England: District nurses draw up plan for changing roles

  1. From Royal College of Nursing's (RCN), Nursing Standard website.
    No date. posted this week.
    RCN is = to ANA. Nursing Standard is similar to AJN and Nursing World, ANA's website. District Nurses are visiting nurses. Karen

    Framework is aimed at reducing inappropriate referrals and meeting local needs

    District nurses draw up plan for changing roles
    By Paul Dinsdale

    DISTRICT NURSES have drawn up a blueprint for their future in a bid to overcome the 'confusion, uncertainty and upheaval' they are facing.

    In particular they want to halt the number of inappropriate referrals they receive, which prevent them spending more time with patients who benefit most from their services.

    The blueprint has been drawn up by seven members of the RCN's district nursing forum following a consultation exercise with forum members. It sets out a framework for district nursing services that can be adapted to meet local needs.

    The document points out that the number of visits made by district nurses has fallen in recent years, but their workload has increased. This is because of the increasing number of patients with complex needs who are being cared for in the community as well as the large number of inappropriate referrals district nurses receive.

    The forum will now draw up a set of criteria for referrals that it hopes could be adopted nationally.

    Forum vice-chair Lucy Botting said the publication of the framework was intended to stimulate discussion about the direction of district nursing.

    'Although the number of visits by district nurses is falling in many areas, there are now more complex cases involving patients coming back into the community after discharge from hospital, so each team should evaluate the skill mix it needs to meet local demands,' said Ms Botting.

    'The issue of inappropriate referrals has caused problems in recent years, as many NHS organisations have "dumped" cases on district nurses if they didn't seem to fit anywhere else.

    The problem has been that the role of the district nurse has not been clear and we need to clarify it in order to have more control over our workload.'

    Another reason to define the role more clearly is to improve recruitment. District nurse numbers are falling and, while student numbers are improving, it will take time for the increase to be felt in the community. The forum says district nurses should be able 'to articulate patient need and identify what is needed in terms of grades and skills in order for the service to have a positive impact on community health'.

    It says that the number of district nurses employed needs to reflect a culture of proactive care rather than merely reactive or crisis intervention.

    Although the recommended ratio is around one district nurse to 3,000 people, the forum says this approach is 'not helpful' and that it is not possible to suggest an ideal grade and skill mix that could be applied to all teams.

    District Nursing: Changing and Challenging - a Framework for the 21st Century will be published later this month.
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