It is 8.30am on a Monday morning, and the members of the district nursing team based at Crosshouse Area Centre in Ayrshire are starting their day. Student nurse Katy Chan is on the telephone, picking up messages left overnight. Among them is a call from the daughter of a patient who is receiving end-of-life care at home. Her mum has dislodged the syringe delivering pain relief, and help is required. Within minutes, District Nurse Barbara McFadzean is in her car, ready to respond.
“It is our job to make sure that people receive exceptional care at home,” she says. “No one wants to be in hospital if they can help it, and we do everything we can to prevent admission.”
She works in Kilmarnock where her team is aligned to two large general practices covering a mix of rural and urban areas, with pockets of high deprivation. Barbara, alongside five Community Staff Nurses and two healthcare assistants, assume nursing responsibility for lists totalling 20,000 patients.
Nursing people in the community involves providing complex patient care at home including at end-of-life. Barbara says: “We can be asked to deal with any care situation; we have a high skill set and are experts in delivering holistic care. Daily, we can range from managing long-term conditions to dealing with acute or chronic wounds.
“We also invest a lot of time with patients, planning and anticipating their ongoing care needs.”
Barbara does around a dozen home visits over a typical clinical day, as well as liaising with other health professionals and signposting patients and relatives to additional services, if required. Her job also involves clinical supervision, caseload management and coordination of care delivery, case reviews, keeping up-to-date with practice and policy changes, recruitment, staffing issues, and rota preparation.
The team also operates treatment room clinics within the GP practice for patients on the caseload who are not housebound but still require wound care, suture and clip removal, bloods to be checked, and injections.
Referrals to the DN team can come from GPs, hospitals, the Allied health team, patients themselves and their carers – anyone can call the community nursing team directly. Between them, the nurses here carry an active caseload of around 250 patients at any one time, and provide services seven days a week.
As a Charge Nurse in district nursing with the East Ayrshire Health and Social Care Partnership, Barbara is also striving to create an advanced role for those community nurses who have completed their specialist practitioner qualification. This involves advanced assessment, planning and initiating treatment for patients who would normally have been seen by the GP.
She is currently creating frameworks for ongoing supervision and professional development for these nurses, whilst urging them to utilise their extended skills to benefit patients. She also advocates collaboration with social care colleagues and working in partnership with GPs, to keep patients well at home for longer.
Barbara says: “I believe district nurses are managing patients better as result of embracing this advancing role, keeping them safer and longer at home, which has obvious benefits and measurable knock-on effects.
“While this keeps us busy we still value making time for a chat and a cuddle, and our patients really appreciate that.”
Seventeen years later, Barbara is still in no doubt that community nursing offers the promise of an extremely fulfilling career for ambitious young nurses. “All the policy drivers, the national strategies, are pointing in this direction,” she says. “Care in the community is the future.”
Pressure on district nursing however is growing – so creative person-centred solutions are being found. “It takes tenacity to innovate,” says Barbara. “Once people see the value of extra training, they get it. By working differently, and gaining new skills, this team is delivering a broader range of services and patients like it and value our service.”
Because of her creative leadership approach, Barbara was selected to be one of only 20 community nurses from across Scotland to take part in the Queen’s Nurse Development programme in 2017.
“Day-to-day you’ve got your head down, so it’s been fabulous to suddenly find myself thinking differently,” she says. “Thanks to the QNIS I feel even more passionate about my job. I want to be the very best District Nurse that I can be, and to inspire others to strive for the same.”
For student nurse Katy Chan, who has her sights set firmly on working in intensive care when she qualifies, her 12-week placement at the Crosshouse Area Centre has been an eye-opener. “It has given me a different perspective on community nursing,” she says. “I now have huge respect for what they do to keep people at home and ease pressure on the hospital, and I won’t forget that when I am back working in there.”
The East Ayrshire District Nurses mentor nursing students from the University of the West of Scotland and auxiliary students from the Open University. “I want the next generation of nurses to see what wonderful professional opportunities the community offers,” says Barbara.
“That way we can carry on developing district nursing and continue to meet more patients’ needs at home.