Fears have been raised about the future of district nursing, as student numbers decline.
Crystal Oldman, chief executive of the Queen’s Nursing Institute (QNI), said funding and workforce issues were preventing healthcare bodies from being able to release their nurses for training.
“If there are fewer, fewer district nurses being trained it’s not easy to turn the tap back on”
Dr Oldman told Nursing Times that action was needed now before it was too late.
“If you are all thinking ‘it’s a problem we can kick the can down the road, we will deal with this when austerity is over’, there won’t be the service there,” she said. “When we all need a district nurse in the future where will they be?
“We are flagging this as an issue. If there are fewer, fewer district nurses being trained it’s not easy to turn the tap back on,” she said. “We are creating a legacy of a decline and we are allowing it to happen, we should be intentionally reversing that decline.”
Her warning came as a new report from the QNI – titled the District Nurse Education Report 2016-17 – showed that the rise seen in district nurse students in recent years had stalled.
Between 2013-14 and 2014-15, the number of people entering a district nurse specialist practitioner programme increased by 32% from 427 to 566 and stayed stable in 2015-16 at 565. However, the report revealed that in the last academic year new students fell to 551.
“More care is required to be delivered in the community… yet we are not investing in any kind intentional way into that workforce”
There was also a significant 10% drop in the number of people qualifying from a district nurse specialist practitioner course in 2017, compared to 2016, from 517 to 464, the document noted.
In addition, it higlighted a slight reduction in UK universities approved with the Nursing and Midwifery Council to offer these qualifications, from 44 in 2016 to 42 in 2017.
Of the 38 universities approved by the NMC that responded to the QNI’s survey, two said they were no longer running the course. One was planning to apply for re-approval in 2021.
Dr Oldman said this decline in students was against a backdrop of a 46% plunge in district nurses since 2010.
She added: “Our concern is that, at a time when more care is required to be delivered in the community, at a time when are facing winter pressures, when we want to free up as many hospital beds as possible and have all those people who can be cared for at home cared for at home – that we have the potential to fix this problem and that we have the potential to have more nurses trained to be the team leaders, to take that responsibility to lead autonomous nursing services in the community, who will manage all of that risk if they are trained, who will manage all of that risk of taking care of people who would otherwise be in hospital, taking care of them in their own home – and yet we are not investing in any kind intentional way into that workforce.”
She said provider organisations were “crying out” for more support to enable their nurses to enrol on a district nursing programme. Barriers standing in their way included funding to pay nurses a decent wage while they trained and finding the backfill nurses to cover the student while they were studying, warned Dr Oldman.
“There is the absolute problem of where do you get the skilled nurses in order to do that backfill”
She said: “Across the country there are differing ways of supporting nurses to go onto the district nursing programme. In some areas there is backfill, in other areas there isn’t, so where there is no backfill there’s very little capacity to then be able to send a senior staff nurse onto a district nurse programme, even if you want them to you haven’t got anyone to backfill.
“In other areas, there’s no way to be able to pay them their salary, so if you are at the top of band 5 and you are going onto a district nurse programme, you may be asked to go on to the bottom of band 5 as if you were a newly qualified nurse and take that salary for a year,” she noted.
“You can’t really do that because you’ve got financial commitments so to lose £4,000 to £5,000 in a year is a huge amount to give up and you are going to do additional work because it’s an academic as well as professional qualification,” she said. “Then there is the absolute problem of where do you get the skilled nurses in order to do that backfill even if you have the money for them?”
Dr Oldman called for a public audit in England to determine the true need for district nurses, like there had been in Wales.
She also said more should be done to raise the profile of district nursing to encourage more people to enter the profession. She added in the future the QNI would be publishing a series of positive case studies to help people understand the role and value of a community-based nurse.