The QNI has published safety standards for the district nursing workforce , amid concerns that workloads among services are ‘ far exceeding ’ capacity .

The standards , developed by the QNI ’ s International Community Nursing Observatory and led by workforce academic Professor Alison Leary , outline factors to consider when planning workforce to meet demand , set out areas of risk and provide examples of ‘ red flags ’ that require escalation .

For example , the standards identify a caseload of more than 150 per wholetime-equivalent ( WTE ), and nine to 10 visits a day for community nursing teams , as probable tipping points leading to work being left undone . They also state that a nurse visit should last at least 30 minutes to allow for the entire nursing process to take place .

Red flags identified include :

• District nurses being unable to close caseloads .

• Work being deferred on all or most days .

• Any high-priority work being deferred , for example end-of-life care .

• High staff turnover and sickness .

Professor Leary expressed concern that current district nursing workloads are ‘ far exceeding the capacity of services ’. She pointed out that district nursing services ‘ rarely refuse patients or close a caseload ’, which she said is a ‘ high-risk strategy ’ that has led to ‘ unremitting demand ’.

Professor Leary continued : ‘ District nursing teams are acting as a failsafe for other NHS and social care services , rather than as a district nursing service per se . Patients are being referred to them simply because other services are short staffed or are not offered as a 27 / 4 service .’

Draft post-registration standards ‘ largely fit for purpose ’, says NMC

The NMC ’ s proposed post-registration standards are ‘ largely fit for purpose ’, although concern remains that they are ‘ too generic ’ to be applied to some community specialisms .

The nursing regulator said the 2,363 responses – including from nurses , members of the public and organisations – to its consultation on the draft , which ran from April to August 2021 , were ‘ predominantly positive ’ with a ‘ small number of suggested improvements ’.

The standards under review are for specialist community public health nursing ( SCPHN ) and specialist practice qualifications ( SPQs ).

Longstanding concerns resurfaced over the ‘ generic ’ nature of the SPQ standards , with some nurses voicing misgivings over patient safety and the ‘ dilution ’ of specialist skills .

Currently , the NMC has separate SPQ standards for district nursing , general practice nursing , community learning disabilities nursing , community children ’ s nursing and community mental health nursing . But the proposals introduce a single set of core standards for all programmes .

Between 72 % and 88 % of relevant respondents agreed the proposed SPQ standards were applicable to each community field of practice . However , the NMC said some thought they were ‘ too broad ’ and wanted ‘ more field-specific standards ... to reflect the ‘ specialist aspects of each SPQ role ’.

Otherwise , the NMC said the draft SPQ standards were ‘ reasonably well received ’, while 75 % backed the proposed SCPHN standards .

NMC executive director for professional practice Professor Geraldine Walters said the responses represented a wide range of views , from ‘ different fields of practice and all four UK nations ’.

‘ We ’ re pleased the responses are generally positive , with most people supporting the ambition and intention of these future standards .

‘ We also received lots of wider useful feedback , and it will take a few months to give the responses the consideration and scrutiny they deserve .’

MS nursing ‘ significantly under-resourced ’, report finds

Multiple sclerosis specialist nurses are significantly under-resourced , which means they are often unable to deliver vital work such as home visits , a charity has warned .

A report from the Multiple Sclerosis Trust says a 50 % increase in the MS nurse workforce – amounting to an extra 149 whole-time-equivalent ( WTE ) staff – is needed to make workloads sustainable . It is based on a survey of 133 services and 176 MS professionals in the UK , conducted in August 2021 .

The number of WTE MS nurses rose from 250 in 2018 to 298 in the latest survey but the report says caseloads are rising faster – up from 379 to 472 per WTE nurse – well above the recommended limit of 315 . Almost 80 % of MS patients live in areas where the caseload is above this limit . It also reveals that around a third of MS specialist nurse services are unable to provide either home visits or ward visits ( 36 % and 33 %, respectively ), while 15 sites ( 12 %) are unable to offer either .

The report calls on MS specialist nurse team leads , commissioners and directorate managers to consider upscaling services . It argues the cost of training hiring more MS nurses will be offset because of the ‘ resulting reduction in the use of unscheduled care and emergency services ’.

The report notes : ‘ There remains a lot of work to be done to ensure that everyone living with MS has access to the specialist care and support they need at the right time and in the right place . The MS Trust is working hard to ensure that no one has to manage MS alone .’

ALAMY X3