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PRACTICE COMMENT

'Community nurses do have the power to save our NHS'

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Crystal Oldman reflects on how community nurses can improve people’s health at every stage of life

In advance of the Queen’s Nursing Institute’s annual conference, I have been reflecting on the collective power of community nurses to improve the health of our nation - and when I say “community nurses” I mean nurses across the whole range of specialties. We are there to support people at every stage of life, often when they are at their most vulnerable.

At the start of life, midwives provide expert, skilled care with parents increasingly requesting a home delivery. Within two weeks, midwives hand over care of the new family member to a health visitor or family nurse, who offers support until the family’s youngest child starts school. Significant investment in the health visiting service in recent years has raised expectations about the opportunity to improve the health of our younger population, for example by reducing the prevalence of obesity and other lifestyle diseases.

School nurses continue this public-health approach, promoting and supporting health and wellbeing - including providing safeguarding activity and offering sexual health advice - to schoolchildren. Young people who move on to higher education may go to university-based practice nurses for immunisation, cervical screening and family planning services. Those who go straight to work may engage with occupational health nurses.

As young adults become parents themselves, the cycle continues and community nurses, health visitors and midwives may see families through two or three generations in the same neighbourhood, building a longstanding, trusted relationship with the whole extended family.

A third of us will have a mental health problem at some point in our lives. Community mental health nurses help people remain in their homes and communities, offering a wide variety of interventions and support programmes. Other community-based specialist nurses become experts in specific conditions, from continence to Parkinson’s disease. There are also community nurses providing care for people with learning disabilities, and community children’s nurses supporting those with long-term and life-limiting illnesses. Others provide outreach services to vulnerable and marginalised sections of society.

For older adults and the less independent, district nurses are key coordinators of health and social care services. These nurses are the experts in managing long-term conditions, wound care, and preventing hospital admission and readmission of people who can be safely cared for at home. At the end of life, district nursing and hospice-at-home nursing services are critical to ensuring both the person who is dying and their family receive the support and services they need to enable a comfortable, dignified death.

This brief reflection highlights the tremendous power of community nurses to influence the health of our nation at every stage of life. We know our neighbourhoods and we build strong relationships with our communities. We are a huge force for good and I am confident that community nurses will yet prove to be the saviours of the NHS.

Crystal Oldman is chief executive of the Queen’s Nursing Institute.

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