Getting the best out of staff in a district nursing team: nurturing resilience

The purpose of this paper is to discuss ways to improve the working environment for district nursing (DN) teams and foster resilience within the team. The NHS is an organisation that most are justly proud of, but it is struggling to meet the demand for its services within the existing funding arrangements and associated staffing pressures. DN services are at the forefront of experiencing the aphorism that, while resources are finite, demand for healthcare is infinite. This article will focus on resilience within DN teams and survey findings from district nurses about their teams.

Resilience refers to the amount of flexibility in the team—at what point does the team become so over stretched that it cannot maintain a reasonable equilibrium between capacity (funding and staff availability) and demand (workload and both clinical and quality standards), causing it to buckle? As set out in Figure 1, if any one (or more) of these four variables exerts pressure in excess of what the team can withstand under normal working arrangements, the equilibrium shifts and pushes normal working into the resilience buffer zone. The effect on the team depends on both the intensity of the pressure and the size of the buffer zone, which acts as a shock absorber. If the pressure is too great or the resilience buffer zone is too small, the team is unable to absorb the impact, and there is a knock-on effect on one or more of the remaining pressures. For example, if workload pressures increase, the response might be that clinical and quality standards fall, staff sickness and turnover increase or the budget becomes overspent with temporary staff.