RCN primary care adviser and nursingtimes.net's star blogger Lynn Young has a word of caution - and a sense of déjà vu - on scrutiny measures for community nurses
The end of 2007 is upon us, and it's been an eventful year for some. As for me, I've decided it's time to ‘come out’.
I am now a certified OAP and a Grandmama, so lots of life changes for me, but for those in primary care who find me a bit of an agitating nuisance, let me bring reassurance I am certainly not ready to throw in the towel and enter the gentler but poorer world of retirement.
Health and competence willing, I intend to hang around for a good while longer and continue the many battles flourishing in the community health setting.
This week a sense of déjà vu has set in as the RCN is increasingly connecting, at national and local levels, to rather suspect time and motion studies being carried out by organisations like Meridian and Ernst Young on the work of community nurses. The point is I have been here before and I know the games that people are up to.
In the early 1990s the Tory government came out with the Value For Money Unit, which certainly did its stuff in Sefton and Staffordshire Community trusts. The result, for a time, was wholescale dismay, negative hyperactivity and intense communications and negotiations between Trust management and the RCN. It time it all went away, but left some blemishes in terms of new skill mix and bigger district nurses teams.
This in itself may not be a terrible thing - not many district nurses would argue that everyone carrying out some kind of nursing in a patient’s home has to be a properly qualified district nurse. But while there is always scope for re-examination of working practices the process of change needs to be carried out for the right reasons and in a sensitive manner.
The reports being sent to the RCN do not make me cheerful. It feels as if the companies used do not understand the complexities and subtleties of community nursing – and why should they? And are they only interested in what the nurses are doing? There is little knowledge on how nurses decide what is required, the value of relationships and interaction between nurses and families and how workload demands are managed and appropriately shared between work mates.
But there is good news to report: while community nurses are having to bear the onslaught of scrutiny by time and motion, rather industrial thinking type folk at the DH have made contact with the RCN about this trend.
The DH wants to learn from the RCN what some of the findings mean in real, human terms. We will do our best at these meetings to ensure the value and breadth of community nursing is understood rather then focussing all energy into insignificant number-crunching.