WHILE’S WORDS
What is happening to district nursing? Alison While Alison While is Professor of Community Nursing, King’s College London, Florence Nightingale School of Nursing and Midwifery and Fellow of the QNI
I
‘The contribution of district nursing has been undervalued and neglected to such an extent that the district nursing workforce has fallen by 44% since 1999.’
The QNI is currently seeking the views of district nurses to inform their 2020 Vision: Focusing on the Future of District Nursing. http://www.surveymonkey.com/s/TPPFFPH Bennett V, Nicholson W (2013) Care in local communities: a vision and service model for district nursing. Br J Community Nurs 18(2): 74–6 Department of Health (2011) A Call to Action: Health Visitor Implementation Plan Summary Progress Report. http:// tinyurl.com/kn8p798 (accessed 15 October 2013) National Nursing Research Unit (2013) District nursing: who will care in the future? Policy+ 40: 1–2 Queen’s Nursing Institute (2013) Report on District Nurse Education in England, Wales and Northern Ireland 2012/13. http://tinyurl.com/k6fyzkk (accessed 15 October 2013) While A (1978) The vital role of the cottage-community hospital. J R Coll Gen Pract 28: 485–91
572
Alison While
© 2013 MA Healthcare Ltd
t is generally agreed that the current configuration of the health service focused around secondary care in hospitals is unsustainable. The changing demographics of an ageing population emphasise the need for change towards more local and primary care, perhaps accompanied by short-stay beds overseen by GPs in what were previously called ‘cottage’ or ‘community’ hospitals (While, 1978). This is not a new idea, but one of the many concepts that seem to be recycled within the NHS over the years! Key to this shift in care will be a strong, well-educated and valued district nursing workforce. But while there is increasing recognition that district nurses are an important component of the health-care workforce (Bennett and Nicholson, 2013), district nurses and the contribution of district nursing have been undervalued and neglected to such an extent that the district nursing workforce has fallen by 44% since 1999 and qualified district nurses only represent 12% of the community nursing workforce (National Nursing Research Unit (NNRU), 2013). The role of district nurses and the skill-mix within community nursing teams varies considerably across the UK, further adding to the uncertainty of those who might aspire to a career in district nursing. An additional challenge is the demography of the qualified district nursing workforce, with a larger proportion (27%) of nurses over 50 than in NHS hospitals (19%) (NNRU, 2013). The Queen’s Nursing Institute (QNI) (2013, p. 1) has noted that ‘the demand for district nursing services is rising, but the number of qualified district nurses is in decline’. The numbers of nurses being educated as future district nurses are low and below replacement levels for those leaving the profession. This reflects low commissioning but also insufficient applicants with adequate numeracy and literacy currently working as registered nurses (QNI, 2013). In England, an initiative (Department of Health (DH), 2011) has started to reverse the decline in health visitor numbers. However, the success of a similar initiative for district nursing will be predicated upon an adequate supply of suitable registered nurses wishing to be district nurses. This requires more pre-registration programmes to offer ‘real’ district nursing and primary care experiences rather than the rebranding of care home and hospital ambulatory and satellite care settings as community care placements. Additionally, it will require a cultural shift among many pre-registration nurse educationalists believing that district and community nursing is somehow ‘less important’ and BJCN does not comprise ‘acute care’ nursing.
British Journal of Community Nursing Vol 18, No 11
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 129.096.252.188 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
What is happening to district nursing? Alison While Alison While is Professor of Community Nursing, King’s College London, Florence Nightingale School of Nursing and Midwifery and Fellow of the QNI
I
‘The contribution of district nursing has been undervalued and neglected to such an extent that the district nursing workforce has fallen by 44% since 1999.’
The QNI is currently seeking the views of district nurses to inform their 2020 Vision: Focusing on the Future of District Nursing. http://www.surveymonkey.com/s/TPPFFPH Bennett V, Nicholson W (2013) Care in local communities: a vision and service model for district nursing. Br J Community Nurs 18(2): 74–6 Department of Health (2011) A Call to Action: Health Visitor Implementation Plan Summary Progress Report. http:// tinyurl.com/kn8p798 (accessed 15 October 2013) National Nursing Research Unit (2013) District nursing: who will care in the future? Policy+ 40: 1–2 Queen’s Nursing Institute (2013) Report on District Nurse Education in England, Wales and Northern Ireland 2012/13. http://tinyurl.com/k6fyzkk (accessed 15 October 2013) While A (1978) The vital role of the cottage-community hospital. J R Coll Gen Pract 28: 485–91
572
Alison While
© 2013 MA Healthcare Ltd
t is generally agreed that the current configuration of the health service focused around secondary care in hospitals is unsustainable. The changing demographics of an ageing population emphasise the need for change towards more local and primary care, perhaps accompanied by short-stay beds overseen by GPs in what were previously called ‘cottage’ or ‘community’ hospitals (While, 1978). This is not a new idea, but one of the many concepts that seem to be recycled within the NHS over the years! Key to this shift in care will be a strong, well-educated and valued district nursing workforce. But while there is increasing recognition that district nurses are an important component of the health-care workforce (Bennett and Nicholson, 2013), district nurses and the contribution of district nursing have been undervalued and neglected to such an extent that the district nursing workforce has fallen by 44% since 1999 and qualified district nurses only represent 12% of the community nursing workforce (National Nursing Research Unit (NNRU), 2013). The role of district nurses and the skill-mix within community nursing teams varies considerably across the UK, further adding to the uncertainty of those who might aspire to a career in district nursing. An additional challenge is the demography of the qualified district nursing workforce, with a larger proportion (27%) of nurses over 50 than in NHS hospitals (19%) (NNRU, 2013). The Queen’s Nursing Institute (QNI) (2013, p. 1) has noted that ‘the demand for district nursing services is rising, but the number of qualified district nurses is in decline’. The numbers of nurses being educated as future district nurses are low and below replacement levels for those leaving the profession. This reflects low commissioning but also insufficient applicants with adequate numeracy and literacy currently working as registered nurses (QNI, 2013). In England, an initiative (Department of Health (DH), 2011) has started to reverse the decline in health visitor numbers. However, the success of a similar initiative for district nursing will be predicated upon an adequate supply of suitable registered nurses wishing to be district nurses. This requires more pre-registration programmes to offer ‘real’ district nursing and primary care experiences rather than the rebranding of care home and hospital ambulatory and satellite care settings as community care placements. Additionally, it will require a cultural shift among many pre-registration nurse educationalists believing that district and community nursing is somehow ‘less important’ and BJCN does not comprise ‘acute care’ nursing.
British Journal of Community Nursing Vol 18, No 11
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 129.096.252.188 on December 7, 2015. For personal use only. No other uses without permission. . All rights res
