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District nurse numbers plummet leaving services under-resourced and unsafe

Only 4,031 “full-time” district nurses are now working in the NHS in England.

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Under-resourced and sometimes unsafe services are impacting on patient care.

A new report from the Royal College of Nursing (RCN) and Queen’s Nursing Institute (QNI) has called for urgent investment in District Nursing, as new figures show the number of District Nurses working in the NHS has dropped by almost 43 per cent in England alone in the last ten years.

As a result, there are only Only 4,031 “full-time equivalent” district nurses are now working in the NHS in England, compared with 7,643 in 2009. A ratio of only one District Nurse for every 14,000 people – this compares with one GP for every 1,600 people.

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The report warns that District Nursing services are significantly under-resourced, sometimes with unsafe staffing levels, and have serious retention and recruitment challenges – directly impacting on patient care.

It calls for a commitment to investment and training to meet the challenges caused by simultaneous rising patient demand and falling numbers of these highly-qualified staff.

Helping to avoid hospital admissions.

Dr Crystal Oldman CBE, the QNI’s chief executive said: “This new joint report illustrates the central position of the District Nurse as the key professional in delivering outstanding healthcare to people in the home and the community. Working with GPs and other members of the multidisciplinary team, District Nurses have the knowledge and skills to support people living with complex long term conditions to manage their own health and avoid unplanned hospital admissions.

“Conversely, lack of investment in the District Nursing service leads to greater strain on other parts of the health service, including GP practices and hospitals. With a rising and ageing population, many of whom are living with multiple long term conditions, we need a deliberate and intentional investment to support District Nurses to continue to deliver complex care to the patients, families and communities that they serve.

“The success of the NHS Long Term Plan depends on the capacity and capability of District Nursing teams and renewed investment in their education, recruitment and retention is urgently needed.’

District Nurses are a lifeline for patients.

Yinglen Butt, Associate Director of Nursing at the Royal College of Nursing, said: “Given the fundamental role District Nurses play in delivering personalised care close to home, and in reducing the burden on hospital providers, the chronic underfunding of this service is an outrageous false economy.

“District Nurses provide a lifeline for patients, many of them frail and elderly, who often can’t leave their own homes to get care elsewhere.

“It’s time Ministers undertook a proper assessment of staffing needs based on the fundamental principle of patient safety, and enshrined explicit accountability for delivering this into law.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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