District nursing is key to supporting and caring for individuals and their families within their homes, and avoiding unnecessary hospital admission. This is reflected in the policies of the four countries of the UK. In Scotland, the district nurse is a core member of the integrated community nursing team (Chief Nursing Officer Directorate, 2017). The career pathway for District Nurses in Northern Ireland (NIPEC, 2022) sets out the requirements for district nursing (DN) teams to support the delivery of person- and family-centred care that is safe, effective and of high quality. The value of the DN team, as part of multi-professional teams in primary care, is set out in the Welsh National Community Nursing Specification (Strategic Programme for Primary Care, 2022). Recognition of the contribution of district nurses is also reflected in the NHS Long Term Workforce Plan (NHS England, 2023), which has set out a 150% increase in district nurse training by 2031/32. This is during a time when the King's Fund has reported that community nursing is in a ‘cycle of invisibility’, where they can be overlooked and can be difficult to evaluate (Baird et al, 2024).
Developing the future DN workforce is directly linked to students undertaking pre-registration nursing programmes. The Nursing and Midwifery Council's (NMC, 2018a) ‘Future nurse: standards of proficiency for registered nurses’ sets out the knowledge and skills required for registered nurses to be able to work across all care settings and care for people across their lifespan. To achieve these proficiencies in all care settings, the NMC's (2018b) ‘Standards for pre-registration nursing programmes’ require approved education institutions and practice learning/employer partners to provide a variety of practice learning opportunities for students to meet the holistic needs of people who use these services, as well as their families and carers. Despite the NMC requirement for practice learning opportunities across a range of settings, a survey of pre-registration nursing placements found that, at the time of responding to the survey, 20% of the student nurse respondents (n=1347) had not experienced a community placement, while 15% of respondents had already had three community placements (Queen's Nursing Institute, 2021). If students are unable to have a community placement during their programme, this must be exceptionally reported by the university to the NMC (2023). A qualitative study exploring pre-registration nursing students' perceived barriers to employment in DN identified several factors (Lavery and Morrell-Scott, 2024). These included a lack of awareness of the role of the district nurse leading to role ambiguity. This was compounded by the perception that wards are the ‘be all and end all’. The visibility of DN to address these myths must not be underestimated when developing the curricula for pre-registration nursing programmes.
Garry (2022) reflected on his positive community experience, where he was supported and welcomed by district nurses committed to creating effective learning environments with reflection on learning throughout the working day. The ‘Standards for student supervision and assessment’ (SSSA) (NMC, 2018c) set out the requirements for effective practice learning, supervision and assessment of students. The introduction of the practice supervisor role, alongside that of practice assessor provide an opportunity for students to be supported by a range of health and social care registered professions, while they work in partnership with people who use services and carers to meet the holistic care needs of the local community. Consideration should be made on how these opportunities can be capitalised upon to showcase community nursing to the future nursing workforce.
In January 2023, the NMC Council agreed changes to certain education standards; now, the UK has left the European Union and made a commitment to undertake a review of practice learning (NMC, 2023b). This was to build on previous work that explored practice learning internationally and identified that its quality is dependent upon several key elements. These elements include integration of theory and practice learning, high-quality simulation which supports theory and practice learning, good quality clinical teaching and learning, focused learning experiences and graduate programmes for newly qualified nurses. The NMC has now launched the Review of Practice Learning, which includes independent research focusing on practice learning in the four countries of the UK and internationally (NMC, 2024). The review will also include the NMC's quality assurance activity and the ongoing evaluation of simulated practice learning. Stakeholder engagement with people who use services, students and registrants is key to ensuing the completeness of the review. To support this, a community of interest has been set up. This will be used to share updates on the progress, as well as share opportunities to be directly involved in the review. I would like to encourage the reader to sign up for the community of interest to ensure that student learning incorporates both hospital and community services.
Further resources:
- Nursing and Midwifery Council's review of practice learning: https://www.nmc.org.uk/education/developing-our-education-requirements/reviewing-nursing-and-midwifery-practice-learning/
- Sign up to the community of interest: https://r1.dotdigital-pages.com/p/129A-1B4W/practicelearning