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Filling a void in district nursing

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The new QNI standards aim to reflect the significa The new QNI standards aim to reflect the significant development of district nursing since the NMC standards were created over 20 years ago

It’s impossible to move away from the fact that community care is the future for the NHS. Whether it is seven-day services or new models of care, primary care is continually being lauded as the way forward. Yet this can’t happen without supporting the nursing workforce that will make this a reality.

The British Medical Association (BMA) recently released a report stating that general practice and community care needs ‘a meaningful programme of reform, which creates a sustainable, modern and flexible service’.

What is interesting is that the BMA report finally acknowledges the need for practice and community nurses to receive enhanced training in order for general practice ‘to reach its full potential’. This is something that the nursing profession has been saying for years. The Shape of Caring Review was set up to ensure the workforce is trained for the demands of the future, and there are upcoming frameworks expected from Health Education England (HEE) to illustrate this.

One step towards ensuring a well-trained competent workforce, is the release of a new set of voluntary standards to enhance the education and training of district nurses (see Resources). The Queen’s Nursing Institute (QNI) and the Queen’s Nursing Institute Scotland (QNIS) partnered to develop a document offering guidance on education and practice for district nurses in the four countries of the UK.

While higher education institutions are not mandated to implement these standards, the QNI recommends that higher education institutions map them into their education contract.

The standards came about when the two organisations identified that the current Nursing and Midwifery Council (NMC) standards for district nurse training were outdated and didn’t reflect a contemporary district nursing service. The current standards are around 20 years old, so the QNI and the QNIS decided to create standards that could enhance the NMC standards for the district nurse Specialist Qualification Standard (SPQ). Representatives from the NMC were present at all of the meetings during the standard’s development.

Crystal Oldman, chief executive of the QNI, says that the standards are not meant to override the NMC’s current education standards.

‘We respect the NMC standards and we are not in any way trying to compete or replace them. These are there to enhance them,’ she says.

The SPQ is the NMC-approved qualification run by a number of universities, which allows nurses to develop the skills necessary for district nursing.

Joint effort
The standards were developed with a group of representatives from a number of nursing organisations such as the Royal College of Nursing, HEE, Public Health England, the Department of Health and the NMC.

Mary Saunders, project manager for the standards, says one of the biggest challenges was overcoming the policy and language differences between the four countries. ‘District nursing as a profession is essentially the same wherever you go. Although there are different structures in each country, the care is the same and this in the end was how we overcame [the challenge],’ she said.

The members of the Association of District Nurse Educators (ADNE) were heavily involved with the QNI and QNIS in developing the standards by organising focus groups and disseminating the draft guidelines to the district nurse students they teach and other key stakeholders.

Heather Bain, chair of the ADNE, says that the standards are a step in the right direction and that they acknowledge the complexity of the district nurse role and the move towards advanced practice.

‘We did feel that the old NMC standards were outdated and did not reflect today’s district nurse practice. Our students and practice teachers, who support the learning in practice of the students, said the same thing. The consultation process was robust and we are pleased that it was recognised that revised standards for district nurses were required,’ she says.

During the development of the standards, the QNI consulted nurses on the draft standards. This was answered by 260 district nurses. Nearly all of the nurses (98%) said ‘yes’ when asked if the standards reflected their expectations of the future role of district nurses. When asked if any standards were unnecessary 96% said ‘no’.

The standards fit into four different domains: clinical care, leadership and operational management, facilitation and learning, and evidence research and development. Within each domain there are a series of standards which reflect good practice for district nurses. They also contain more information about how nurses can engage with technological advances and project management. The new standards reflect how district nursing as a profession has developed since the NMC standards were released in 1994.

Postgraduate education
Going forward, the ADNE has committed to the standards.

It will map current and future programmes against the standards. All future district nursing courses commissioned by HEE will adhere to the QNI standards.

The final page of the standards reveals that the QNI has committed to review these standards in 2020. ‘We believe that this document has a five- year life. We are committed to reviewing this in 2020, if the situation remains the same,’ says Ms Oldman.

‘However, if the NMC are in the process of reviewing their SPQ standards, we hope that these will inform the revision,’ she adds.

However, Ms Bain says there is still room for development of the standards. ‘We need to ensure that the district nurse students are supported in practice by a suitably qualified practice teacher who is educated appropriately (ideally at postgraduate level) to support the student working towards an advanced level of practice. This detail is not explicit within the standards.

‘While we acknowledge we are in a period of transition,’ says Ms Bain, ‘nursing is now a graduate profession and many of us would have liked the standards to have been specific about the requirement to move to postgraduate education for district nurses. It is almost contradictory to allow the academic level be decided by individual programmes but have standards that reflect the complexity of an advanced role.

‘We appreciate that these standards are voluntary and cannot reflect everyone’s vision of district nursing, but the standards could have been seen to have more teeth if they had stated an expectation that, by 2020, the majority of district nurse education will have moved to postgraduate level,’ she adds.

Ms Saunders says that she hopes the standards will ‘raise the profile of district nurses, create more excellent practitioners, and enable commissioners to appreciate the breadth of the role’.

Time will tell how effective the standards are and whether they are a step in that direction.

1. Queen’s Nursing Institute. The QNI/QNIS Voluntary Standards for district nurse education and standards. 2015.

2. Nursing and Midwifery Council. 1994. Specialist Practitioner Qualification Standards.

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