I am a District Nurse Team Leader with NHS Fife covering a large, mainly rural area, from Dalgety Bay to Kincardine. As well as the five district nursing teams in the locality, I also line manage the Dunfermline evening nursing service. I hold my own caseload of patients, while supporting charge nurses who manage their own caseloads. Geographically, it is a very wide area to cover which, as a team leader, is quite challenging, just trying to get from one base to another. Patient needs are extremely varied and we care for people across the age spectrum – it definitely keeps the job interesting.
When I was a final year nursing student I had my own small caseload during a community placement and I absolutely loved it. After qualifying, my initial post was in a day hospital and then in acute surgical. I was seconded to work with the breast specialist team which had a little bit of community in it and it reinforced that the community setting was my end goal. I secured a post as a community staff nurse soon after in 2003 and have been working with district nursing teams ever since. In my first community post, I had a fantastic charge nurse - she was a wonderful role model and really encouraged me to develop further professionally. I undertook the specialist practitioner course in 2011 and worked as a charge nurse until the team leader post I’m now in came up around three years ago. I’ve got the best of both worlds – I am out and about seeing patients but I’m also the team leader, with the opportunity to develop other staff, working with them modelling the behaviours, skills and competencies that support and enable person-centred care in the community.
The complexity of care for patients in the community has increased hugely over the last few years, with significant advances in technology. My expertise is in delivering and coordinating that complex care, working with patients, their families, carers and the health care team. It means where previously people couldn’t have stayed at home they now can because staff are skilled with specialist knowledge and equipment. As a team leader, I ensure we are developing our workforce so they can meet the needs of these patients. It requires the clinical knowledge to manage complex care in the community and I use my advanced assessment skills to anticipate their needs. A broad knowledge of other agencies is key to look at what services are available to support patients. My approachable and confident manner is essential to give patients and families confidence in the nursing team. Above all, my clinical skills allow me to make rigorous assessments and to coordinate care. We are highly trained, we are skilled, and we assess risk ensuring that patient safety is at the forefront of everything we do. The bottom line is, people can stay at home with complex symptoms because we can manage people at home now who need a more intensive level of nursing care.
Looking after people at the end of their lives is particularly rewarding. Being able to support people at home, where that is their preference, and manage their symptoms well with their family around them is one of the best parts of being a district nurse. Recently, there was a lady at end-of-life who had expressed her wish to remain at home. This was so important to her as her family would have faced challenges being able to visit her in hospital. I met with her and her relatives soon after her diagnosis, listened to their concerns and hopes for managing her symptoms. The team’s involvement became greater as time went on. We arranged to put the bed and specialist equipment in an area of the house where she really wanted to be. We increased the services needed to support her and her family. She was comfortable, her symptoms were well managed, and she passed away in her home with her loved ones there around her. She had her wish to die at home fulfilled. If she had to go into hospital it would have been a completely different experience for the whole family. That’s what you want to be able to do for all patients – make sure all things are in place to make a difference to them.