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‘Community care requires a huge change in mindset’

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The clocks go back this weekend, the days will shorten and darkness will descend more quickly than many of us would like. Then Halloween will loom, and the talk will be of ghosts, ghouls and gremlins, rather than coughs, colds and credit crunches.

Nurse educators and managers have been challenged to perform a magic trick, namely to make thousands of nurses spring seemingly from nowhere and to place them all in the community as competent practitioners so patients can receive care closer to home.

This trick will be no treat for these nurses or their patients. Community care mirrors hospital care in some ways but huge changes are needed in a nurse’s mindset when leaving the ward for any community post, whether in an urban or rural setting.

There are aspects of nursing common to all of us. But take a cohort of nurses who may have experienced community care only for a few months during training, pack them off to a polyclinic or other facility that exists to rubber-stamp patient access and choice, and trouble will ensue.

Care closer to home sounds very comforting; it’s the scarf and gloves of healthcare. But explore the idea further and it becomes more filled with holes than my feeble attempts at knitting.

How should care closer to home be defined? There appears to be no consensus, although I hope kitchen-table tonsillectomies will not be making a comeback.

If Lord Darzi & Co expect us to siphon off nurses from acute care or allocate newly qualified nurses to the community, someone somewhere needs to be certain of what has to be achieved, why it has to be achieved and how it will be audited.

We must be able to vouch for the quality of educational preparation. Funding for this needs to be guaranteed, as does protected learning time. Community care can be cost-effective but it is a dangerous error to believe it can be achieved on the cheap.

Working in a walk-in centre, a GP surgery, a nursing home or an out-of-hours clinic demands new skills in addition to those already gained in a hospital setting.

Many stumbling blocks exist. If nursing staff are taken from hospitals, who will staff those hospitals?

But when all is said and done nurses should be supported and respected, regardless of the setting in which they work.

Jane Warner is a practice nurse in Devon

Want to read more of Jane Warner’s opinions? Just click on the more by this author link at the top of the page.

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