The recent report on community nursing released at RCN Congress highlights the pressure that community nursing is currently under.
Falling district nurse numbers, social care cuts, and an ever growing number of increasingly complex patients. It’s a frightening mix and with a significant number of district nurses set to retire in the coming decade, it’s hard to see that others will be rushing to step into their shoes.
It’s already a tough job without all the increasing pressure currently being loaded on. Working in a ‘hospital without walls’ is a challenging role. Making decisions about frail and elderly patients with multiple co-morbidities in their own home takes skill and training. There is no second opinion readily at hand – you are on your own with limited resources. While nursing support workers do a great job in working alongside registered nurses in the community, the complexity of the work means that the ratio of registered nurses and support workers must not swing too far in the wrong direction.
The push to increase the numbers of health visitors is welcome. However this campaign is more likely to recruit from the community nurse workforce as those already working in the community are more likely to apply. For those working in hospitals, it can be a leap of faith to take that step to work outside the hospital environment that they are used to.
Also the increase in health visitor numbers must not be used as a panacea for the fall in district nursing numbers. I was struck by how Andrew Lansley answered a question about declining nos of district nurses at RCN Congress by talking about the increasing number of HVs. A good initiative but it’s not the same thing.
The RCN report makes clear for the urgent need for more district nurse numbers and support for this crucial arm of the profession. Lack of support and care of patients in the community will inevitably lead to more hospital admissions. It feels like we are just going around in circles. Policy makers need to wake up to the fact that all the money comes out of the same pot so cuts in the community will lead to increased costs in hospitals.