Thursday 15 September 2016

The decline of District Nursing,

Well..... sorry it has been a while.. A long long while.

I have no real excuse aside from busy life, although work has been hectic.

As some know i am a community nurse part time around my children's medical care. A job i have always loved, it was my goal all through my training to get out into community and make a difference, for 3 glorious years until....

To start district nursing is changing, we are getting patients discharged who until recently would have stayed in hospital, the skills that are needed are increasing as we do more and more to keep patients at home to avoid admissions. Chest drains, chemotherapy, flushing picc lines and negative pressure dressings are a few of our latest skills

Currently community nursing in my area is undergoing a lot of changes. These are not always for the better. They have changed from locality based to GP aligned. This means we have to drive further which takes longer, great when they have just cut the mileage money that we would get for using our own cars. They have changed all of the shift patterns and now no one knows what anyone else is doing. We now have long days and short days, early shift and then shifts all the way up to 10pm. Gone are the days when district nursing was the better job to fit around your family. Some nurses have been working 3 weekends a month for months on end. The then decided to move half the nurses to a different base and move a whole host of new nurses in, then changed all the little teams about so we all feel like we have been on the Smiler at Alton towers.

Then when we weren't confused enough they gave everyone a laptop and decided that every patient on the case load needed reassessment, this takes 2 hours minimum and we have nearly 2000 patients.

It has been leaving us nurses on the ground demoralized, unappreciated, ignored, over worked, underpaid and sometimes with no lunch/breaks because you know that if you don't go to the extra visits then those patients wont get seen that day. My conscience will not let me enjoy lunch knowing that people who are sick wont get their visit so i choose the work.

i wouldn't mind but its not even been good for my diet because i end up stress eating chocolate and whatever i can find in the car. even those out of date voice tablets got eaten!!

Then the whole paper light/paper free thing comes in. This should be labelled
Won't have time to do the paperwork on the computer so will have to do it at home.
I am getting home from a long shift and then having to do 2 hours of UNPAID work on the laptop catching up with outcomes and assessments that cant wait.  All to protect my PIN and to stop the niggling messages from management to ensure my outcomes are up to date.

Work suddenly became a chore when it hadn't before, morale was so low, we were and still are losing good experienced nurses in droves, 8 will be leaving in the next month, 8 good hardworking nurses who have had enough, some are going back to hospitals because it is now the easier option for families.
In a meeting when they knew 6 were leaving, we had raised concerns about being short staffed and were told that they would only be replacing 1 nurse but don't worry they have a new manager.
I hope that she comes with a band 5 uniform and she can go out on visits.
We have lots of management, at the moment they don't seem to be managing anyone, there is no support, all concerns are answered with " i can see the concern but" they are just patching the leaks and sorting out the complaints from irate patients and family members about how their dear old gran didn't get a visit today or this week. Then we fall into the cycle of seeing the complainers to stop the complaints coming in and the lovely sweet quiet patients who need visits but wont complain miss out.
Can you feel my frustration yet, i hide in my car so that i avoid swearing at any manager who asks me if i am ok.

We are having to cancel anything none essential and then still people aren't getting the visits that are needed.
 so for the sake of my sanity i had to look else where.  

This isn't an easy decision, i love my job, Well i love 90% of it.
sure there are things i really wont miss, like seeing 17 patients a day and feeling like i haven't given everyone of them the time they deserve or getting abuse from patients or relatives for things i have no control over.
To be honest ill be very happy not to have to put female catheters in anymore. I am far too polite to go rummaging around lady bits. that goes for pessary rings too and probably bowel care. If you don't know what that is don't google. just have a think and that's probably correct.

However There is a lot that i will miss.

Some of the patients  are amazing, they are tough and brave. They are so grateful for the care that they get. i feel humble being able to help them on a daily basis. Seeing them recover is a treat.

Being involved with palliative care has always been an honor. Knowing that someone has been able to die where they want to and peaceful is a great feeling of achievement.

Knowing that i have helped a family to grieve for their loved one and being able to support them through this journey. Helping them remember the happy memories that they have rather that just remembering the end.  This is a large part of my job. something that i feel i do well and get positive feedback about and yet i have to go and its heartbreaking that all the skills that i have learnt over the years will no longer be going towards our NHS.

What i will miss the most is my little team, from the top to the bottom these nurses have been amazing, each one having there own strengths and willing to teach and nurture others, our immediate boss, who herself was under supported has been great in trying to motivate the team. Sadly she is also leaving. These ladies and one man will be always remembered with fond memories and lots of laughter, from their often wicked or rude sense of humor.

I don't like change at the best of times so it is a big deal that in a months time i wil no longer be a community staff nurse, i am moving to a Global Enteral feeding company to join their team as a specialist enteral feeding nurse. This job is my dream job, its the one i wanted to do even before i thought of doing my nurse training.It is still in the community and i will still have lots of patient contact.

I also think that i have a unique background that will help me in this role. I have been on the other side, I have been the parent whose child has just been given a feeding tube and I've needed support and training from the very same specialist nurses who i will be working with. I have needed them to go into school to to train F's teachers. i understand the feeling of shock and fear that you get when this huge responsibility is thrust upon you.

All in all a positive move but there will always be that part of me that is sad that my district nursing days are going to be behind me. I have definitely grown as a nurse here and i am leaving a better person for it. Its just feels like it will only get worse and i worry for what the future of district is going to be.

Research seems to be agreeing, pressure-on-district-nursing-services-is-leaving-staff-broken