nursing forum chair Gail Goddard told Nursing in Practice that many trusts are merging smaller teams into larger ones to cover broader geographical areas.

Where this has happened, district nurses have to travel further to care for people in the community, and heavy traffic in urban areas adds to these already long journeys.

She said: ‘Workload pressures are increasing; as the survey shows, community nurses are working many unpaid extra hours to complete the care of patients.’

Ms Goddard said that administration volumes had also increased: ‘The amount of administrative work required of district nurses has also grown, mirroring the report’s analysis of the increase in time taken by district nurses to complete paperwork after each visit, with many trusts requiring district nurses to complete templates for certain treatments.

Another district nurse explained to Nursing in Practice that: ‘Some of these templates are up to 10 pages long for wound care or pressure ulcer prevention for example and it may take a nurse as long to document the visit as it does to carry out the care itself.’

The QNI’s report also scrutinises the growing impact of virtual wards and remote monitoring on community nursing services, with only 4.5% of the 1,500 survey respondents saying that virtual wards had decreased their workload.

However, 28% of the district nurse respondents said that virtual wards had increased their workload, with 46.2% of respondents saying that they had made no difference.

This contrasts with the mood at RCN Congress where speakers saw a ‘wide opportunity’ for virtual wards to provide more ‘expansive and holistic care’.

Discussing the continuation of remote and virtual work following the pandemic, Ms Goddard outlined how virtual appointments with older patients can be challenging, especially when patient’s calls with GPs fall through due to difficulties with technology with some patients.

‘GPs then require community nursing services to visit to do further diagnostics to aid their diagnosis, which is also increasing the workload.

‘This is not GP bashing as GPs are under enormous pressure and there are not enough of them to cover their workload, but there is a knock-on effect to community nursing,’ she said.

The report goes on to  detail how ‘electronic scheduling’ does not give staff enough time to complete their work, with some trusts struggling with an unrealistic ‘culture of always saying yes to referrals,’ regardless of whether the team is at capacity.

Ms Goddard explained that trusts which use electronic systems to manage off duty staff usually require nurses to add hours onto a health roster to be paid for those extra hours in arrears.

However, some trusts will not allow staff to claim extra hours in this way, and instead suggest that time is taken back in lieu.

‘But when workload is higher than capacity, as it is in most areas, the possibility of finishing early or taking a day off to regain that time is very challenging,’ Ms Goddard said.

The QNI report further shows a rise in Band 3 and 4 staff joining district nursing teams, including nursing associates, with 52.4% having no nursing associates on their team in the 2023 survey results, compared with 73.9% in 2019.

Despite these challenges, the report showed that the number of team leaders without prescribing qualifications has also fallen, with almost a third of team leaders holding a V300 qualification in 2023, compared to 18.5% in 2019.

Further, the number of respondents who had completed an advanced clinical assessment course or module had also risen, at 43.4% in 2023 versus 38.2% in 2019, with growing numbers of district nurses also working with a DNSQ qualification, despite most employers not requesting this.

This increased training is reflected in the growth in respondents who are being paid at Band 7 on the Agenda for Change scales, while the number of those on Band 5 and 6 has fallen.

Despite the rise in district nurse leaders working at Band 7 and above, Ms Goddard described how many district nurses are not being paid appropriately for any overtime work that they do, with Band 6 nurses being paid overtime at a Band 5 rate, for example.

She warned: ‘The concern about the future of the DNSPQ qualification is having a direct impact as some nurses are choosing to follow the Advanced practice career path as there is no clear supported career progression within district nursing.’

In the report the QNI concluded: ‘Many though not all of the concerns raised by district nurse team leaders included in this report could be addressed by greater central government funding.’


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