With more services moving to the community, nurses needs to be confident in all setting, says Eileen Sills
All of us can reflect on moments in our career that stand out. I have had many highlights over the past 32 years, but the one thing that stands out is our community integration programme. For me, this has been positive personally and professionally.
As part of the transforming community services programme, Guy’s and St Thomas’ bid on behalf of King’s Health Partners to be the host organisation for both Lambeth and Southwark community provider services in March last year. We won the bid and I was asked to lead the integration programme.
I had been an acute nurse for the whole of my career with the exception of four weeks as a student nurse, so this was very much outside my comfort zone. What did I know about community services?
So, I spent a week in each borough for an in-depth induction. This was probably one of the most important clinical times I have ever spent.
“Our integration is not about hosting community services - it’s about improving patient pathways so the transition between hospital and home is seamless”
We all have views about different areas of our profession, often developed from experiences, hearsay or myths and I was no exception. I thought I had an idea of what community teams did. My eyes were opened within 48 hours of my first week.
I was struck by the incredibly complex care, the broad range of nursing roles, the highly developed decision-making skills and the ability to manage risk and care for patients in some very deprived areas.
We all think we manage risk well but working with high-tech equipment in a clinical area staffed 24 hours a day is much easier than working through how patients and carers will fend for themselves.
I also witnessed the true meaning of holistic care. It’s not just about a clinical task or visit, but about developing a sense of a person’s surroundings and enabling them to live as full a life as possible. I saw and was part of that care, which was very humbling.
When the riots took place, I understood how difficult and important it was for clinical teams to continue with their duties.
One thing that stood out is how the profession has compartmentalised expertise. It is critical that, as nurses, we are more open to the learning opportunities that come from working in different settings. We have much to learn from each other; for example, community nurses integrate health improvement into clinical care to encourage patients to make healthy lifestyle choices.
As the chief nurse, I regret that I did not venture outside much earlier. Had I done so, we could have identified opportunities for developing patient pathways and workforce skills much sooner.
Maximising nurses’ contribution is not just about holistic care during an acute episode but seeing patients as a people; how they function at home and as part of society is critical. If we get this right, both patients and the profession will benefit. Our integration is not about hosting community services - it’s about improving patient pathways so the transition between hospital and home is seamless.
It’s also about a workforce that is confident in any setting. The opportunities are fantastic but we will only realise the potential if as a profession we acknowledge that nurses need a broad set of skills. I would encourage all of you to consider how you would get the right experience.
I am as guilty as anybody in wanting to stay put but, if I had my time again I would not hesitate to look for an opportunity to gain nursing experience in the community.
To fill that gap, I continue to gain community experience, as do my senior team, by rotating work and shadowing community staff. We are recruiting to rotational posts that will cross acute and community settings. This is just the beginning and we are looking ahead very optimistically.
Eileen Sills CBE is chief nurse at Guy’s and St Thomas’ Foundation Trust