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Why is it so hard to fill community nursing posts?


Student affairs editor Anthony Johnson ponders the issues around attracting nurses into the community sector. 

I’ve been sadly absent from this role at the Student Nursing Times recently because of the pressures related to completing a 9,000-word dissertation. Like a lot of students, I know that this will probably be one of the toughest achievements you will ever have to undertake, but it is the last hurdle before the ‘freedom’ of post-registration.

As my dissertation discussed the factors that cause community nurse retention I thought I’d write an article, as an aspiring community nurse, about something that is bothering me: why is it so hard to get nurses to join the community?

Nurses in the community represent only 15% of the total population of UK nurses (about 45,000).

“It’s such an important part of our health service and receives nowhere near the emphasis it deserves.”

This is astounding given that the Primary Care sector delivers approximately 90% of all NHS activity for only 7.5% of it’s budget. It is such an important part of our health service and receives no where near the emphasis it deserves in nursing training.

This is most worrisome because almost 60% of the workforce in 2012 was over 45. We’re now in 2017, five years on, which means that of those that haven’t added to the current 40,000 vacancies in England, the rest will probably choose to in the next 10 years.

We need to replace these nurses, we need the community to look attractive and we need to expose students to the area as often as possible.

In my experience that isn’t happening at the moment. I only know of three final year students in my entire trust that are choosing to complete their final placement in the community, and one of them is myself.

”My colleagues see it as a place where older nurses go before they retire.”

When I talk about the community with my colleagues they see it as a place where older nurses go before they retire. They think there are no specialised skills involved in the work, and that it is mainly task-based nursing.

I cannot disagree more.

The community sector is quite literally what you make of it. If you want to make nursing easy and just give insulin you can do. If you want to create a long term relationship with a diabetic patient and attempt to educate them about their health and provide them with the tools they need to manage their own condition so that they can potentially even stop taking insulin, you can do that too. 

It is the opportunity to advocate for my patient’s improved health, that draws me to the community. I have personally always hated, as a politically aware student, being in the hospital, looking after patients who are medically fit-for-discharge, but who have nowhere to go because of the cuts to social care.

Nursing in the hospitals feels like a firefight to discharge patients only for them to be readmitted again. In the community that pressure is replaced by one which compels you to avoid unnecessary admissions through health promotion.

“Nursing in the hospitals feels like a firefight to discharge patients only for them to be readmitted again.”

For me, it is so much more rewarding but it is obviously my own personal opinion, my bias. It is this bias that I think is the major issue for the recruitment of community nurses. Who shapes our experience of nursing? Our mentors and our placements. Both of which are predominantly based within the acute sector with potentially only one placement in the community.

We are literally indoctrinated into thinking that the community is ‘not for us’ because of the constant exposure to our hospital-based mentors who’s bias is against the community. I do not think that this is an active process unless our mentors are hoping that they can manage to plug their vacancy rates with us.

I think that it is a subconscious bias to direct students away from ‘uninteresting areas’. 

I myself, as a soon to be Student Health Visitor, am also going to be guilty of this. If I ever get a chance to talk to a nursing student I will probably direct them away from areas I find unfulfilling.

We cannot remove bias, we can only expose students to a variety of different viewpoints.

That is why the solution is to expose students to more community placements. Let them see what is on offer in the area. I know that this is difficult given the current vacancy rates and tension within the primary care sector, but how else are we to stem the tide?

Removing mentorship as a principle, whilst probably another example of the lower expectations that we have for the educational standards of our profession is also an opportunity to drastically increase the number of students that can have community placements. Especially, if it was paired with ‘long-arm’ support from senior nurses such as community matrons and team leaders.

”If we do not meet the aims and transition services into the community, our NHS will likely buckle.”

If we do not meet the aims of the Five Year Forward View and transition services into the community our NHS will likely buckle.

I am not someone, like politicians, who think that this is the only problem that will destroy the NHS. I think the history of my articles at the Nursing Times has shown that.

But we have to meet the obligations of the role of a nurse and remember what we are there for - advocates for our patients.

We need to support the community and play our part as individuals to encourage future nurses into the community.

For those who are interested, my dissertation showed that what the system needs to do is:

  • Reduce workloads;
  • Reduce the causes of stress;
  • Increase patient contact;
  • Provide more educational opportunities;
  • Offer flexible-working opportunities;
  • And, of course, to increase the pay of community nurses.

Readers' comments (3)

  • Interesting perspective and welcome to your forthcoming your in the community.

    I hear too often, that community is where you go to have flexibility with family life or when you are looking to retire as if it is an easy option and would challenge those views.

    As a community staff nurse I draw on my knowledge in anatomy, physiology, biochemistry, psychology, health promotion and multiple conditions to ensure clients get holistic care for their health and well being.

    The knowledge and expertise required in the community setting is of an advanced nature as on any day you could be nursing people with sub acute episodes of their underlying condition through to managing people at end of life and sorting out safeguarding issues.

    You are working as an independent practitioner without the immediate support of ward colleagues which requires you to be confident in risk assessing situations and interacting with health and social care colleagues to meet people's acute and chronic needs.

    Many who talk about community nursing have either spent minimal time in it or worked in it many years ago. It is at the forefront of national policy about the direction of travel for healthcare and will provide you with a sense of satisfaction in using your clinical knowledge to maximum impact.

    If you want to make a significant difference then I would advise you to seriously look at what community nursing has to offer.

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  • I started my nursing training as I want to be a district nurse. I am/was working/volunteering in a variety of community roles: in a community pharmacy and as a community first responder. My community placement was some how just in a different part of the hospital: the clinical research facility. I still want to be a community nurse, but am going to have to arrange my own district nursing experience. My main frustration with my course is that for many of us it is entirely hospital based. Only about half of the students in my group will get to do a proper community placement and even then it is only five weeks. The university and hospital couldn't care any less, about students who want to begin their careers in community nursing.

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  • I believe different branches have different experiences. I am a 2nd year child nursing student in community at the moment on my final 2nd year placement, with the health visiting team. This is the second health visiting placement I've had out of 6. I have had a positive experience and the team I am with are wonderful, however I do not believe it is an appropriate progression point placement into 3rd year. By the time I start my next placement in January, It will have been 10/11 months since I have been on the wards - (99% of our outcomes/competencies' are clinical/ward based) and am anxious I will have deskilled by the time I return to the wards for my penultimate 3rd year placement.

    I believe if we were given a more varied experience of the paediatric nursing community role, many of us would be more open to applying for community roles when we qualify. However the majority of us at my university get placed with the health visiting teams for our community placements, and begin to find it monotonous and repetitive, as we are not health visiting students and can only do so much. Additionally, we have little to no say on where we are placed, so this issue cannot be easily avoided.

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