District nurses have ‘untapped potential’ to reduce hospital admissions
LONDON: The health system is “failing to capitalise” on the skills, knowledge and experience of district nurses as a resource for helping with the avoidance of unplanned hospital admissions, according to a report.
Researchers found there was an increasing expectation that community health services and district nursing will contribute to avoiding unnecessary admission to hospital.
For example, 60.4% of NHS commissioners in England had set out in contracts the role of community health services in preventing unnecessary hospital admissions
Of those, 48% included a specific expectation that district nursing teams would work to manage ambulatory sensitive conditions at home to avoid unplanned admission, they said in their report.
But, despite the emphasis on district nursing teams preventing unnecessary admission, many teams said they lacked the basic tools to manage some of the most common ambulatory care sensitive conditions.
Only 13.3% of teams had access to rescue medications, such as antibiotics and steroids, and just 14.6% reported having a patient group direction to facilitate the management of a patient experiencing an exacerbation of chronic obstructive pulmonary disease.
While 28.6% of teams had an independent prescriber qualification, a number would need access to this and associated diagnostic equipment in order to safely and effectively manage an exacerbation.
In addition, many nurses holding the District Nursing Specialist Practitioner Qualification had minimal opportunity to consolidate and maintain their skills in practice following the course.
Researchers from the Queen’s Nursing Institute’s (QNI) International Community Nursing Observatory looked at contracts from a sample of commissioning bodies in England, Wales and Northern Ireland.
They also carried out a survey of district nursing team leaders across the three countries, receiving 726 responses.
The study report, called Untapped potential: District nursing services and the avoidance of unplanned admission to hospital, was written by John Unsworth, professor of nursing at Northumbria University.
He said his research showed that the district nursing workforce had the “skills, knowledge and experience necessary to care for a range of patients at home who might otherwise end up in hospital”.
Professor Unsworth stated that the “only way out of the current pressures” on the health services was through “robust and transparent workforce planning” that accounted for skills as well as numbers.
He added: “No one would argue that the number of staff is not important, but we also need to ensure that we fully utilise the specialist skills and knowledge of the staff we have.”
QNI and Royal College of Nursing (RCN) figures show that district nursing in England has been in decline for than eight years, with numbers falling by 48% since 2010. Rates in Wales and Northern Ireland have also reduced over the same period.
Although the decline has been reversed with more investment in training specialist practitioners, the QNI has warned that the number joining the profession is not enough to return numbers to their previous level, or meet rising demand.
QNI chief executive Dr Crystal Oldman added: “This report outlines how there is untapped potential for admission avoidance work to be undertaken by existing district nursing teams.
“While capacity remains a significant issue, district nursing team leaders in particular have the capability to manage patients safely and effectively at home with a range of acute and long-term conditions.
“This report reaffirms the value that the District Nurse Specialist Practice Qualification brings to team leaders who are at the forefront of providing care to people in their homes and in our communities,” she said.
The RCN’s lead for community and end-of-life care, Carolyn Doyle, said: “District nurses make an enormous contribution, which is often invisible – a patient’s front door is their front line.
“The impact of what they do is vast, including to help prevent avoidable hospital admissions. We have to invest in the services they provide, for patients and for the nurses themselves.”
