Community nursing should be taught as separate degree

19 January 2010 | By Steve Ford

Community nursing should be offered as a degree subject separate from general nursing, according to a leading nurse academic.

Laura Serrant-Green, professor of community and public health nursing at the University of Lincoln, told Nursing Times there was a tendency to view community nursing as simply district nurses, health visitors and school nurses.

But she said the expanding role of nurses in community settings – in line with policies on public health and moving more services out of hospitals and nearer to home – meant discussion was needed around future training.

Speaking ahead of her inaugural lecture at the university’s Lincoln Academy next week, Professor Serrant-Green said: “The entrepreneurial appeal that started community nursing is still here.

“The biggest thing is how we shape it in the future,” she said. “What kind of animals do community nurses need to be?”

Professor Serrant-Green said: “In the future there will be much more caring for groups and communities, rather than just treating individuals.”

She suggested a separate degree would support the “innovation and entrepreneurial approach” needed to “think on their feet” outside of hospital settings.

“We need to sit down and discuss what kind of community practitioners we need,” she said. “All the professional bodies need to start thinking about this now.”

Professor Serrant-Green said the Prime Minister’s Commission on the Future of Nursing and Midwifery, of which she is a member, had discussed the issue.

She said the commission’s job had been difficult because of the changes already taking place in the profession – namely the move to degree-only entry.

She said the commission’s final recommendations would offer a “direction of travel” on the future of nursing, with recommendations on to achieve it.

“It will say, what do we think we want in 20 years time and these are the paths to get there,” she said.

Professor Serrant-Green’s lecture – titled Lady Superintendents, Sanitary Inspectors and Entrepreneurs – Community Nursing, 150 Years and Counting – will consider the past and the future of community nursing.

Readers' comments (18)

Student MH Nurse | 19-Jan-2010 9:19 am
I don't know if there are any other courses are being taught across the UK, but I am in my second year (2008 cohort of 40 students) of a community based degree at University of Essex in Southend. The 2009 cohort has 80 students with plans for 120 in the 2010 intake. I am on the mental health path, however the university also provides adult nurse training (ratio of 1:3 mental health:adult).

I love the course but I have certainly experienced some resistance, with many qualified nurses believing that I will still have to work on a ward for at least 1 year, if not 2 before moving out into the community. I hope that given time (for the policies to filter down and take effect) this resistance will lessen and I will not struggle to find band 5 posts in the community suitable for a newly qualified nurse!
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Michael Sandiford | 19-Jan-2010 9:45 am
I think this is a great idea! Community nursing offers its own unique challenges. I would have loved to have done this course as community nursing was always my main area of interest.

I think the idea of nurses needing to have experience in hospital prior to starting a community post is a bit old fashioned. Nurses I have worked with who moved from hospital to community sometimes seemed to have a "thats not how its done in hospital" attitude. Taking nurses fresh from training means that they won't have already picked up habits that might not be appropriate in community settings.

With more and more services being moved into community settings, I hope this course gets offered at more institutions.
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Anonymous | 20-Jan-2010 6:35 pm
I thought as a health visitor I had already undertaken extra qualification by undertakein my SCUPN training at PgDip!!! I feel that my nurse training porior to this has helped me in fulfilling my role, and worry that they are considering this move
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Anonymous | 21-Jan-2010 8:55 am
I do not think this a good idea. Like the other comment, as a HV I have already completed a PGDip in community nursing but constantly rely on my general background. I also think that the way nursing is 'breaking up' into subgroups weakens the profession. Health Visiting has cared for communities since it's beginning and I find it odd that Professor Serrant-Green suggests this is something for the future. Professor Serrant - Green asks what kind of 'animals' do community nurses need to be? I suggest we just focus on having nurses who are well trained and forget the animals.
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Anonymous | 21-Jan-2010 9:31 am
If pre-registration courses are doing what they should be doing, then nurses will have the skills needed to work in any environment.

Ideally you want to be able to introduce a nurse to a patient and have a care plan produced that is suited to the patient, environment, and any clinical conditions that are present or underlying.

There may be the perception that you need hospital experience because in the community you are much working far more independently than you ever are in a hospital setting. You have no colleagues to quickly grab for a second opinion, if you need a doctor to review a patient then you've got to be very sure of your reasons for wanting the review. Patients in community do deteriorate - before you can decide if the deterioration is significant or within the bounds of their illness you need to be able to notice the deterioration.

The other thing that holds community nursing back is those already in community - community nursing was traditionally where you went to do 9-5, and to get away from the 'heaviness' of ward work . There is often resistance to change, reluctance to deviate away from task based nursing, and a willingness to pass on anything slightly complex to other services/professionals and the earliest available opportunity.

