Reflections on shadowing community nurses

The Personalised Care Deputy Director, Workforce & National Clinical Lead, and the Personalised Care Deputy Director, Policy and Strategy recently spent a day shadowing a Queen’s Nurse to better understand how personalised care applies to practice, and what opportunities and challenges there are:

Queen’s Nurses are community or primary care nurses who have demonstrated a high level of commitment to care and nursing practice and had the title conferred on them by the Queen’s Nursing Institute (QNI).

The QNI is a registered charity dedicated to improving the nursing care of people in the home and community.

Michelle spent the day shadowing Val, Queen’s Nurse, Clinical Lead and District Nurse in Walsall. Val had attended a joint Personalised Care Group / QNI event focussing on what personalised care is and what it means for nurses in practice). Nicola spent the day shadowing Gail, Queen’s Nurse and District Nurse Team Manager in Whitton and Twickenham.

During the day we visited a range of people and their families as well as attending multidisciplinary team meetings to assess people’s care packages. The visits clearly illustrated the variety and challenges in the role, from caring for people right at the end of their lives to supporting people living in sub-standard accommodation facing wider difficulties around the social determinants of health.

What struck us from the outset was Val and Gail’s pride in their jobs as district nurses and a strong sense of being privileged to be a guest in someone’s home and life. They both highly valued giving direct care and were keen that their administrative duties did not impact on this.

During visits it became apparent that community nurses operate as skilled generalists, often with specialist knowledge in a variety of areas such as tissue viability or end of life care. They often go in to support someone with one identified need which turns into a bigger need – medical or non-medical – requiring coordination with other services and a real understanding of the individual’s circumstances and preferences.

Nurses go out of their way in these circumstances to make sure people have the support they need.

The visits showed the potential of the personalised care model to free up nurse time. Nurses encounter daily issues where people may struggle to self-manage their conditions as they have low levels of activation – knowledge, skill and confidence.

With more tailored support and interventions from others like health coaches or through peer support, people who have low activation can be better supported and have improved outcomes. This has the potential to free up district nursing time to focus on people with more complex needs and redesign services that better match a person’s needs.

Nurses have a strong motivation to come into the profession to help and are natural ‘doers’ to solve problems for people in their care. Moving to a more facilitator/coach model and taking a more asset based ‘what matters to you’ approach, rather than ‘what’s the matter with you’, can be quite a shift for some practitioners.

Many nurses already deliver great personalised care and it’s fantastic to see them in action, but we need to support them so that it’s more consistent. We have been working to bring national nurse leaders together to see how we can collectively support the profession, raise awareness and ensure that nurses have better knowledge, skills and confidence to deliver personalised care.

The conversations that health and care staff have with people, their carers and families are at the heart of personalised care. What could be regarded as routine conversations can have huge impact on individuals. Enabling people to manage their own health and wellbeing, based on their priorities and concerns, means people feel listened to, understood and more in control. The skills needed to do this effectively need to be learned and it requires a fresh mindset.

Over the next ten years, the Personalised Care Group is rolling out training and development for health and care staff to develop their knowledge, skills and confidence as part of Universal Personalised Care.

Nurses have a key role to play and will be integral in driving improvements in personalised care.

Nicola Kay

Nicola Kay is NHS England’s Deputy Director for Personalised Care Policy and Strategy.

In her role, she develops and leads the approach to scaling up and mainstreaming personalised care, including embedding the relevant IT infrastructure, developing necessary skills across the NHS, identifying new legislative rights and strategic stakeholder engagement.

Nicola leads a team which work closely with local areas to embed new opportunities for personalised care in areas such as substance misuse and neuro-disability. Her team also includes a range of people who bring their own lived experience to the team’s work.

Prior to joining NHS England in 2016, Nicola worked for 10 years as a civil servant in a range of central government policy, strategy and finance roles. She led on health and social care spending at HM Treasury, including the commissioning reforms in the 2012 Health and Social Care Act, the Dilnot Commission and the 2010 Spending Review.

Michelle Mello

Michelle Mello, RN, BSc (Hons), MSc, PGCE is Senior Nurse Advisor, Team Chief Nursing Officer, NHS England

Michelle is a nurse with over 38 years’ experience of working in the NHS in a variety of roles. This has included clinical, management, commissioning, strategic and executive level posts. Clinical roles included working in hospitals and in the community as a health visitor and diabetes specialist nurse. Michelle also worked in a senior academic post at Warwick Diabetes Care, University of Warwick.

Since 2012 Michelle has held national roles in NHS England working with the Chief Nursing Officer, Right Care Team and latterly the Personalised Care Group. From November 2020 to March 2021 Michelle was seconded to the London regional team as Clinical Quality Director. In 2022 Michelle retired and returned part-time to NHS England.

She is a Florence Nightingale Foundation Scholar and Queens Nursing Institute Fellow.

Follow Michelle on Twitter: @MSHMello

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