It was dark when I set off from home, it was the dead of winter and bitterly cold. With Christmas tunes playing on the radio I headed out on the M65 in the North of England. As the sun began to rise as I neared my destination, I was able to appreciate the beautiful countryside that graced the road I travelled on. This was certainly different to the warm, well-lit and sterile ward environment that I was used to nursing in.
Why was I here you may ask? It was because I was spending the day with the district nurses as part of the Nursing Now 30 day challenge for December around Mentoring. Having worked within secondary care for 20 years I wanted to see a different side of nursing.
Gathering my coat around me against the cold I entered the health centre, met up with the team leader and received a warm welcome. On entering the office of the district nurses, the overarching atmosphere was one of calm and professionalism. There were groups of nurses busying themselves for the day ahead, picking up their schedules and chatting about their patients; making plans and conferring with each other for advice. It felt like a workplace in which everyone’s opinion was valued and one in which the patient’s care was at the heart of everything they did.
Setting the scene for the day ahead the team leader advised me to:
“Just think of district nursing as being like your ward and this being the nurses’ station, the only difference is that the patients are out there in the big wide world, in the community setting.”
Immediately, I had this image in my head of a group of patients in a virtual ward, a bit like a computer game. For some reason they were all in beds; although I knew that this wasn’t the case. They were all connected in an invisible but tangible way to this vital team of nurses who were responsible for their care. The only difference being that instead of walking down a corridor to interact with the patients, we had to jump into a car to visit them. The office environment was very similar to my own, identical computer log ins, the exact same printer model, the same information posters. There was one crucial difference, in that when the district nurses leave the office and go to visit their patients, they do so on their own. This requires them to be lone workers at times, whereas on a ward there is always someone in the vicinity to consult with if we are unsure about anything.
However, despite this difference, this day was a lightbulb moment for me around nursing as a profession. It highlighted the fact that even though as nurses we may work in different environments, we all possess the same skills; they are universal and transferrable. We are equipped with these skills as a consequence of our training and our knowledge, the way we carry out those skills is the same regardless of where we carry them out; be it a GPs surgery, a hospital ward, a neonatal unit, a hospice or someone’s own home. There are obviously nursing roles that require additional skills but fundamentally we all have a core cohort of skills that we use in the day to day care of our patients.
This idea was reinforced during a number of visits to the homes of patients that were receiving palliative care. During each visit a full holistic assessment of the patient was undertaken; their pressure areas, their nutritional intake, pain management etc. all in exactly the same way as it is carried out in a hospital environment. Watching two nurses draw up the required medication for the driver in the kitchen of a patient’s home, I was transfixed by the similarities to ones I witnessed prepared in a ward treatment room.
What made the day special for me was witnessing the patients cared for in their own homes, where they had chosen to be; surrounded by their loved ones and their own belongings. At each visit the nurse was warmly welcomed like an old family friend. Even the patients’ pets greeted them with delight !!! It was obvious that trusting relationships had been built during the course of the patient’s illness and that care was given in collaboration with all parties involved. I witnessed skilled discussions with patients and families around how care needs could be met within the home, with the patients’ wishes and choices at the heart of all decisions made.
It was a privilege for me to have spent the day with an excellent mentor who was so skilled in her art of district nursing that she made it look effortless. She taught me about the joy that comes from being a district nurse caring for people in their own homes and the positive impact this has on the patients. I think we should all as nurses explore each other’s roles as this increases our understanding of the challenges we each face. It also encourages working across boundaries and collaboration within our wider nursing teams.
What the day also illustrated for me was the ubiquitous nature of nursing. Nursing permeates all levels of our society regardless of if you are rich or poor, young or old There are nurses in GP surgeries, homes, schools, prisons, maternity services, mental health, learning disability nursing; the list is endless. Nurses are crucial in maintaining and promoting the health of the nation. This is especially pertinent as the NHS 10-year plan is targeting investment in community services and district nurses are at the heart of that. This is where the majority of care could be carried out. Who would want to be in hospital if they could be at time ?
As Lord Crisp said during the Nursing Now Launch in December:
"Probably the biggest thing we can do to improve health is to empower nurses..”
Sounds like a good plan to me.