So how is this for a novel idea - how about a training course that is centred around patients that produces nurses who are confident about working in any setting ?
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Maryam Omitogun | 21-Jan-2010 11:46 am
I dont support the idea of creating a separate degree for community nursing.
All experienced qualified general nurses should be able to work competently as a community nurse. By creating anoter separate degree for nurses will not add to the knowlwdge and experience one has got as a registered nurse especially if one has got broad experience in general nursing and hospital experience.
All the skills and knowledge needed as a community nurse will have been learnt while undergoing training as a qualified nurse.
All this degree creation is encouraging the young nurses to run away from having hospital experience. They are just after the salary they will get after graduation and this is not helping the servive users and the organisation they work with.
If one is qualified as a nurse on a diploma level, all nurses should go for their degree if they wish just like the Doctors,and there should be a specific start salary for a degree holder in nursing studies,All degree holder in Nursing studies should be concidered as a generalist and should be able able to work in any specialist,management and leadership role.
This type of degree I'm talking about is not attached to the NMC and this should be given a very good recognition.
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Caz W | 21-Jan-2010 1:08 pm
I don't agree with this idea. I think if you do a general nursing degree, you can work on the wards and in the community or any other number of settings. If you are well-trained and a decent nurse, you should be able to adapt to different environments. You can then go on to further study according to the preferred area you choose. I only qualified a year and half ago and worked on the wards for a few months to gain a bit more general experience. I am now happily working as a community nurse which I love. I'm quite interested in other community areas such as school nursing so could do this as I have an adult nursing degree but by the same token can do bank on a ward/A&E dept to insure I keep a range of different skills.

Student MH Nurse: I work with others that have gone straight into the community from qualifying so this is totally possible. I'm talking about community staff nurse rather than MH nurses tho so not sure about your branch. It depends on the trust you work for but some places are very resistant to change and the older nurses who've been there for years couldn't go straight into the community so that's probably why you're getting some negativity about this. However I would say that having some ward experience helps - I had 8 months but I'd say 1-2 years is about right, as in the community you're on your own and have to deal with situations on your feet. I've been lucky in terms of training and have been trained loads in the community, but if you can find a supportive ward to get some training and experience behind you first, I believe this would prove beneficial to you, your patients and colleagues in equal measures.
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Susan Preston | 21-Jan-2010 4:26 pm
I do not agree that a separate degree course shoiuld be started for community nursing.I trained in Adult nursing and had clinical placements on a wide variety of wards and departments in a general hospital and alsoo in the community. I decided that having done my community placement I wanted to work as a community nurse as soon as I finished my training. Fortunately a post became available just before I completed my training and I secured a job as a community nurse. I feel that the experience and knowledge I gained from doing the Adult nursing course enhanced my practice in the community setting and without that I would not have been as good a nurse if the emphasis of my training had been solely community based. There are already opportunities for nurses to get jobs as community nurse without having to work in a hospital first, and I think that if more health authorities allowed this there would be no need to split the range of nursing courses further.
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Daphne Woodhouse | 21-Jan-2010 4:39 pm
Having made good use of Professor Serrant-Green's earlier research I have a great respect for her opinions and look forward to reading her inaugural lecture (sadly I'm unable to attend). I think the design of the community degree course would need to take account of and forestall many of the fears and views expressed above as these are not groundless. But I also think that it is possible & desirable to go back to the drawing board and create a course that will take us into the future, joining up the dots of policy and equipping nurses to deliver a refreshed vision of community care.

I am about to return to general practice nursing having worked in sexual health in hospital settings for 10 years. I would hope that any new degree programme would not exclude nurses from transfering between hospital and community nursing. If this happened I could see a staffing problem in one or other environment resulting from restricted mobility between the 2 settings.

I also think that some experience in both areas helps the interface between them which is helpful to create smooth pathways for patients when transfering from one to the other.

I look forward to hearing more but hope I don't have to do another degree to work in the community!
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Anonymous | 22-Jan-2010 7:05 pm
I disagree. I am a final yr adult nusring student and had the opportunity to undertake a community placement. It was my experience in acute care that gave me the confidence in the community. I don't think i could go out into the community without first having hospital experience. Even the community nurses who went straight from training said if they had had some acute experience their entrance to the community might have been easier.
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Anonymous | 22-Jan-2010 7:48 pm
I don't understand why the professor believes a degree in community nursing is a good idea. As the HV's previously pointed out ( and school nurses) they have to undertake further training anyway to do the job, a path which I embark upon starting Monday! My PGdip in Specialist Community Public Health (HV). This is higher than a degree!!
I also feel that with life experience and 10yrs nursing in lots of different specialisms and with a military background as well as civilian training, I can offer far more as a community nurse than someone straight out of university.
However, having worked for a community nursing team at band 5 I would say that the move to include management and leadership skills into community nurse training is long overdue and necessary!
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jjjez@hotmail.com | 24-Jan-2010 3:55 am
Utter nonsense. it would more sense to train one branch of nurse generically in all areas and then get them to specialize afterwards.

I mean, yes a community staff nurse can call an ambulance, but would they be happy that that was their limits? i think not.

