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Moving from hospital to community

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Courses enabling nurses to easily move from hospital to community nursing will come into force early next year, in line with the Department of Health's updated mandate to Health Education England (HEE). The mandate was published on 1 May and says that the courses will be available by March 2015.

A spokesperson from HEE said that the forum creating this course will meet for the first time in June to discuss the details. 'The purpose of [the course] will be to make recommendations with respect to delivering an integrated approach to care ensuring a supply of community nurses with the right skills to deliver more proactive care out of hospital settings and into primary and community settings,' the spokesperson said. However, she was unable to comment on what the courses would include or who would be involved in creating them.

Nursing leaders welcome the courses. Crystal Oldman, chief executive of the Queens Nursing Institute (QNI), says the course is 'overwhelmingly positive' and will 'support the move of nurses into the community.'

Head of policy at the Royal College of Nursing (RCN) Howard Catton agrees. 'District and community nurses are absolutely critical in delivering more care to patients in their homes and the community in line with the Government's agenda.'

He stops short of saying it is a good thing but thinks that 'in principle, it is the kind of initiative we need to be looking at, even though it is not a silver bullet on its own.'

The idea of a course has also been praised by nurses working in the community. Leigh Toogood, a practice nurse in London with an A&E nursing background, highlights the lack of formal training that was available to help her with the transition.

'I was given a list of things that I needed to learn by another practice nurse and was lucky to find a job in a place that allowed me to carry out training while on the job. However, it was all carried out in an ad hoc way and in small steps. If there had been a formal course when I had made the transition, I would definitely have taken it up.'

However, while this course is a positive step for community nursing and workforce numbers, the lack of detail around the course and its development is concerning, Mr Catton says.

'I would like to see more detail about how this will work, to make sure that the funding is there and that it is a quality experience.

'There has quite rightly, been a lot of focus on hospital nursing recently, but there hasn't been as much attention on nurses in primary care. We need to do more to support and enable both student nurses and those already working in the hospital to experience working in the community.'

The need for a course to encourage nurses into the community nursing workforce not only raises awareness of community nursing but raises its value as a profession. It highlights that community nursing is challenging and requires a different skill set, Ms Oldman says.

'It recognises that working in the community is different from working in the hospital and that there is a level of preparation required to make that move successfully.'

Key differences

'The main difference between the two types of nursing are the different environments. In the community, district nurses visit people's homes and have to carry out personal risk assessments every time they enter a new home. In the community you have to rely on your own abilities to problem solve and to assess risks. A hospital nurse's environment is a lot more controlled and contained,' says Ms Oldman.

'Every time they leave a home, a district nurse must determine whether it is safe to leave their patient alone or with their carers, whereas a hospital nurse is able to hand over to another nurse once their shift finishes and they know that their patients are in safe hands.

She also highlights the variations between being part of an extended team and working alone.

'District nursing also has a high level of autonomy where nurses do not have easy access to other health professionals, while nurses working in hospitals are able to consult other members of staff on the ward or members of the multidisciplinary team, should they need to.

'Working in the community is not for everyone, as it requires a great deal of independent working. This must be included in the selection process to ensure that all nurses moving into the community are aware of the level of autonomy.'

'Some people will love it, but others will not,' Ms Oldman adds.

Mr Catton says that some nurses' perceptions of community nursing need to be changed for a course like this to be successful.

'There are a whole set of myths that need to be debunked, such as the fact that nurses are required to work for two years in hospitals before working in the community or that working in the community is less challenging, which isn't true,' he adds.

Ms Oldman says that clinically there is little difference between the settings. 'Clinically, community nurses are seeing more and more complex conditions, acutely ill patients and those with multiple conditions. There is more of a synergy between the conditions that community nurses and hospital nurses see as more care is being moved into the community.

Carol Williams, nursing director of an NHS England area team in South West England, says the diversity of conditions seen by community nurses needs reflecting in the course. ' The course should include masterclasses on frailty, nutritional deficiencies, acute conditions, falls prevention, diabetes assessment, spirometry, good wound care, leg ulcer treatment and how to run clinical groups with patients so they can also learn from each other.

Ms Williams thinks that rotational programmes, would be a good way for all nurses to be able to experience both settings. 'This is something that we would love to work on in our area to encourage more hospital nurses to make the transition [to the community],' she adds.

Mr Catton agrees with this. 'We need to develop rotational roles so that all nurses wishing to work in the community can experience the practicalities of working in that environment with support.'


Ms Toogood says she is unsure of how many nurses will initially take up this course and move into primary care. 'Steps need to be taken first to make community nursing more attractive as a profession for registered nurses and student nurses, such as ensuring that some people's renumeration and further training is stable across all areas.'

Ms Oldman says she is unaware of how many nurses will move from the hospital to the community but that it will need to be a well-managed process for workforce planning. 'I don't think [that an influx of hospital nurses] will mean nurses in the community will feel displaced.'


Ms Oldman says that even though it can be a challenge for hospital nurses to move into the community, they will find that community nurses, and the community in which they end up working, will embrace them. 'The skills used in hospital settings are just as valuable in the community, but need to be used in a different way.' The introduction of courses to help nurses transition from working in a hospital to working in a community can only be a positive step, she thinks.

Mr Catton says: 'In principle this is a good thing. I think we need to do more to support and enable both student nurses and those working in hospitals to have greater exposure to work outside of hospital roles.'

Ms Oldman agrees. 'District nursing needs all the help it can get.'

What do you think? Leave a comment below or tweet your views to @IndyNurseMag

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I’m quite excited for this course. Im hoping to move into community care and yes I agree that community nursing must be well represented to make it attractive as many of my colleagues balk at the thought of me going from hospital to community.
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Community nursing needs to be well represented within the Nursing Degree just at the hospital. There is not enough training being given to students and this area of nursing is not advertised as much. There needs to be additional training for students and this will raise the awareness and the attraction of Community nursing.
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