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Workforce planning for district nurses is 'ad-hoc and outdated'


More than half of district nurses say workforce planning is controlled by finance rather than patient need, according to survey results shared with Nursing Times.

The Queen’s Nursing Institute said the research was evidence of serious inadequacies in methods for working out caseloads, nurse numbers and skills mix – with decisions often simply based on what budgets allow or the “way things have always been done”.

“It is imperative that commissioners and providers have the right tools to enable them to minimise risks associated with workforce shortfall”

Crystal Oldman

Staffing needs were determined by “available budget”, according to 52% of respondents to the QNI’s survey of 150 district nurses. Only 15% said “size of caseload” was the determining factor.

The research also revealed that nursing teams found it almost impossible to plan staffing needs, even in the short term. Asked what period ahead their team was able to forecast staffing requirements, 40% said a week, 11% a month and 47% said that they were unable to predict at all.

In addition, nearly a quarter of survey respondents, 23%, said time was their allocated in 15 minute slots, rather than continuing as required until all patients were seen.

Feedback from the survey revealed district nurses felt under pressure from increasing demand for services without any increase in staff numbers. “Stress has increased among the teams resulting in increased sickness and nurses leaving the services,” said one respondent.

The survey was carried out as part of a wider QNI study into the district nursing workforce, which concluded deployment was based on flawed plans that failed to take into account the needs of local communities and the demands of the job.

The study, commissioned by NHS England, revealed a patchy picture of workforce planning, with much still done on a fairly ad-hoc basis. For example, there was often reliance on the judgement of team leaders and over-simplistic standard caseload sizes, despite the existence of new tools and systems to improve planning.

In many places, rostering and record-keeping was still done manually and team structures were based on “standard caseloads or subjective decisions”, which ignored local factors such as deprivation, number of care homes and geographical spread of patients.

In addition, efforts to assess service quality were hampered by inconsistent reporting that often focused on “contacts and not time, quality or complexity”.

Crystal Oldman

Crystal Oldman

“Decision-making remains decentralised, not supported by robust data, and often ignores the complexity associated with local factors,” stated the report.

The QNI said its findings highlighted the need to improve workforce planning and that it intended to start work on developing a standard District Nurse Strategic Workforce Planning Tool, which could be used everywhere and make it easier to compare data and share good practice.

The QNI has submitted a bid to the Department of Health to carry out the work in 2014-15, but noted this may be passed to Health Education England as part of its work on community nurse workforce planning.

QNI chief executive Crystal Oldman said: “It is imperative that commissioners and providers have the right tools to enable them to understand and minimise risks associated with workforce shortfall.”


Readers' comments (7)

  • tinkerbell

    If you're not angry about what is happening to what was OUR NHS then you haven't been paying attention!

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  • tinkerbell

    find out what's going on. Listen to Dr Clive Peedell and get informed. Then decide.

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  • michael stone

    Wow, I'm shocked (not) !

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  • I wouldn't put myself in the position of the nurse in the picture. she looks extremely vulnerable to aggression. there are too many unstable individuals about in isolated areas.
    recently a social worker and young mum was murdered in the woods driving her client from prison to his therapy. He escaped in her car and was eventually tracked down by the police hundreds of miles away.

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  • District Nursing has been a fantastic service for 150 years + but now it is being ruined by managers who know nothing of the job and well meaning auditors who try to make it fit into boxes. Its history is about a flexible 'swings and roundabouts' mentality that ensures all patients are seen even though we have to be an elastic service. Without this approach we will soon just be another 'its not my job/ waiting list' service. District Nursing needs to get back to its roots, small teams that work locally and provide the nursing care to those in their communities - whatever is needed but without heavy handed management and policies designed in hospital that are ill adapted for community - for example the safety thermometer that records 'harms' how can a fall that has taken place before the DN team have even been involved be a 'harm'?

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  • I understand the comment regarding the nurse in the picture and how vulnerable she is; however in rural areas nurses are working like this daily, as lone workers often going to isolated places. i used to work evenings for my Trust, in an out of hours team. We tried to double up if the place was isolated or in a "dodgy" area, we covered both rural and urban areas. however numbers were decimated and eventually we were doing these kinds of visits alone up to 11 pm. We did complain to our managers; their response was to "double up" but they did not provide the staff to do so. We could not refuse to see vulnerable people. Now the service has changed beyond recognition, then we would not dream of refusing to see patients, housebound or not but now there are tight criteria and not I might add considering the nurse's safety. I am glad I got out but feel for my friends still working in these teams.

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  • Anonymous | 21-May-2014 10:39 pm

    thank you for your response to my comment about the vulnerability of nurses working in isolated places. I think even in urban areas visiting any strangers' homes and especially going into some more run down areas puts nurses at risk.

    I feel for all of these colleagues, many of whom are so hampered in their provision of adequate services according to their own clinical judgement and expertise, and the serious consequences and loss to patients and to communities where we all run the risk of being potential patients and needing such care. It is unthinkable how such a situation in a developed country such as Britain has been allowed to arise and especially when one reads in today's Telegraph about poor discharge planning and vulnerable patients being sent home too early and sometimes even alone and in the middle of the night!

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