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District nursing

Nurse helping an elderly woman

About the work

The district nursing (DN) group 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. The teams work in many different environments, including urban, rural, coastal and valleys settings which influence their case load sizes and types of patient population.

The district nursing group consists of senior district nurses from the Health Board and Trusts across Wales. The group meets monthly and co-ordinates the actions required to develop an evidence based workforce planning tool for district nursing. The workforce planning tool, known as the Welsh Levels of Care, will form part of the triangulated approach that will be used to determine staffing levels within district nursing services across Wales. 

Aim

  • to develop the patient acuity and dependency tool, the Welsh Levels of Care for district nursing.
  • identify evidence-based quality indicators sensitive to district nursing which reflect quality in patient care and capture the impact low staffing could have on these indicators.
  • develop a way of evidencing how professional judgement is used to define district nursing staffing levels and skill mix which allows patients to be nursed with sensitivity to their individual needs.    
  • work in collaboration with health boards/trusts across Wales to develop ways of using a Once for Wales approach for data capture and analysis in line with, and in readiness for, complying with the requirements of the Act when it is extended to district nursing services.
  • remain informed and conversant with the progress of Health Boards and Trusts and their compliance with the Interim District Nurse Staffing Principles.
  • work collaboratively with operational leads within each Health Board and Trust to follow the ‘Once for Wales’ approach and support the delivery of the actions set out in the district nursing work stream plan.

Remit

On behalf of NHS Wales the remit of the group is to:

  • develop a national patient acuity and dependency tool, known as the Welsh Levels of Care, for district nursing
  • facilitate and oversee the implementation of the workforce planning tool within Health Boards/Trusts in Wales
  • use the evidence-based approach to develop robust methods, tools and techniques to determine appropriate nurse staffing levels within district nursing services, using the common model of triangulation
  • identify evidence-based quality indicators sensitive to district nursing which reflect quality in patient care
  • develop a way of evidencing how professional judgement is used to define district nursing staffing levels and skill mix which allows patients to be nursed with sensitivity to their individual needs.    
  • identify the informatics system and process for data capture and analysis
  • following a ‘Once for Wales’ approach provide guidance and support to Health Boards and Trusts in preparing for implementation of the second duty of the act
  • support Health Boards and Trusts, and remain informed and conversant, with the progress of and compliance with the Interim District Nurse Staffing Principles.
  • support the All Wales Nurse Staffing programmes publication and communication strategy to ensure stakeholders are informed and engaged
  • working collaboratively, ensure the timely delivery of the actions required as set out in the district nursing work stream plan.
  • support and advise subgroups to undertake task and finish work as identified within the work stream plan
  • provide regular highlight reports and make recommendations, seeking support and guidance from the All Wales Nurse Staffing Group.

Highlights of progress to date

  • collated and analysed a wealth of rich data and information gathered from working with hundreds of district nurses through local and national events and workshops, to co-produce the draft Welsh Levels of Care for district nursing.
  • formed subgroups consisting of senior district nurse leads working on:

    1. the Welsh Levels of Care
    2. quality audit/indicators
    3. professional judgement
    4. informatics.

    5.  
  • devised a comprehensive plan and a range of supportive mechanisms to guide and support operational teams in preparation for testing the draft Welsh Levels of Care for district nursing.
  • reviewed the collective findings of the five quality audits that have been undertaken across five health boards.
  • mapped the way forward to define quality indicators which are specific to district nursing and have a correlation with staffing levels and outcomes for patients.
  • conducted a scoping exercise of the IT data collection systems and input devices used across all district nursing teams in Wales.
  • analysed the findings of professional judgement workshops and explore the correlation between professional judgement and nurse staffing levels and skill mix.