Call for government action on challenges faced by community nurses in Wales

They also want to see more investment in the service in terms of technology and training opportunities for staff.

“We do not always look after our staff very well, we expect more and more from them”

Nurse in report

The calls come from the National Assembly for Wales’ Health, Social Care and Sport Committee, which today launched a report on community and district nursing services in the country.

In the report (PDF attached below), the committee raised concerns that staff morale was low and that nurses were leaving their jobs because they “could not cope” with the stress involved.

It follows an inquiry held by the committee, where assembly members heard evidence from frontline nurses on the challenges they face day-to-day working in the community.

Community nurses described themselves as the “invisible service” in Wales and warned that there was no accurate picture of the number and skill mix of nursing teams, nor the numbers of patients receiving care in their own homes.

One nurse quoted in the report said that they had left district nursing after 18 years because they “could not cope any longer with the stress” and that job workload had increased, and they were understaffed.

Another said: “The past five years has seen diminishing resources in front line services. Nurses leaving and recruitment issues. We do not always look after our staff very well, we expect more and more from them.”

Nurses also reported that there was a lack of information about children’s nurses working in the community.

The committee found that “probably the single biggest issue” raised by community nurses in the inquiry was their “inability to access the most appropriate technology to enable them to do their job effectively”.

Today’s report addresses the concerns raised by those on the frontline and called on the Welsh government to take action.

As part of its list of 10 recommendations in the report, the committee asked the Welsh government to ensure that the role of community nursing was “properly recognised” in workforce planning, nurse recruitment and training across healthcare.

“Community nursing is a key part of the future of the NHS in Wales and we are calling on the Welsh government to listen"

Dai Lloyd

Another recommendation focused specifically on nurse staffing levels and called on the government to “produce and publish a strategy” to extend the Nurse Staffing Levels (Wales) Act 2016, to all settings, earmarking community and district nursing services.

It noted that, while the government had said it remained committed to extending the law, the committee felt it was “disappointing to hear” that for district nursing, an appropriate workforce planning tool – required by the act to calculate nurse staffing levels needed – was not likely to be ready for “some years”.

As an interim measure, the chief nursing officer for Wales, Professor Jean White, has published guiding principles to support the planning of staffing levels within district nursing services.

While the committee said it “welcomed” the publication, it reiterated that this was only an interim measure.

In addition, another recommendation from the committee addressed the issues with technology.

It called on the Welsh government to work with health boards to “ensure proper investment in appropriate technology for community nursing”.

“The use of hand-held mobile devices with instant access to patient information, appointments and emails should be standard across Wales,” it stated.

The recommendations also sees a focus on children’s nurses working in the community. It stated that the government should undertake an audit of the number of nurses in this field to help inform its future workforce planning.

“For the service to improve and thrive we need to make sure that staffing levels are right”

Dai Lloyd

Other recommendations in the report address providing staff with further training opportunities, including the district nursing specialist qualification, and also looked at promoting community nursing as an “attractive career”.

On publication of the report, committee chair Dai Lloyd, said: “We are concerned to hear from nurses about low staff morale and in some cases, nurses are leaving the service as a result of stress and increased workload.”

He said that the Welsh government must provide nurses with the “support and resources they need to do their job”.

“If we are to support individuals and their families to manage their health at home, avoid unnecessary hospital admissions, enable early discharges and help maintain people’s independence then we need a clear picture of what the community nursing situation is in Wales at the moment and investment in the service,” he said.

“For the service to improve and thrive we need to make sure that staffing levels are right, that nurses are provided with the mobile technology they need to do their jobs effectively and that community nursing is seen as an attractive career.

“Community nursing is a key part of the future of the NHS in Wales and we are calling on the Welsh government to listen to what frontline nurses are telling us and work to implement the recommendations laid out in our report.”

Commenting on the report, director of the Royal College of Nursing in Wales, Helen Whyley, welcomed the committee’s recommendations.

“Our members gave evidence to the Health, Social Care and Sport Committee inquiry and we are pleased that the committee has listened to their experience of the challenging environment in which they care for patients,” she said.

Ms Whyley added that the report “must be acted upon urgently” and noted that RCN Wales will be “lobbying” for a timeline for extending the Nurse Staffing Levels (Wales) Act 2016 to community and district nursing.

A Welsh government spokesman said: “We recognise the important contribution that community nursing teams make in delivering care to patients in their homes.

“We will consider the inquiry report and its recommendations and provide a response to the committee at the end of September.”