20. Is district nursing still relevant?

District Nursing Forum

(MFD) That this meeting of RCN Congress discusses whether the role of district nurse is still relevant today?

Debate report

The role of the district nurse is changing. Proposer Kay Durrant asked Congress to debate the role, title and importance of the title of the qualified district nurse. Kay said that district nurses feel passionately about their role and that they are pivotal to society. However, a recent ITV programme Nursing the nation gave a poor portrayal of the role of the district nurse.

Although the additional qualification for district nursing is recorded on the NMC register, it is not a mandatory qualification. Jeannette Dunn, Coventry and Warwick branch, confirmed that the specialist practice qualification had been reintroduced in her area.

Ngaire Cox, from RCN West Sussex branch, pleaded with Congress that we shouldn’t let district nursing be a forgotten specialty. “District nursing is critical to service delivery within the community and crucial that employers support specialist practice pathways and that the RCN should collaborate closely with QNI to ensure this is driven forward” she said.

Christine Yamah, Inner North East London branch, stated that district nurses provide a crucial role in ensuring that hospital admissions – and re-admissions – are reduced.

Kay closed the discussion by stating that “people are still very, very passionate about district nursing. It is a profession, it is a group of specialist practice which we cannot afford to lose and I really hope that message has been made very clear this morning.”

Background

With the Government wanting to avoid unnecessary hospital admissions, more people living to an older age and increasing numbers of people with long-term conditions, district nursing has a central role in the delivery of health care in the community.

The services and roles that have risen from the District Nurse (DN) workforce, e.g. modern matron, team leader, case management, have caused confusion for members of the health and social care team and more importantly patients and carers. However, a report by the Queen’s Nursing Institute, 2020 Vision – Focusing on the Future of District Nursing, found that the confusion that exists could be set aside if DNs were recognised as ‘practitioners, partners and leaders’ of care in the home.

In 2013, the Department of Health England (DH) published a new vision and service model for district nursing which supports DNs in having a graduate level education and a specialist practitioner qualification recordable with the NMC. The document also highlights the need for evidence-based workforce planning for district nursing teams.

As part of its work to modernise nursing in the community, the Scottish Government commissioned NHS Education for Scotland to develop a new career framework for DNs which takes into account the capabilities and advanced skills required to manage increasingly complex packages of care. Building on this framework there is a proposed national educational approach for district nursing to be implemented as part of the CNO (Scotland) Education Review.

In its response to the Transforming your Care consultation in Northern Ireland, the RCN highlighted that the number of district nurses employed within the Health and Social Care trusts fell by 11per cent between 2009 and 2012. Some 72 per cent of the district nursing workforce in Northern Ireland is aged 40 and over.

The NHS workforce census 2011 showed DN numbers fell by 756 to 6,937 in the year to September 2011, a 10 per cent drop since the previous year, and a 34 per cent fall in a decade. The RCN 2011 district nurse survey found the existing workforce is highly qualified, although low in numbers.

References and further reading

Department of Health (2013) Care in local communities: a new vision and model for district nursing London: DoH. Available at: www.dh.gov.uk/health/2013/01/vision-district-nursing/ (accessed 13/03/13) (Web).

NHS Education for Scotland (2012) Career and development framework for district nursing Edinburgh: NHS Education for Scotland. Available at: www.nes.scot.nhs.uk/media/834542/district_nursing_career_framework_fsec.pdf (accessed 13/03/13) (Web).

Queens Nursing Institute (2009 ) 2020 vision: focusing on the future of district nursing London: Queens Nursing Institute. Available at: www.qni.org.uk/docs/2020_Vision.pdf (accessed 13/03/13) (Web).