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Exclusive: Community nurse team pioneers care home link role

  • 17 Comments

A new community nurse role that works exclusively to support care home staff has been pioneered in Devon, with plans to roll it out to the wider region following its success.

Newton Abbot Community Nursing Team introduced the position – called the residential home lead nurse – almost two years ago, after noting the increasingly complex level of care required for older residents.

“I was shocked by the care that was expected of my colleagues in the care home”

Alison Davey

Missed opportunities for providing preventative care was leading to an over-reliance on community nurses and GPs to step in and help care staff.

The new role was created to identify residential homes that need assistance and provide a six-week period of support. This includes taking over care normally provided by district and community nurses, and acting as a role model to care assistants in the home.

The nurse reviews care plans, sets up and signposts to relevant training opportunities – such as those on dementia, nutrition and continence – and from then on makes regular visits to the 26 care homes that the team covers.

Following the role’s introduction, the community nursing team has seen improved outcomes for care home residents, including reduced pressure ulcers.

The team now receives fewer calls about minor health issues and, instead, is contacted on a more regular basis for help with significant, preventative interventions.

“We were expecting carers to be our eyes and ears as nurses and pick up clinical things that we were quick to blame them for if they didn’t let us know”

Jan Hughes

Alison Davey, manager of Newton Abbot Community Nursing Team, introduced the role having developed it alongside a colleague in her previous job.

During her previous post she was alerted to the complexity of conditions now found in care homes, which she compared to those she had seen in the past on hospital wards.

“I was shocked by the care that was expected of my colleagues in the care home,” she said.

“I realised the [high number of phonecalls to my team] was a cry for help. And that it wasn’t that [the staff] were incompetent, it was that the clients were becoming so ill they didn’t know what to do,” added Ms Davey.

Ms Davey appointed community nurse Jan Hughes to develop the residential home lead nurse position, and has since employed her in the role at Torbay and Southern Devon Health and Care Trust.

“I recognised… we were expecting carers to be our eyes and ears as nurses, and pick up clinical things that we were quick to blame them for if they didn’t let us know,” said Ms Hughes.

Ms Davey paid tribute to Ms Hughes’ work in bridging the gaps between community nursing teams and care homes, and also between different providers through a forum she set up.

She said she hoped the role could be implemented across the county.

The new role has been approved to sit within the NHS’s Agenda for Change framework and Torbay and Southern Devon Health and Care Trust is now looking at introducing the position in its other community nursing teams.

  • 17 Comments

Readers' comments (17)

  • michael stone

    I think I like this idea.

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  • Dear Michael
    At first glance this iniative sounds great and any instances of the Public and Private Care Providers working together should applauded.

    Working in the Care Home sector for many years I have seen many changes to what constitutes "Nursing Care" as applied to Care Homes.
    The reason behind this continual debate stems from when there was a distinctive split between Residential Care Homes and Nursing Care Homes defined by the Res.Act and seperate registration and inspection depatments were set up in the Local Council (for Re. homes) and in the Area Health Authorities (Nursing Homes) About 5years ago the Government passed a new act of parliament under which All the registration and Inspection was given to an "Independant" Authority (Now called the CQC ) but there are conditions relating the Homes providing Nursing Care which should ensure that the Nursing Care is provided "in house" I think that the above scheme which is well intentioned, I am sure should be approved by the CQC as I believe that the Homes concerned should be registered to do this and if so could fall foul of the act and then be liable to prosecution.
    The question of Insurance should also be considered, who would cover this in a case of neglect etc. ?the Home or the District Nurse employer, it could be a real minefield.
    One also questions why Residential homes are accepting obvious Nursing Home Patients and why Nurses are condoning this ?

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  • Yep - yet more insidious erosion of the difference between "residential care home" and "nursing care home", driven by the absolute focus on cost rather than quality.

    When will central and local government realise that "innovation" is not needed here? - just do things properly and pay those who are doing the work a fair price/wage. This kind of fiddling around the edges just detracts from the real problem: the country doesn't want to pay the real cost of caring for its elderly.

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  • This discussion is interesting. However, it is nursing profession that took the decision to define nursing care ( RCN 1999) which did not include "personal care" much to the disgust of many nurses; and it was also the NMC (then UKCC) who told Tony Blair's government when they were designing the Care Standards Bill that they could not define "Nursing" as its scope was far too wide.

    So we can't go back - it is the Leaders of the nursing profession that has led nursing down the path of redesigning care. Nurses are now more aligned to medicine that ever before and apart from midwifery, public health and learning disability nursing - just do clinical tasks not real care - as HcSWs and social care workers do the core of nursing.

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  • When I did my training (many years ago) the ''geriatric ward'' cared for patients on a long term basis, often years. Then perhaps 25 years ago things (rightly) changed and those people were discharged to nursing home care, those in nursing homes shifting down to residential care and those who would have been in residential care being looked after at home, everyone involved had extra responsibilities and more complex patients to care for.

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  • michael stone

    The issue of what 'nursing' involves is an interesting debate, and so is the difference between a care home and a nursing home: but there will inevitably be 'some nursing' in care homes.

    What 'I liked' about the piece, was in essence the part below (and I would like to ask one of the nurses involved in this scheme a question - I made an attempt to get a contact e-mail address yesterday). The following looks to me, as if it 'works for the residents'.

    'Missed opportunities for providing preventative care was leading to an over-reliance on community nurses and GPs to step in and help care staff.

    The new role was created to identify residential homes that need assistance and provide a six-week period of support. This includes taking over care normally provided by district and community nurses, and acting as a role model to care assistants in the home.

    The nurse reviews care plans, sets up and signposts to relevant training opportunities – such as those on dementia, nutrition and continence – and from then on makes regular visits to the 26 care homes that the team covers.

    Following the role’s introduction, the community nursing team has seen improved outcomes for care home residents, including reduced pressure ulcers.

    The team now receives fewer calls about minor health issues and, instead, is contacted on a more regular basis for help with significant, preventative interventions.'

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  • Michael,
    All homes are now "Care Homes" under the new Reg.Homes Act the only condition is that if Nursing Care is delivered to any resident in the premises then the Care home must firstly be registered by the CQC to do so and secondly provide Nursing Staff on site to carry out this work.As is mentioned in comments above there has been considerable fudging of the above rules by the Local Authorities and Health Authorities but I think we will find that when sod's law comes into play and an incident occurs the previously mentioned will disappear and put all the blaim onto Guess who?
    Byew the way the Insurance situation is a nightmare. Who is responcible for any Nurses etc who are not on the payroll I wonder.

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  • All very well, Michael - but dealing with dementia, for example, is a specialised task. This initiative doesn't sound to me like an innovation in integrated care but rather a sneaky way for social services to park dementia patients in (cheaper) residential homes that are ill-equipped to deal with them, rather than (more expensive) nursing homes who have the appropriate staff and training.

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  • Anonymous | 13-Jul-2015 8:41 pm
    The definition had already been established by the Previous Act of parliament and backed up by lots of case law. I practise everyone respected the Family Doctor or the Hospital's Medical staff for deciding this but since the intruction of funding by the Local Authorities and colluding with the PCT (now CCG) any tom. dick or body seems to be doing it and many more People have been taken out of NHS free care and put into means tested care just by fidelling the criteriors as far as I know most of this fine work is being done by occupational therapists but I can not be certain

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  • Yes - apparently a three-day course is all that's required for any council office worker to be allowed to determine people's lives.

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