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PNs face ‘tension’ between time pressure and holistic care

  • 9 Comments

Practice nurses face being caught between moves towards providing more holistic care to patients with long-term conditions and local surgery policies of limiting consultations to one problem.

The conflict between local policies designed to deal with current pressures and future national aspirations to redesign services around patients was highlighted last week at a major community nursing conference.

NHS Confederation chief executive Rob Webster told delegates that the holistic nature of care provided by community and primary care nurses should be a key feature of the future models of care provision currently being piloted by NHS England’s “vanguard” sites.

Speaking at the Queen’s Nursing Institute’s annual conference about, he noted that community nurses often “turn up for one thing but there are lots of other things to do and we mustn’t lose that in the clamour for change”.

“I think we’re increasingly winning the argument that services need to look at patients and communities first,” he said.

“If we recognise we’re a guest in their life, they are not guests in our organisations… and if we organise around their needs not out professional egos… then we can create new dynamics in care… we can create more joined-up care, more care that meets the needs of people today,” he said.

He added: “For the 18 million people with long-term conditions who look after themselves…if we provided better self-supported care, better technology we’d get better outcomes. For the three million with three or more long term conditions, we need to join services up around them.”

“There’s inner tension between the expectation of what you feel you should be doing and what your organisation is very clearly stating is their approach and philosophy”

Practice nurse

However, a member of the audience highlighted that many practice nurses faced a “tension” between providing more patient-focused care and local surgery rules responding to increasing pressures on consultation time and patients turning up with so-called “shopping lists of problems”.

She said many nurses worked in settings where there was a sign up saying “one patient, one problem”.

“[GP practices] almost have a very negative view if you go beyond that and deal with other issues,” she said. “That’s a real challenge.

“There’s inner tension between the expectation of what you feel you should be doing and what your organisation is very clearly stating is their approach and philosophy,” she said. “Support for general practice nurses with that tension is absolutely key.”

She suggested there was a need for evidence to support nurses in arguing that “actually it is better use of time and resources to broaden” the consultation from its initial focus.

“The really difficult thing I’ve got to ask you to do is keep operating in one system, while preparing to work in another”

Rob Webster

Mr Webster acknowledged it was also a problem faced by community nurses through the use of “time slots for district nurse visits, which can mean they are very task-focused rather than holistic”.

However, he suggested that things would get better in future, as new models of care were rolled out under NHS England’s Five-Year Forward View plans.

“The big challenge for everyone in the service at the moment is that we are trying to deal with the pressures of today and think about creating a new set of services for tomorrow,” he said. “The really difficult thing I’ve got to ask you to do is keep operating in one system, while preparing to work in another.

“We’re really committed to saying: ‘let’s think differently about the way we deliver care so that we don’t just see people with multiple conditions for one thing when they’re worried about something’,” he added.

Mr Webster also highlighted the importance of supporting nurses and other staff during what he said was likely to be a “decade of change”.

“We know staff in the NHS are the most stressed public sector workers,” he told delegates, noting that if NHS leaders wanted them “to drive forward change… then we need to look after you.”

“What we must do is provide emotional support, resilience, wellbeing for all our staff”

Rob Webster

Reducing stress levels would result in “better decisions, better value, better outcomes, and better services”, he said.

Highlighting the emotional pressure faced by nurses, Mr Webster described his experience of going out with staff to visit patients while in his previous role as a community trust chief executive.

“I just really worried about the patient all the time,” he said. “I’d be thinking afterwards, I wonder how so and so is getting on now because they’re on their own at the moment. I used to do that after just a day.

“How do you carry that all the time, how do you have the emotional resilience,” he asked delegates, noting that staff had told him they mostly relied on peer support.

“It’s not good enough,” he said. “What we must do is provide emotional support, resilience, wellbeing for all our staff.”

 

Queen's Nursing Institute

NHS Confederation chief executive Rob Webster addresses the QNI annual conference

  • 9 Comments

Readers' comments (9)

  • michael stone

    A good description of a problem - will patients [and 'unhappy' staff] experience a solution, I wonder ?

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  • Stone - keep up. Skype, undergoing pilot studies, has been proposed. It will enable nurses to avoid contact with awkward individuals and time wasters such as yourself!

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  • michael stone

    Anonymous | 8-Oct-2015 6:49 pm

    How does Skype resolve this ?:

    She said many nurses worked in settings where there was a sign up saying “one patient, one problem”.

    “[GP practices] almost have a very negative view if you go beyond that and deal with other issues,” she said. “That’s a real challenge.

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  • Stone If you are interested read the Skype research.

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  • michael stone

    Anonymous | 10-Oct-2015 2:29 am

    I'm interested in some of the issues the NT piece raised - Skype didn't seem to come into it from my reading, and 'Skype research' isn't high on my'to do/look at' list.

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  • Twenty minutes for each 'point', most patient visits are 'worth' one 'point'.
    Ok if you're only doing a simple dressing...
    But trying to discuss even simple health promotion messages or, heaven forbid, accept that the patient is a complex individual with multiple health and social issues. And an elderly person who may not see another human being that day...
    Precious little time for acknowledging that .

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  • michael stone | 8-Oct-2015 2:53 pm

    'A good description of a problem - will patients [and 'unhappy' staff] experience a solution, I wonder ?'

    SKYPE!!!

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  • Anonymous | 11-Oct-2015 11:02 am

    ours was Venflon dressing 5 points, full bed bath 20 points, administration of an unprescribed medication 1 point, talk to patient to ascertain if they are depressed and need a further talk 5 points, further talk 15 points! ... and so it goes on. prn system purchased at great expense from Canada for our hospital to calculate the degree of dependence of each patient in turn to calculated staffing levels required for the following day (which proved not to make any difference as it didn't work) as they didn't want it anymore as they found it didn't work for them!!!!!!! :-) such is modern management and their focus on cost cutting rather than on quality patient care. not to mention the time spent by each nurse filling in the forms and carrying out these calculations for each patient at the end of each shift and presumably management time and cost of entering the data into the system and processing it!

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  • hunt will probably sack all nurses any way

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