Changing demographics, improved therapeutics and modifications in healthcare practice, such as early discharge, have changed the volume, nature and complexity of district nursing practice. The latest report from the Queen's Nursing Institute (QNI) (2019) sets out data collected from 2858 online survey respondents across the UK over 6 weeks in June–July 2019 and describes the state of district nursing.
The report outlines workforce challenges that include an ageing workforce, with 46% stating their intention to retire (25%) or leave (21%) the workforce during the next 6 years. And a huge variety of job titles were reported, which cannot help the unique selling proposition (USP) of district nursing as a profession. Similarly, the report reveals wide variation in caseload size across teams as well as roles, responsibilities and pay for those holding the Specialist Practice Qualification for District Nursing (DNSPQ), with significant regional differences.
Nearly 30% of teams were reported as having caseloads of over 400 clients. Therefore, it was not surprising that 48% of respondents reported deferring visits or delaying the delivery of care, that is, leaving work undone, on a daily basis. However, 63% of respondents reported that their team never refused referrals even if they were under-resourced, with 90% of respondents reporting that they worked unpaid overtime with a significant variation in unpaid overtime across pay bands. The extent of reported overtime also varied considerably across the regions, as did the number of vacancies and frozen posts reported, with London and the south-east seemingly having to manage with less cover in their teams.
More than a quarter of respondents reported not having any administrative support, which, coupled with poor IT support due to hardware and software issues and unreliable connectivity, highlights how district nursing services are not enabled to maximise their productivity. Access to improved technology was identified as the second most significant change that could improve district nursing work, after improved staffing. Remote access to patient records and other essential resources should surely be a given in this day and age when the use of smartphones is ubiquitous.
Some two-thirds of the respondents were nurse prescribers; 49% held V100 or V150 and a further 17% held independent/supplementary (V300) status with independent and supplementary prescribing being associated with Bands 6–8. Prescribing within the Nurse Prescriber Formulary was associated with Band 5. Nurse prescribing status was not reported across the regions, but there were significant differences across the regions regarding the holding of the DNSPQ among leaders of community nursing teams, with the lowest levels reported in the southwest, southeast, midlands and east. This suggests that some regions place less value on the district nurse role and the specialist practice of district nurses despite the increasing complexity of practice and role responsibilities.
The lack of consistency regarding remuneration, clinical band, prescribing, role and job title undermines the public's understanding of the title ‘district nurse’ and will further inhibit the development of this distinct part of the nursing workforce upon which many depend for their nursing care in the home. Importantly, the lack of clarity about the USP of district nursing and its career offering will further damage attempts to encourage more student nurses and registered nurses to consider long-term careers as part of the district nursing workforce.
‘The lack of consistency regarding remuneration, clinical band, prescribing, role and job title undermines the public's understanding of the title ‘district nurse’.’