Acute skills are necessary in every job in nursing. moreso in the community. it's not just leg dressings and insulin therapy.

if community nurses had more acute skills they could prevent more admissons by dealing with problems rather than just calling an ambulance.

these think tanks shold be abolished as the ideas come from anywhere but young nurses, the only group worth asking.
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jjjez@hotmail.com | 24-Jan-2010 4:06 am
plus not to mention that these services they fantasize about 'moving into the community' are total codswallop. in an age of declining elderly and even middle aged health they expect to transfer the care f people into the community. well only healthy and capable patients can do this so i'd just like to know how it can be done - which it can't.

other countries just take the simpler route of building sizeable hospitals . why can't we be as clever. why does the target always need to be manipulated?
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Anonymous | 24-Jan-2010 11:21 am
I disagree, nurses need to be trained in the basics altogether as a foundation from which they can develop and then diversify. offering a community degree is a great idea later however I'm not sure how this is different from studying to be a Queen's Nurse or DN degree already around. Divide and conquer is never in the interests of the people.
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karen Staniforth | 25-Jan-2010 9:59 pm
community nurses will not be able to function in such a broad spectrum of patient conditions (medical, surgical and social) if basic training is not undertaken. It would seem to me that someone wants to section off the community into its own structure when in fact it is a continuation of care but in a different setting and different focus. I wonder if the first question which needs to be asked is 'what do community nurses do?' this may give the correct direction of travel for any academic course. My knowledge base is very broad and requires pools of knowledge about primary care services but without a doubt I still rely upon skill learn't in my basic training albeit 32years ago.
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Anonymous | 26-Jan-2010 8:01 pm
A nursing course specifically designed to produce nurses that could work in the community on completion of training was devised by London South Bank University and the first cohort started training in September 2005 and completed training in September 2008. The course was called the Primary Care Pathway (PCP) and since then there has been an intake every September.

Very little publicity was given to the Primary Care Pathway when it was started by LSBU but I would expect Laura Serrant-Green to be aware that the course exists. Students starting the PCP could enter at diploma level and had the option to do the degree in year 3. However, students starting the pathway now have to join at advanced diploma level.

Having been in the first cohort, there were obviously issues with the training programme that needed amending but I am aware that the university has been addressing these issues with subsequent cohorts.

There will always be those that believe you can't work in the community unless you have worked in a hospital but this is nonsense. Students on the pathway complete placements in acute settings during their training so they have experience on wards. If their intention is to work in the community straight away then the pathway equips them to do this. Should they wish to work in a hospital later on in their career then they would probably need extra training and orientation to that area. However, I think this is applicable to any nurse that is planning to change their area of work and if a nurse thinks they can move to a new environment without extra training or support simply because they have worked in an acute hospital setting, then I would suggest that they are naive and potentially dangerous.

With regard to the comment about nurses wanting to qualify with degrees because they want more money, I and several of my peers qualified with honours degrees and we all started on the first step of band 5. Having the degree may potentially help us when we apply for other jobs but for newly-qualified nurses there is no distinction between those with degrees and those with honours when it comes to starting salary.
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Anonymous | 30-Jan-2010 7:10 pm
as a community nurse from 1994 our role has changed dramactically, and as commented by jan 21st 09.31am we are NOT work sherkers who cannot hack ward work, and our role is more challenging then other nurses i know who are hospital based ,i wish my working day was 9-5, but when you are with a patient you cannot say sorry its 5pm i have to go, my working day can be up to 7.30pm to get through the workload, you can see a patient for a simple dressing and when you go there are other concerns and you are there for 2-3 hours.It is a fantastic area to learn / develop and enhance your skills and knowlegde, you work automously and your attached GP has to have a lot of trust in your clinical skills and judgement. I have lost count of how many "hospital" nurses think the community is an easy option , they sharp go back to the ward base as they cannot hack the workload or overall responsibility of the patient care. We have to have a very broad knowledge of wound care / palliative/ medication/ benefits/ catheters, this is a small amount of what we do, we are prescribers / teachers/managers/supervisors, jack of all trades and the master of them, so before anyone can make a judge ment let them try, i think not.
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Alan O'Brien | 2-Feb-2010 5:44 pm
I don't want to sound too old fashioned but bear with me.
I worked for two Years on an Acute admission Unit, and also felt the urge to work in the community where you do develop skills and develop services that are more tailored to the consumer group.
I still believe that the time I spent in an acute care setting developed my ability to cope with challenging situations and think on my feet, without which I dont believe I would have performed as well as a CPN.
In Patient services are the most criticised, and under valued area of Psychiatry, however when performed well this work is essential to the positive outcomes of consumers in the community. Everything that happens in the in patient setting is magnified and remembered, a positive experience leads to better outcomes with ongoing care in the community.
We need to develop a higher profile for in patient Nursing making it an achademic essential for all newly registered mental health nurses
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