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District nurses’ time with carers must be valued

The Royal College of Nursing Congress is always fascinating – part trade union bun fight, part professional information sharing  and networking bonanza. Last night I went to lead a session on carers, flying the flag for our area of interest. All around me were nurses, proud of what they do if a little exasperated. Many felt the need to express their individuality, almost jockeying for position within the profession itself – the district nurses, for example, with blue t-shirts emblazoning  “DISTRICT NURSE…” across their chests.

I wonder what it is that is making the district nurses feel they need to go to this length to be noticed. I guess they feel they’re not visible or valued enough, or that their roles are being eroded.  Many are not based in primary care any more – in England at least. GP practices rarely have “their” district nurse and instead there is a team based centrally.

I’m sure there must be benefits, but I struggle to see how this makes sense. We’re splitting apart the key professionals who could  have a quick word with each other, pass on information which they’ve picked up on a home visit, and ensure that links are made on a human level. A nurse from Wales – based in a primary care practice – described this succinctly. When she or a colleague think a carer could do with support, they have a quick word together and whoever is the best person  makes a few calls, nips round, gets it sorted. Simple as. I don’t know why we keep inventing structures which make it easier for people to get lost.

Last night, with the RCN, I ran a workshop on how we can work with nurses to crack this issue of identifying and supporting carers because they are in a key position to pick up when someone is struggling.  We had a reasonable turn out – almost all district or community nurses in fact – and about half the room were also carers themselves. We do well to always remember that carers wear many hats in life.

As well as their stories of caring, they were talking about feeling inadequate if they identify a carer but then have nothing to offer them, or not knowing the up to date information on what’s available. They also described being so rushed for time – time spent engaging with carers figures nowhere on performance targets. Work we’ve done with the Queen’s Nursing Institute, which specialises in district nursing, says the same.

So how do we fix it? One solution has to be enabling district nurses to use their time in a more holistic way rather than just counting the clinical tasks they’ve called round to deal with. Explaining to a carer how to best look after the person they care for, and dealing with their concerns about treatment – those are clinical issues in my book. Supporting carers with their own health and stress issues –  well that too, I would say, is verging on clinical – or at least will likely become so. I don’t see the problem with measuring this and counting it as a valued part of the nurse’s role. Too often it’s someone else’s job, in someone else’s targets. Sometimes someone’s and no-one’s.

I think the problem is that we are often way too focused on counting. The NHS is very keen on counting everything – time, money, and of course I understand why. In the process, however, we sometimes completely miss what it all adds up to.

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May 16, 2012 - Posted by | Health | , , ,

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