This weeks’ blog is by Stephanie Reynolds, Senior Lecturer, MSc Nursing course lead, Birmingham City University (stephanie.reynolds@bcu.ac.uk)
Having researched the background into community nursing , and specifically district nursing within pre-registration adult nurse education, I raise the question as to whether community nursing should be a nursing field/ separate branch alongside the other 4 fields of: adult nursing, child nursing, learning disabilities and mental health. I ask this because adult nursing education particularly in more recent years has become very secondary care focussed with most student nurse placements taking place in hospital settings. Equally secondary care dominates academic teaching due to most nurse lecturers being from a secondary care background. The NMC proficiencies focus on predominantly acute care and technical skills as opposed to more subtle skills aligned to primary care such as holistic assessment, autonomous working, and preventing hospital admission. The suggestion that community nursing should be a field in its own right has been identified for almost two decades , and yet continues to have not been officially addressed or acknowledged by national bodies such as the NMC. There is however scope within the NMC proficiencies to have a community focussed course, and this has been implemented in isolated areas across the country, most notably the University of Roehampton . With workforce development plans for increased care in the community in order to ease the pressure on secondary care, more interest in community nursing care needs to be generated. Current academic curriculums without specification of community learning, but an amalgamated approach can mean that pre-registration students lose the impact of a raised awareness of community learning, particularly if a community placement has not been afforded them during their education.
The community nursing profile within education is reflective of media interest where attention is almost always focussed on care in the secondary setting. There are many popular hospital dramas, and news reporting always uses the hospital as a setting for breaking stories of interest to the media, COVID19 being one such example where the clap for carers took place outside hospital entrances. The thrill of the emergency draws the attention of prospective adult nursing students to want to be lifesavers and have a ‘heroic’ profession to aspire to. Likewise, Accident and Emergency, and critical care placements are seen as the ultimate learning opportunity, where there is plenty of action, and doing something to a patient rather than working with them on their care is seen as more powerful than observing and thinking about the wider issues of a patient’s individual needs. As a placement manager in a community setting, I found that students frequently asked how they would achieve their ‘skills’, and it was implied that a community nursing placement was of lesser importance in terms of learning. I would often point out that they would be learning different skills to those obvious practical ones outlined in placement documents. This is what nursing education needs to embrace, that community nursing is different to secondary nursing. It is not a lesser field, nor is it de-skilled or somewhere you go to retire, as promulgated in myths that stem from secondary care dominance and appear to be unchallenged by a specialty that can be hidden behind closed doors. It is a specialist field where the more you learn, the more confident you can become in managing complex patients at home with social and financial factors, in addition to physical factors. It is a setting where you can learn to diagnose complex health problems and see patients improve because you have worked with them, built a rapport and trust with them, and imparted knowledge so that they can take care of themselves and their own condition. It offers the opportunity for autonomous working, prescribing tailored care, prescribing medication and managing or de-escalating immediate situations as a lone worker, and these constitute challenging and specialist skills, far removed from a job suitable for someone ready to retire.
The pathway for newly qualified students to become community nurses needs to be embraced and valued nationally from the outset and therefore from the start of pre-registration education. Nurses need not to be divided, but to respect their different skills. Preliminary data from my research on students shows that they do not feel confident to have employment in the community straight from qualification, conforming to another myth that they need hospital experience first5.
References
1. REYNOLDS, S (2024) The Habitus and Field of District Nursing: a discussion around its professional status and symbolic capital. Br Community Nurs. 2024 Dec 2;29(12):565-574. Doi: 10.12968/bcjn.2024.0081
2. LONGLEY, M., SHAW, C., & DOLAN, G. (2007). Nursing: Towards 2015: Alterative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015. London: Nursing and Midwifery Council.
3. WILLIS, L. (2015) Raising the bar; The Shape of Caring review. A review of the Future Education and Training of Registered Nurses and Care Assistants. Health Education England
4. QUEENS NURSING INSTITUTE. Pre-registration community nursing placements. Survey report. 2022.
5. WHITE, R (2019) The truth about district nursing. Nursing in Practice https://www.nursinginpractice.com/professional/the-truth-about-district-nursing/