A Word version of this briefing produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust aimed at health care professionals is available for LKS staff to share in their own organisations.  Please feel free to reproduce it (with acknowledgement) for your own purposes.

Impact on library policy/practice 

• While library and knowledge services provide valuable support to community nurses’ practice and CPD, it is more difficult to see how LKS can support their recruitment
• LKS services may however be in a good position to support the retention of existing community nurses, for example by supporting revalidation
• Due to the aging profile of the community nursing workforce, it may be a long time since formal study was undertaken, so for those that are looking to do further study more support and follow-up may be required when it comes to using the evidence-base
• With a heavy caseload, they may not have time to visit the library so there may be a need for outreach to their bases

The problem

• An aging workforce (Buchan, 1999) (Gaze, 2001) (Parish, 2005) (Ford & Dowler, 2011)
• Ford (2014) found that since the 2011 Health Visitor Implementation Plan there had been a year-on-year increase in the workforce which had reached 10,382 by May 2014. At the same time the number of district nurses had fallen from 7,813 in May 2010 to 5,586 in July 2014
• Evans (2016) pointed out that there had been a 48% drop in district nurse numbers between 2000 and 2014 with numbers falling to fewer than 6,000 full-time roles in England.

Why people go into community nursing

• Community nursing is often seen as a career destination after a period working as a nurse in the acute sector (Buchan, 1999)
• More mature nurses are attracted by the opportunity to function independently and autonomously (Buchan, 1999)
• Enjoying community placements (Gaze, 2001)
• The opportunity to work with families (Gaze, 2001)
• The opportunity to influence health policy (Gaze, 2001)
• Being inspired by one’s family and colleagues (Gaze, 2001)
• Increased initiative (Thurtle, 2005)
• More autonomy (Thurtle, 2005)
• Preferred hours (Thurtle, 2005)

What has been done to attract more people?

• In South Essex – a practice-nurse apprenticeship scheme to train and prepare students for work in general practice (Bishop & Jones, 2001)
• Fear (2004) describes a 14-week broad-based community experience for pre-registration nurses which was positively evaluated by both mentors and students
• Pre-registration placements (Robinson, 2004)
• Rotational programmes for newly-qualified nurses (Robinson, 2004)
• Schemes to train nurses from other sectors (Robinson, 2004)
• A rotation scheme for newly-qualified staff nurses run jointly by an East-London Primary Care Trust and a hospital (Abbott, Bryar, & Hostettler, 2005)
• A final-placement scheme for community-nursing students developed in Walsall Teaching PCT (Doley & Roberts, 2005)
• Leicestershire County Council and Rutland Community Health developed a return-to-practice scheme with the University of Northampton (Amin, Martin, & Turney, 2010)
• Nursing students at the University of Bradford joined community teams specialising in smoking cessation, care of the homeless and cardiac rehabilitation (Dean, 2010)
• University of Cumbria students spend half their placement time in the community (Dean, 2010)
• ‘Hub and spoke’ programmes where a central mentor allocates students to different placements so they can gain a variety of experiences (Dean, 2010)
• A return-to-practice programme in NHS East Midlands (Dean, 2010)
• A collaborative scheme developed between Leicestershire Partnership Trust and De Montfort University in which nursing students were able to undertake delegated care activities independently while working in community practice placements (Brooks & Rojahn, 2011)
• In September 2008, Yorkshire and Humber Strategic Health Authority involved local providers, local universities and service users in a project that aimed to offer opportunities to third-year nursing students interested in careers in the community at the point of registration (Brown, 2013)
• In Leicester a framework was developed between practice and higher-education providers which had a remit of enhancing existing community placements (Brown, 2013)

What puts people off going into community nursing?

• Stringent entry requirements and lengthy education programmes (Meehan, 2004)
• Salary (Cameron, Armstrong-Stassen, Bergeron, & Out, 2004)
• A lack of recruitment and retention programmes (Harrison, 2004)
• Routes into primary care being “complex, confusing and convoluted.” (Harrison, 2004)
• A limited pre-registration curriculum (Robinson, 2004)
• Limited clinical-learning experiences (Robinson, 2004)
• Few clinical-learning experiences available in general practice (Robinson, 2004)
• Over-rigid content and funding of training programmes (Robinson, 2004)
• Lack of money for training schemes (Robinson, 2004)
• Worries about overloading experienced practice nurses (Robinson, 2004)
• Different perceptions about priorities among GPs (Robinson, 2004)
• A lack of information about the workforce and evidence about what works (Robinson, 2004)
• Challenges universities face in getting community placements for their students (Dean, 2010)
• Misconceptions about unrewarding and unchallenging work, lack of career advancement and a negative working environment (Sheedy, 2011)
• While (2014) commented that few community nurses were recognised in the mass media or the professional press and that the media more often promoted hospital-based services rather than community ones.

