Feb 192019

In this Blog, Richard Desir, Senior Workforce Transformation Nurse, Aneurin Bevan University Health Board and All Wales District Nursing Workforce Operational Lead shares the journey of the development of an evidence based workload and workforce tool and Interim Nurse Staffing Principles for District Nursing.

The All Wales District Nursing workforce and workload group is tasked to develop a District Nursing Workload and Workforce Tool that has been evidenced within the Welsh context, that would assist Health Boards in community nursing workforce planning. This important work will positively contribute to the delivery of care to patients in their own home and help shape the workforce by ensuring the safe and effective deployment of district nurses to meet the needs of the populations they serve.

A triangulated approach will be used when calculating the number and skill mix of nurses required within District Nursing Services, which takes into account:

  • Patient acuity and dependency
  • Quality audit
  • Professional judgement

The group has undertaken a staged approach to developing the learning and evidence base with each stage of the development of the Quality Audit tool and the Welsh Levels of Care, using service improvement methodology Improving Quality Together 1000 Lives (2014), each phase follows the Plan, Do, Study, Act (PDSA) cycle.

Under the leadership of Paul Labourne, Richard Desir and Katrina Rowlands the All Wales District Nursing workforce group have embarked on a remarkable and ambitious journey to journey to create the evidence to:

  • Determine what is quality and how this can be measured and articulated?
  • Develop and test an acuity and dependency tool to help assess workload.
  • Explore how professional judgement is used to inform decision making the associated factors

Throughout 2017/18 over 600 frontline District Nurses and management teams have engaged in workshops held across Wales to explore how the ‘Welsh Levels of Care’ could be used as an acuity tool within district nursing and sessions have been held to inform the further testing of the District Nursing Quality Audit.

The testing of the quality audit tool has resulted benefitted patients and district nursing teams by triggering:

  • Systematic roll out of National Early Warning scores within district nursing
  • Systematic roll out of “what Matters to me “ framework
  • Systematic improvement to equipment available to district nurses
  • Systematic capturing patient outcomes and experience to inform service improvement
  • The early digitalisation of capturing data and using that data digitally
  • Creating new evidence
  • Energising the district nursing workforce

The Chief Nursing Officer in Wales requested that an interim set of guiding nurse staffing principles for district nursing be developed and implemented to support the preparation for extension of the Act while the work to develop an evidence based workforce planning tool for District Nursing is undertaken. In September 2017 the District Nursing Staffing Principles were launched. These are monitored biannually and individual feedback provided to each organisation involved.

The implementation of the district nursing staffing principles has enabled a baseline assessment of services to understand where service development is required.  Enabling district nursing teams to be well defined, well led, and well supported.  They have highlighted areas where demand and capacity may be mismatched and further work is required.  It has introduced additional skill mix to district nursing such as administration support that has released time for patients.  The iterative assessment of the principles and the feedback given is supporting organisations with their development of the core universal nursing care at home service recognising the unique contribution district nurses play in the management of population health, improving public health and keeping the patient at the centre of care.

If you would like to find out more about the work undertaken by the District Nursing work stream  please email richard.desir@wales.nhs.uk or Katrina.Rowlands@wales.nhs.uk

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