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Improving efficiency and strengthening relationships

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Claire Read reports on a roundtable discussion about how technology can support community nurses. 

This roundtable was held in partnership with Allocate

Ask someone to name the areas of nursing in which technology might have the biggest potential to improve things, and community is typically one of the first on the list. The idea of district nurses swapping a car boot full of paper files for one electronic device is one that is eminently appealing. It holds the promise of increased efficiency, less time spent travelling back to base, and more time spent with patients.

A recent Nursing Times roundtable, held in association with Allocate, made clear that – in some areas of the UK, at least – technology is already supporting just that kind of increased efficiency. Sarah Hayes, deputy chief nurse of Whittington Health NHS Trust, was able to offer a striking statistic to illustrate the point.

“We found that introducing just an iPad saved an hour of a nurse’s day,” explained Ms Hayes, whose organisation provides community services across north London. “It was amazing. Because you were able to FaceTime, you were able to take away a morning handover. We haven’t quantified it any more, but I just think that’s very interesting.”

round table 3

Sita Chitambo added that technology had also made it possible to more appropriately use that increased capacity, through a workforce planning tool called eCommunity. The head of nursing explained: “You can see your daily capacity, and it RAG [red, amber, green] rates your priority 1s, priority 2s, priority 3s. So you can allocate staff according to that.

“At the end of a day, everybody’s gone home knowing which patients [they will be seeing the next day]”.

That sort of efficiency – in an era in which pressures on district nursing continue to grow – is of course hugely valuable. But our panellists were keen to stress the potential benefits of more technology went beyond that.

Panellists from Staffordshire and Stoke on Trent Partnership NHS Trust, for instance, pointed to its power to strengthen working relationships. Far from isolating colleagues from one another, they’ve found technology is actually bringing teams together. While district nurses in the area no longer go back to a central base, they do go to GP surgeries to charge up their technology and hold virtual meetings.

“It’s about the wider team for us,” emphasised Pam Davenport, district neighbourhood manager for the trust. “We do have staff that Skype into handover and we’ve linked in with GP surgeries. So they go into a GP surgery, and we’ve got docking stations in the surgery so they can dock and then Skype in. It’s keeping them in touch with their team, but it’s also building relationships again with GPs.”

The strengthened relationships between district nursing teams has paid huge dividends when planning resources across the area, she said. “We’ve used eCommunity to share and move patients across around flexibly [in line with] capacity and demand.

“So when there is a staffing problem, a nurse will say: ‘I don’t mind going to that team tomorrow to support’, because they’ve seen each other on conference calls; on the Skype calls. So I think actually that’s really improved our relationships. Also what the teams are doing is more transparent. They can all see what each other is doing.”

So technology is driving greater efficiency and stronger relationships across the community. But could it do even more? Could it help address some of the thorniest issues currently facing district nursing? Our panellists thought so. Take, for instance, the image of the field.

“The public think about district nurses and they think about Heartbeat, and about The Royal, and about Call the Midwife. That’s how it’s seen,” feared Maria Trewern, head of workforce insight at NHS Professionals and the new Royal College of Nursing (RCN) chair of council.

round table 2

Those around the table agreed that this outdated image did district nursing a great disservice. They wondered whether more clearly emphasising the way in which technology has been embraced – nurses on the go, using tablets, videoconferencing, and electronic case management – could actually be a way to attract people to the field.

Liz Jones, marketing director at Allocate Software, said she knew of an organisation working with the NHS which very explicitly focuses on technology to appeal to graduates. “It really does matter in terms of the vision of what the job is,” she argued. “And you think about the imagery that’s used currently for district nursing, it doesn’t represent what the job is in reality.”

It was a point with which Crystal Oldman, chief executive of The Queen’s Nursing Institute, agreed. “If you get students in [to district nursing] and they can see how tech is being used, and they can see iPads, and they can see it’s all efficient, then they’ll think I want to go and work in that kind of world.”

Of course, more people becoming interested in district nursing will be of limited value if the posts aren’t there for them to occupy. Here too, panellists felt technology could play a role, by making it possible to demonstrate the full scope of a community nurse’s work, contributions and expertise.

“The complexity thing has always really been a struggle. People make so many false assumptions about nursing, and I think it’s one of the ways technology can help,” said Professor Leary, who is chair of healthcare and workforce modelling at London South Bank University.Use technology to collect data on all of these areas, suggested Alison Leary, and you can fundamentally change the perception that nursing is simply about a series of tasks rather than about the application of knowledge in a myriad of complex ways.

Kathryn Yates, professional lead for primary and community care at the RCN, added it was crucial commissioners understood the complexity of the work now being carried out by community nurses.

“We have now moved into a very different way of caring for people at home. If you’re thinking of, say, syringe drivers, peripherally inserted central catheter lines, [central venous catheters such as] HIC lines, home ventilation.

“Things have changed considerably and there is increasing expectation that people will be managed and cared for at home with greater complexity.”

Leigh Malyon, account manager at Allocate, agreed. He suggested that technology could make it easier to quantify and record the full scope of the work being done by district nurses – and, in so doing, make the case for investment.

round table 1

“It’s probably the least task-orientated of all the specialties for nursing; it’s the most holistic,” he argued. “Technology makes it possible to capture all of those activities in a quick and easy way, to demonstrate the value of that role to the commissioners. I wonder if technology has got to fill that gap and evidence that, in the short term at least.”

Could such data also prove useful in tackling one of the most significant challenges across the whole of nursing – that of workplace planning? Many on our panel expressed frustration at the lack of one clear point of responsibility for that crucial issue, but did feel use of technology could help with the formulation of local plans. Indeed, Ms Davenport reported it had already made a difference in her area.

“We did some workforce planning locally, about three years ago, and it was the first time in about 15 years we had any investment in our community services from the clinical commissioning group. We were able to demonstrate that actually we didn’t have enough capacity in our teams to meet the demand that was coming through, and they invested in our services. For us that was a really big turning point.”

But if the roundtable discussion brought plenty of examples of where technology is already helping, it did also offer a strong insight into areas for further improvement. If efficiency is truly to be improved, many suggested that having systems that talk to one another will be key.

As Celine Grundy, service improvement manager at Staffordshire and Stoke on Trent Partnership Trust put it: “Currently in our own organisation, we have quite a number of systems in which the nurses have to duplicate the information for expenses, for mileage, for equipment.

“When we get to the point that isn’t happening, that will be the efficiency that district nurses will have.” And there was a sense from our roundtable that the time to get to that point – for organisations to take action – is now.

The panel: 

  • Sita Chitambo, head of nursing, Whittington Health NHS Trust
  • Pam Davenport, district neighbourhood manager, Staffordshire and Stoke on Trent Partnership NHS Trust
  • Celine Grundy, service improvement manager, Staffordshire and Stoke on Trent Partnership NHS Trust
  • Sarah Hayes, deputy chief nurse, Whittington Health NHS Trust
  • Liz Jones, marketing director, Allocate
  • Alison Leary, chair of healthcare and workforce modelling, London South Bank University
  • Leigh Malyon, account manager, Allocate
  • Jenni Middleton, editor, Nursing Times
  • Maria Trewern, head of workforce insight, NHS Professionals and chair of council, RCN
  • Crystal Oldman, chief executive, The Queen’s Nursing Institute Kathryn Yates, professional lead for primary and community care, RCN

Lucy Aldridge, senior marketing manager, Allocate
07967 813 875 

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