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Staffing issues are creating unsafe caseloads

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District nursing is being stretched to the limit District nursing is being stretched to the limit

Decreasing the number of community nurses while increasing the number of patients treated in community settings has the potential to create unsafe caseloads, a report from the Queen's Nursing Institute (QNI) has found.

The report stated that district nurses are working in ‘high pressure environments where resources are scarce and there is a risk that care may be left undone.’ Additionally, teams are stretched by a renewed focus on providing as much care as possible in community settings. The situation has become so severe, in some areas, that services may be dependent on staff working unpaid overtime each day in order to complete their caseload.

‘The issue of safe caseloads is one that has been of growing concern to district nurses in recent years and we receive more questions on this subject than almost any other,’ said Crystal Oldman, chief executive of the QNI. ‘This is against a background of overstretched services that are struggling to cope with the number of patients being referred to them for the expert care that they provide.’

The report also stated that a conundrum exists in the supply of community nurses. More nurses can be encouraged to do placements in the community to increase numbers, but this increases the already strenuous demands on the nurses.

‘Frequently these are patients with complex long-term conditions, who need specialist healthcare in the community for them to be able to live with dignity in their own home,' added Ms Oldman.

‘There is now general recognition among policy makers, commissioners and service planners that we need a stronger framework of principles and measures in order to meet individual and population need.

The QNI intends to promote discussion on the subject, and can be reached at

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I am a community nurse and yes I see first hand how overstretched we are. We as front line staff are vulnerable due to the fact that we are lone workers and resources needed are not always readily to hand due to financial constraints....where oh where is the logic in cutting community nurse jobs when the emphasis on "care in the community" to ease the strain on hospital admissions and speedier discharges is an ongoing government health initiative !....there is no logic at all. Nurses need much more recognition and support in order to provide the best sustainable care possible.
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