References

Abbott, S., Bryar, R., & Hostettler, M. (2005). Developing career pathways for new nurses: lessons from inner London. British journal of community nursing, 10(11), 508-512.

Amin, M., Martin, S., & Turney, N. (2010). Evaluation of a return to practice health visiting scheme. Community Practitioner, 83(3), 25-28.

Ashley, C., Halcomb, E., Brown, A., & Peters, K. (2018). Experiences of registered nurses transitioning from employment in acute care to primary health care–quantitative findings from a mixed-methods study. Journal of clinical nursing, 27(1-2), 355-362

Bishop, T., & Jones, J. (2001). Recruitment: working together to support new practice nurses: a practice nurse apprenticeship scheme. Practice Nurse, 22(6), 14-22.

Brown, K. (2013). Community placements for nursing students. Primary Health Care (through 2013), 23(6), 28-30.

Buchan, J. (1999). Nurse till you drop! Nursing Standard (through 2013), 13(13-15), 34-35.

Cameron, S., Armstrong-Stassen, M., Bergeron, S., & Out, J. (2004). Recruitment and retention of nurses: challenges facing hospital and community employers. Nursing leadership (Toronto, Ont.), 17(3), 79-92.

Cho, E. M. (2009). Recruitment and retention in residential care. (MR55205 M.A.), Royal Roads University (Canada), Ann Arbor. Retrieved from https://search.proquest.com/docview/305159823?accountid=48232 Hospital Premium Collection database.

Cowley, S., & Bidmead, C. (2009). Controversial questions (part two): should there be a direct-entry route to health visitor education? Community practitioner : the journal of the Community Practitioners’ & Health Visitors’ Association, 82(7), 24-28.

Dean, E. (2010). Pressure on universities to find more community placements. Nursing Standard (through 2013), 24(52), 12-13.

Doley, B., & Roberts, S. (2005). Managing student transitions into primary care. British journal of community nursing, 10(12), 563-565.

Evans, N. (2016). Picture of a ‘broken’ workforce. Nursing Older People (2014+), 28(8), 8.

Fear, T. (2004). Community placements for pre-reg nurses. Journal of Community Nursing, 18(5), 32-34.

Fear, T. (2016). Developing sustainable placements: nursing students in general practice. Primary Health Care, 26(10), 24-27.

Ford, S. (2014, Nov 12-Nov 18

Nov 12-Nov 18, 2014). Ups and downs in the community nurse workforce. Nursing times, 110, S6-S7.

Ford, S. (2015, 2015 Feb 19). Yorkshire trust shores up community services with overseas nurses. NursingTimes.net.

Ford, S., & Dowler, C. (2011, Jul 19-Jul 25

Jul 19-Jul 25, 2011). 100,000 fewer nurses in 10 years predicted. Nursing times, 107, 2-3.

Gaze, H. (2001). Matching expectations. Community Practitioner, 74(12), 448.

Gordon, C. J., Aggar, C., Williams, A. M., Walker, L., Willcock, S. M., & Bloomfield, J. (2014). A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce? BMC Nursing, 13(34).

Harrison, S. (2004). Routes into primary care ‘complex and confusing’. Nursing Standard (through 2013), 19(3), 7.

Meehan, F. (2004). A gathering of the masses. Journal of Community Nursing, 18(7), 3.

Norman, K. M. (2015). The image of community nursing: implications for future student nurse recruitment. British journal of community nursing, 20(1), 12-18.

Parish, C. (2005). Recruitment needs to double to keep pace with retirement rates. Nursing Standard (through 2013), 19(33), 8.

Robinson, F. (2004). Innovative schemes to recruit practice nurses. Practice Nurse, 28(7), 10-16.

Sheedy, S. R. N. B. M. H. S. (2011). A call to action: dispelling the myths and reducing the negative factors impacting nursing recruitment to long-term care. Perspectives (Pre-2012), 34(4), 17-26.

Thurtle, V. (2005). Why do nurses enter community and public health practice? Community Practitioner, 78(4), 140-145.

While, A. (2014). Where is the recognition of community nurses? British journal of community nursing, 19(11), 570.