My journey into community nursing
12 March 2020 | Neema Young
Upon completion of my BSc Adult Nursing training at Anglia Ruskin University (ARU) in 2018, I went straight into Community Nursing as a Newly Qualified nurse and worked with the Cambridgeshire Peterborough Foundation Trust (CPFT). Recently, I have started a new role in the Learning and Development team as an Assistant Practice Educator for Nursing Associates.
You can’t be what you can’t see
It has been an interesting journey into nursing. When I chose to retrain as a nurse in my 30s in the UK – a country far away from home – it was a big leap from marketing or working in environmental conservation or the volunteer work I did with young people. I started off as a support worker to gain some experience of care work then started my nurse training. Towards the end of my 3rd year training, I was not sure where I would work. I remember contemplating the pros and cons of hospital and community roles. There were so many students in my cohort who were confident about the wards they were going to work in – whether general medicine, surgical, rotational programme or critical care.
I suppose my interest in community nursing started when I got a chance to do a placement in the community in my 2nd year. I soon realised that I thoroughly enjoyed the placement and was mind blown by the District Nursing service. ‘Wow! Free at the point of access medical care in your own home 24/7 – how brilliant is this!’ Patient contact is a big part of community nursing and I loved getting to know my patients and being able to be there from the beginning to the end of their treatment and in some cases the end of their lives. I was interested in palliative care and my dissertation focused on the role of community nurses; and, of course, the flexibility of hours in the community also suited my work-life balance.
I was born in Kenya and have lived in the UK for 10 years. Health services in Kenya are not free and people have to pay to access medical services. I always think to myself, how lucky are we to have the National Health Service.
During my nurse training, I remember going to the Florence Nightingale museum in 2016: ‘I still have my souvenir pencil!‘ The very same day we passed by St Thomas’ Hospital and we took pictures next to the Mary Seacole statue. Looking back, these two women are historical figures who made a very significant contribution to nursing.
‘Never think that you have done anything effectual in nursing in London till you nurse, not only the sick poor in workhouses, but those at home.’
Florence Nightingale, 1867
Florence Nightingale was instrumental in initiating nursing education programmes and also contributed to the development of district nursing in the UK and to the foundation of the QNI. Today, as we celebrate the International Year of the Nurse and Midwife, we also look at how modern nursing has evolved from when nurses were ‘submissive’ and essentially just followed doctors’ orders. Nowadays nurses are critical thinkers and autonomous practitioners, for instance, Specialist Nurses, Advanced Nurse Practitioners (ANPs) and the Nurse Consultants who work in Multi-Disciplinary Teams (MDT).
When I looked at the collected works of Florence Nightingale, I found this fascinating description of a District Nurse:
- A District Nurse must be of a higher class and have fuller training than a hospital nurse, because she has no hospital appliances at hand at all; and because she has to make notes of the case for the doctor, who has no one but her to report to him. She is his staff of clinical clerks, dressers, and nurses.
- A District Nurse must “nurse the room” as well as the patient and teach the family to nurse the room.
- A District Nurse must bring to the notice of the Officer of Health, or proper authority, those sanitary defects, which he alone can remedy. Thus dustbins are emptied, water butts cleaned, water supply and drainage examined and remedied.
During my training, people said going straight to the community would de-skill me or that I would need to have one year’s experience in the wards before coming out in the district. These myths about community nursing need to be busted. When I chose to be in the community, my personal tutor encouraged me to apply for the position, daunting as it may seem to start. It is like a hospital without walls, you have to think on your feet, and not only deal with patients – but with the family, carers and surrounding environment.
Times have changed and like with any career or vocation the more you do it, the more you get used to it and become more competent. Slowly, you realise that you are not alone and with a supportive team you will grow in confidence and achieve your competency. Don’t hesitate to call the duty nurse or do a joint visit with a colleague. It is important to remember the NMC code and that you are accountable for your actions and work within your scope of practice; don’t be afraid to say no if you don’t feel comfortable or safe. At times, people expect you to have answers for everything; however, you should not be afraid to say you don’t know, speak to colleagues, refer to evidence-based practice or signpost them.
Nursing in the Community
The new QNI film about community nursing captures beautifully what it is like to work in the community. Loneliness and social isolation is without a doubt a big issue in the community. According to the Office of National Statistics (2010) over 2.2 million people aged 75 and often live alone. At times, community nurses are the only people patients see, because they are housebound. The charity Age UK (2016) revealed that ‘half a million older people go at least five or six days a week without seeing or speaking to anyone at all.’ Sometimes, patients not only see district nurses as their professional contact but also as their friends too, because of the relationship formed during the visits.
Nurses and other health care professionals are skilled workers – our work is very complex especially with an increase in chronic conditions and terminal illness. We deal with vulnerable people: you need to be skilled in order to provide high-quality holistic care and ensure a patient is safe at home and, where possible, avoid hospital admission. I gained so much confidence in dealing with different situations and as an autonomous worker: you work closely with the MDT, support students (nursing students, nursing associates, medical students) and other new staff in the team.
Community nursing is a rewarding career and has taught me a lot and with the support of my team, ‘I am who I am’ today! I would encourage people to go for it. The NHS England Long Term Plan envisions more care in the community. Therefore, there is a need for more community nurses – there are career development options such as training to be a district nurse or other specialist nurses (diabetes, continence, Parkinson’s, tissue viability) and general practice nurse.
I have now moved on and started a role as an Assistant Practice Educator supporting Nursing Associates in Cambridge. Nursing Associate is a new role that was introduced in 2017 to bridge the gap between Healthcare Assistant (HCA) and nurse. Essentially, after training, a nursing associate is meant to support a nurse and contribute to nursing care so that it frees a registered nurse to focus on more complex clinical care.
There are many possibilities in nursing: my advice for everyone is to embrace any opportunity that comes your way; nursing has a lot of career options so don’t limit yourself. The world is your oyster and once you are a nurse you will always be a nurse. Nurses have been voted as the most respected professional by the public, we should be proud of what we do and give a strong voice to the profession.
A multi-cultural society
I would also like to highlight that we live in a multi-cultural society. According to the NHS staff from overseas statistics briefing paper 2019 approximately 153,000 people who work in the NHS are non-British. Most organisations are talking about diversity and inclusion in the workplace. Personally, I recall even as a student every time I looked at the NHS top leadership and spoke to BAME staff, I kept wondering, are there any people who looked like me at the top? The Snowy White Peaks report and Workforce Race Equality Standard (WRES) 2020 report shows that Black and minority ethnic (BAME) staff have poor work experiences, face discrimination and are not represented at senior leadership level.
Last year, I joined our Trust’s BAME staff network and when CPFT introduced reverse mentoring I showed interest and was lucky to have the opportunity to have four sessions with a senior board member (the Director of Finance) and even attended a whole day trust board meeting where I was the only BME staff member. I have always thought to myself, ‘I am just a band 5 and no one will listen to me’. But, wherever you are, you can make a difference. It is important to have conversations about race and diversity, know who your colleagues are and support them. As I have said previously, the beauty of NHS is that it truly celebrates what the UK is – a multicultural society that has over 210 nationalities working for it.
Lois A. Monteiro (1985) Florence Nightingale on Public Health . Public Health Then and now https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.75.2.181
https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7783 NHS staff from overseas: statistics