The values and beliefs that underpin the role of the district nurse are the same today as when the Queen's Nursing Institute (QNI), a charity dedicated to improving the nursing care of people in the home and community, was founded in 1887. The key components of this highly skilled role centre on the value of keeping people at home where they want to be, with the relationship between nurse and patient as the principal therapeutic tool. The nurse works with the whole family unit as well as their carers. Expert assessment of needs and the provision of patient-centred care that incorporates clinical and social care needs should never be underestimated.
The role of this autonomous practitioner can be extremely practical, intensive and technical. Much of the work of the district nurse is unpredictable and variable and, as a result of this, district nurses have to be responsive, flexible and adaptable. Although these facets of the role should be lauded, there are a number of inherent contradictions. For example, district nursing is autonomous but it is also dependent on its networks and contacts. District nursing responds to demand, yet it must be proactive as it manages the care of people with long-term and short-term needs in all communities. On a daily basis the district nurse integrates with a large number of other people in and beyond the spheres of health and social care (QNI, 2014; Health Education England (HEE), 2015).
The fundamental role of district nursing is to enable and provide services that promote health and wellbeing, encourage self-care and deliver personalised health outcomes in the confines of the person's own home. These services must be appropriately integrated with social care and suitably signposted so that, whether for urgent or more planned treatments, there will be a full range of coordinated, high-quality, accessible and well understood services in place that are locally led (HEE, 2015).
District nurses require particular competencies and flexibilities as well as the ability to work in partnership with patients, carers and communities, and a variety of other professionals and voluntary workers. New care models can only become a reality if there are enough staff in possession of the right skills, values and behaviours to deliver them. There is a need to grow, develop and sustain a workforce that is able to work across hospital and community boundaries and to practise beyond the traditional professional confines.
If the district nurse is to retain a key position within the multidisciplinary team in community health care, and the service is to meet the key responsibilities (in England) as discussed by HEE (2015), then it needs to be noted that we are failing to train sufficient numbers of new district nurses to replace those who leave or retire. Failing to address this issue now will only mean that this expert practitioner's role will fail as the number required to care for people in their own homes will not meet demands. A 2016/17 audit undertaken by the QNI (2018) confirmed a decline in the number of new entrants to district nursing courses by 2.5%. There has also been a decrease in the number of those who are qualifying with the Specialist Practitioner Qualification by 10% as compared with the previous year. This, suggests the QNI, is a cause for serious concern. If the numbers of students being enrolled onto district nursing courses are insufficient then it is not as a result of a lack of student demand, or indeed service or patient need. It reflects, however, concerns about higher education funding for nursing.
District nurses up and down the country are, quite rightly, proud of the role they perform and the services that they provide to people. However, if they are to be valued and permitted to do what they do best, nursing people in their own homes, then there is a dire need now for more investment (human and material) into this essential service.