Less than half of patients receiving home nursing care know if the person treating them is registered, fuelling fears that district nursing is losing its identity, according to a Queen’s Nursing Institute study.
The report said patients often view the person that treats them as part of an “invisible army” of community staff but often cannot distinguish between a district nurse and a healthcare assistant.
This is indicative of the changing skillmix among community nursing teams, of which an “alarming consequence” is a “growing loss of nursing skills”, the institute warned.
It highlighted falling district nurse numbers over the past decade combined with an increase in use of HCAs to deliver elements of care previously the done by experienced community nurses, such as tube feeding patients, treating leg ulcers and changing urinary catheters.
The QNI’s report “Nursing People at Home” is based on a survey of 265 patients, in-depth interviews, and discussions with patient organisations. It forms part of the institute’s “Right Nurse, Right Skills” campaign which calls for a properly skilled and trained home nursing workforce.
The survey found the majority of patients - 70% - reported receiving a good or excellent standard of care from community nurses, but that the experience of some patients was “far from satisfactory”. The problems most commonly highlighted were lack of dignity and respect, feeling unsafe and inability to ask questions or voice concerns.
The institute said feedback on care quality was linked with the type of nursing staff that provided it. Of the 31% of patients who rated care as “excellent”, the report said “the vast majority received their care from a registered nurse only”.
One nurse quoted in the report said: “When patients see a uniform, they presume that the person wearing it is capable of the role but I fear this is often not the case.”
The government last week confirmed moves to introduce voluntary regulation for HCAs. Despite this, the QNI said it was renewing its call for mandatory regulation so HCAs could “play a full and accountable part in the delivery of care”.
The QNI also called on the Department of Health to introduce a regular national survey of patient experience of community services, comparable to the national inpatient survey.
- The institute also announced the induction of 31 new Queen’s Nurses at an awards ceremony in London on 15 November, bringing the total to 199. QNI fellowships were awarded to former chief nursing officer for Northern Ireland professor Martin Bradley and Ann Rowe, Department of Health implementation lead for the Family Nurse Partnership programme.