Perceptions of Nursing and Midwifery

24 hour nursing in the community by Lynsay Ward

It often comes as a bit of surprise when people find out that the district nursing service is 24 hours and 7 days a week.

Recently my husband (a paramedic) was called out to a patient requiring a catheter change that the out of hours doctor had booked to be seen at hospital, luckily my husband is aware of our service workings due to my shifts and was able to have the patient redirected and seen within their own home, stopping an unnecessary hospital admission.  However not everyone is so lucky and it pays to have an idea of what each service can do and when to make the most of the NHS services.

I thought I would take a few minutes to talk about how our service operates 24 hour cover and what kind of things we would normally do.

Within our area, and this may be different for other areas and trusts, we have a day team based within an area who generally cover the day shift 8am-4:30pm Monday to Friday. Each member of the cluster, along with a few nurses who are specifically employed for evening working take a turn usually once a month to work the evening shift from 4pm -midnight. This is followed by a night service who work the intern shift from midnight until 8am. The day team also work a weekend day or evening shift once a month to allow cover on Saturday and Sunday.

However the work varies considerably depending on what shift is being covered.

Day shifts can cover anything from diabetic care, to wound dressing, to catheter care or even social issues. Whereas the evening and weekend services cover essential visits only, this may be later diabetic care or daily visits for wound dressing and often includes call outs for blocked catheters or breakthrough pain medication and even verifying patient deaths.

I done a weekend shift just a few weeks ago and my day went something like this:

8am start and text to cluster band 6 to let them know that I am about to start lone working. Set up my identicom which gives us emergency help if required and go to my first patient who required diabetic support.

Between 8am and 9:30am I visited another 6 patients for diabetic care, then I returned to the GP practice where our base is for a quick toilet break, filled up my water bottle and gathered stock for my remaining visits.

As we do essential visits only at the weekend, I had a look at my list and went to my next patients home who also required diabetic support at a later time, on arrival they did not answer the door. I was not overly concerned as I know the patient well and it is a common occurrence for them to be out but I contacted the band 6 to make them aware and to let them know I would return later.

I continued to my next two patients, bilateral leg dressings and a medication administration and returned to try and reach my patient again. I still had no answer and was starting to become concerned so contacted the band 6 again and let them know I would contact the patients next of kin. I left a message and moved on to my next two patients, both a daily wound dressing.

After these visits I returned and was still unable to reach the patient or their next of kin so I contacted the band 6 and we discussed what options we had. It was decided that I would try again in half an hour and if there was still no answer I should contact the police to break in to the property just incase the patient was unwell. This is understandably a difficult decision as if the patient was found well then there would be damages caused to the property to gain entry but there is the risk that the patient could be unable to answer the door due to being unwell.

I visited my final scheduled patient for wound care and returned...and after the first knock the patient answered the door! I was so happy to find them well and explained that we had been ready to contact the police...the patient had simply been out shopping.

As my scheduled visits were completed I returned to the office and had my lunch break. After lunch I had plenty paperwork and referrals to do and chase up so I settled down to do those for the few hours before I had to leave to do the afternoon diabetic care visits. During this time we are 'oncall' with the NHS24 service who can ask us to attend to patients for call outs. That day I did not get called out but often we can have a number of visits to go to in the afternoon.

At 4pm I locked up the GP surgery and headed out to the afternoon visits I only had three visits to do as a neighbouring member of staff had offered to go to one of my patients as they were near to one of hers, so at 4:30pm I was able to text the band 6 to let them know that I was finished and heading home for the night.

So there is an idea of what kind of things we do at the weekend, generally call outs from NHS 24 are for a mixture of catheter problems, breakthrough or palliative medication administration or wound care where the dressings have not stayed in place or are wet through and these can happen throughout the weekend or evening shifts.

So next time you need a community nurse you will know that we are always around even if you don't always see or hear from us!

Lynsay x

What inspired you to write this blog?

The Transforming Perceptions of Nursing and Midwifery 30 Day Challenge

 

What is your role?

Community Nurse, Edinburgh Napier & QMU graduate, RCN Lothian NQN branch exec.

 

What are your nursing and/or midwifery qualifications?

Community Nurse, Edinburgh Napier & QMU graduate, RCN Lothian NQN branch exec.

 

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