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Specialist district nurse role ‘vital’ to safe care in community


The specialist district nursing qualification is “vital” to ensuring safe and well-managed care in the community, according to new research.

The research published by the Queen’s Nursing Institute (QNI) and funded by the Department of Health highlights the key role of the Specialist Practitioner Qualification in District Nursing (SPQDN), especially when it comes to preparing nurses to lead community nursing teams and influence policy.

“Respondents felt specialist district nurses were the best key workers to have”

Candice Pellett

It also suggests the qualification has a direct impact on the quality of care patients receive and can help the NHS save significant sums of money.

The study, published today, was sparked by the QNI’s 2014 report on the future of district nursing, which gathered views from more than 1,000 district nurses and highlighted concerns about sufficient numbers of suitably qualified team leaders.

The QNI’s district nursing project manager Candice Pellett surveyed and carried out a series of focus groups with district nurses, students on SPQDN courses, university lecturers, practice teachers and mentors.

She said the feedback showed the qualification was “essential” in ensuring nurses had the right skills and competencies to operate in the ever more complex field of community-based care with multiple benefits for patients and healthcare employers.

“The overwhelming message from the focus groups and surveys was the SPQDN is vital to the safe delivery of patient care and in managing teams within the district nursing service,” she said.

“It is viewed as being essential preparation for the challenging role of leading teams to deliver the district nursing services in the community and to contribute to policy decisions,” she told Nursing Times.

Queen's Nursing Institute

Top district nurse to lead ‘nationally important’ discharge planning work

Candice Pellett

Nurses said the top three skills they had learned from the programme were leadership and management skills, clinical assessment skills and autonomous decision-making.

Many made a direct link between the qualification and the quality of care saying nurses with the SPQDN were better at managing case loads, working with and understanding the needs of families and carers, more likely to innovate and were best-placed to co-ordinate services for some of the most vulnerable patients.

This was especially true when it came to the ability to prescribe medicines.

“Independent nurse prescribers reported they could offer timely and faster access to medicines particularly at weekends when access can be more difficult,” said Ms Pellett.

“When it came to patients with complex, multiple, long-term conditions, respondents felt specialist district nurses were the best key workers to have because they have those specialised clinical skills of diagnosing, prescribing and evaluating care, helping keep the patient in their place of choice and reduce inappropriate hospital admissions,” she added

“This new report sends a very clear signal about the value of the DNSPQ”

Crystal Oldman

Nearly two thirds of nurses – 62% – who took part in a survey felt aspects of care could be compromised without the qualification especially around decision-making, case management and leadership.

Several participants raised the issue of “over-visiting” patients in the community. “This is when nurses may lack confidence in deciding when it is safe to discharge patients from the caseload,” noted Ms Pellett. “The evidence we’ve gathered shows clinicians with the qualification are confident in making decisions about when to give back responsibility or empower a patient with self-care again.”

The study painted a mainly positive picture when it came to accessing training but it also highlighted some issues.

More than 91% of nurses said their organisations currently seconded nurses to do the SPQDN. However, some teams were left short-staffed because of lack of cover for those doing the training.

More than 15% of those surveyed reported being unable to do the training because their employer only supported a modular approach, which takes longer than the one to two years normally taken to complete the programme.

Another issue was the fact modules were often specific to one education provider and could not be transferred to another university if a nurse changed employer and wanted to finish the programme elsewhere.

Others were put off embarking on the training because they felt two years was too long, while 29% said potential applicants were deterred because they would be expected to accept a lower salary.

Overall 72% said they were supported in undertaking professional development, with more than 86% saying they had an annual appraisal.

However, 28% felt they had limited or no support for their professional development due to lack of backfilling, low staffing levels and financial constraints.

Nurse arrives at a patient's home

Acute and community nurses work together to reduce COPD admissions

A nurse arrives at a patient’s home

Employers benefited from specialist district nurses’ enhanced skills and expertise and ability to shape services to respond to local demand, the research found.

There was also a strong financial benefit with a significant return on investment through the prevention of inappropriate hospital admissions and fewer hospital re-admissions and more timely and effective care at home.

In addition, those with the SPQDN felt more confident in getting involved in policy decisions and contributing to wider strategy.

They were also helping to train and inspire community nurses of the future with 84.6% reporting they mentored students.

The report concluded that the qualification “supports the development of practitioners with effective and transformational leadership skills” able to respond to changes in local and national policy and help shape policy.

“District nurses undertake care for people in their homes that not so long ago would have been done in a hospital setting so we need skilled leaders to lead the teams providing these complex clinical procedures and supporting whole families,” said Ms Pellett.

“This piece of work needed to be done to evidence the fact this qualification is vital to ensure there are highly skilled nurses coming through that can do this work now and into the future in a changing environment,” she told Nursing Times.

“This piece of work needed to be done evidence the fact this qualification is vital to ensure there are highly skilled nurses coming through”

Candice Pellett

One thing that was striking was how little research there was on the value of the qualification, she added. A key recommendation of hers was for more research to be carried out including a study to follow a group of nurses undertaking the SPQDN to track the development of their knowledge, skills and attributes and assess the impact on patients, families and carers.

Dr Crystal Oldman, the QNI’s chief executive, said: “This new report sends a very clear signal about the value of the DNSPQ.

“One of the most important points emerging from the report is the complexity and high quality of nursing care delivered by district nurses in the community today,” she said.

She added: “The DNSPQ is the very best preparation for a nurse working in the community to deliver holistic care, managing complex caseloads, preventing unnecessary hospital admissions and promoting patient comfort and safety.’


Readers' comments (2)

  • michael stone

    If 'care of the elderly', in particular, is to be 'moved more into patients' own homes' [which seems to be the plan], district nurses will be crucial to the success of this. And an increasing emphasis on 'better co-ordination' between hospital and community, etc, is also present in current 'guidance/targets'.

    It seems obvious, and so obvious that it seems beyond rational argument [whether or not a research study has 'proven' the point], that senior district/community nurses will be fundamental to the success or failure, of this 'new model of care provision'.

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  • Specialist nurses are more expensive. Realistically the NHS can't afford quality only quantity.... If you pay peanuts you get monkeys

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