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The New Welsh Levels of Care tool benefits District Nurses in Wales

The New Welsh Levels of Care tool benefits District Nurses in Wales

Jody Hill, District Nursing Project Lead


Hello, my name is Jody Hill, and I am the District Nurse Project Lead for the All-Wales Nurse Staffing Programme at Health Education and Improvement Wales (HEIW).

I have been a nurse for 40 years within the NHS, across many settings, from ITU to Medical wards, practice nursing and latterly as the Quality Lead for the Cervical Screening Programme in Wales. I joined the Nurse Staffing Programme team in March 2020 as the post offered a unique opportunity to raise the profile of district nurse staffing establishments and focus on providing care sensitively to patients.

The district nursing work stream engages with district nurses across Wales. There are 159 district nursing teams working across Health Boards and Trusts in Wales. These teams are grouped by locality or clusters within their Health Board or Trust. They work in many different environments, including urban, rural, coastal and valley settings which influence their case load sizes and types of patient population.

Throughout the past 18 months I have engaged and worked closely with district nursing operational leads, team leaders and community nurses from all the Health Boards across Wales. I have learned how the day-to-day working of the teams has had to change to prioritise care and adopted new ways of working to cope with fluctuating staff availability throughout the Covid-19 pandemic. District nurses have taken on new roles and skills to care for increasingly complex patients within the community. I have been struck by the way community nurses at all levels have adapted and risen to the changing and increased demands on their service. They have shown immense bravery in the face of uncertainty during the pandemic.

Throughout all this the workstream group members have been developing  the draft version of the Welsh Levels of Care (WLoC) for use in district nursing. They’ve also engaged in piloting the tool across all the Health Boards. This patient acuity and dependency tool has been widely accepted by those who have used it. District nurses across Wales have shown an enthusiasm and interest in the WLoC and ongoing training sessions are being offered to extend their knowledge of the acuity tool.

The group have continued to meet monthly (although not always quorate during lockdown) to devised quality indicators. These need further work to show how district nurses influence patient outcomes positively and which are sensitive to nurse staffing levels. Work will also be undertaken to incorporate professional judgement into the triangulated approach which will be used to calculate nurse staffing levels within district nursing teams when the 2nd duty of the Act is extended.

The adaptability and dedication of district nursing teams has been evident particularly over the past 18 months. Calculating and maintaining evidence-based nurse staffing levels can give nurses confidence in their ability to deliver care and job satisfaction, as well as aiding recruitment of new nurses into the profession.

Over the coming year I would like to be able to provide more face-to-face support to operational teams and move the work forward.

If you would like to find out more about the district nursing workstream please visit the relevant sections on our website.

I look forward to continuing to work with you all.