Promoting health and wellbeing across community nursing teams: role of the specialist practitioner district nurse

The COVID-19 pandemic has put the NHS under unprecedented pressures, although it could be argued that the NHS was already working under extreme demands to meet the needs of an ever-changing population while striving to achieve quality care (West et al, 2020). This article explores how community nursing teams can use strategies to reduce work-related stress and promote wellbeing in staff. Before the pandemic struck, there was already a growing concern into the psychological wellbeing of nurses, with an increasing focus on burnout (Tahghighi et al, 2017). The pandemic has exacerbated this and created burnout among nurses: a recent nursing survey revealed that 76% of nurses believed that, since the pandemic, their own levels of stress and burnout have increased (Royal College of Nursing (RCN), 2020a). Burnout can be defined as a syndrome caused by long-term stress in the workplace that has not been successfully managed (World Health Organization (WHO), 2019). There is compelling evidence that working under extreme circumstances has caused stress in the workplace and high levels of turnover in staff and intentions to quit. The NHS national staff survey revealed that 44% of nurses and midwives had become unwell due to work-related stress (RCN, 2020a). Farmer (2019) reported that, in the first 8 months of 2019 alone, 1 million NHS nurses had mental health-related sickness. The Queen's Nursing Institute (QNI) (2020a) reported that district nurses have had very little support or recognition during the pandemic in comparison to staff working in acute hospital settings; this is despite the fact that community nurses have also required to continue working remotely with increased demands on caseloads, particularly palliative care. Poor recognition of their efforts has had an impact on morale in the workplace (QNI, 2020a). Middleton (2016) concurred with the QNI that district nurses are overlooked, despite being key players in holding the NHS together. West et al (2020) highlighted that the growing gap between capacity and demand in community nursing settings has led to staff reporting feeling ‘exhausted’ and ‘broken’ district nurses' caseloads have no capacity limit, which becomes a challenge when presented with limited resources and stress-related sickness. Hall (2016) believed that managing stress in community nurses must be prioritised to ensure that nurses feel valued, and, if this is not prioritised, then staff retainment will continue to be compromised. McKinless (2020) agreed with the importance of managing stress in the workplace and reported that retention of nurses and job satisfaction have become an issue due to the stresses and complexities in community nursing. The nursing 2030 vision, which was shared by the Chief Nursing Officer Directorate (CNOD) of Scotland (2017), aims to achieve a nursing workforce that is prepared to meet people's needs and the complexities of care. It recognises that nurses require the education and skills to identify issues around nurse staffing levels and present the evidence to ensure that adequate numbers of nurses are available (CNOD, 2017). Similarly, West et al (2020) recognised that autonomy, belonging and contribution are required to ensure that nurses' wellbeing is supported and they remain motivated. The NHS Long Term Plan (NHS England, 2019) committed to investing in community health services because it acknowledged the increasing complexities and challenges faced with patient care in the community sector and the difficulties to manage this with understaffing and limited resources. In addition, it aims to provide the same values for its staff as those that they strive to achieve for their patients (NHS England, 2019). Consequently, since the COVID-19 pandemic, the NHS People Plan 2020/2021 (NHS Our People, 2020) has proposed the need to transform NHS culture and look after the health and wellbeing of colleagues as the service continues to respond to new challenges. The QNI voluntary standards (2015) stated that district nurses should promote the mental health and wellbeing of people and clinically supervise, manage and appraise staff. In addition, it is also a legal requirement for employers to protect employees from stress (Health Service Executive, 2019).