Community nursing - what's it like ?

[Frootlepootle]

Considering applying for a band 5 post in the community but have only ever worked in a very busy ward environment. I want less stress basically and the opportunity to provide better nursing care. I'm in my early 50s and the thought of doing my current job into my 60s is frightening. Any thoughts about the realities of community nursing would be very welcome to help me decide if his would be a worthwhile move or just going from the frying pan into the fire !

DH made the move in mental health nursing in 2015. Completely ruined him. Totally burned him out, he had previously worked and been deputy manager in busy chronic and acute wards. Being solely responsible for a massive caseload of patients (far too many for any individual, but community nurses are just as stretched as all other areas of the NHS) was just too much. At least when he was on a ward, whilst still overworked, the load was shared between him and his colleagues. When they lost a patient, they came together and supported each other. Not so in the community, whilst they were there for each other, the responsibility felt very different to him. He lost a patient in 2018, not his fault at all, in fact the coroner highlighted his care as one of the few big positives in the patient’s care, but it sent DH into a massive downward spiral from which he is still recovering. Took a further two years for him to finally get out. Prior to this, he felt he could never ‘switch off’, patients would ring his work phone and leave voicemails at all hours. He was a social worker, police officer, carer, counsellor, all rolled into one. He even bought himself a stab vest after being chased from the house of one patient with a kitchen knife.
Only one case and I’m sure it is the opposite for others - but you did ask for experiences!

Oh dear ! So sorry to hear that. I guess the level of autonomy/personal responsibility isn’t necessarily a good thing at times. Was he a community RMN then ?

He was, yes. Still is, but in a different role.

Sorry, not in the community, but still and mental health nurse

Bloody hard work. Terrible for you physically. I had to stop doing it in my 40s as my body said no. I went into podiatry instead which is 9 to 5 with weekends and Bank Holidays off. Quite honestly podiatry is a fantastic career for the over 40s and you get higher bands much much quicker.

Thanks everyone ! Bumping

Bumping as also a nurse considering the same move but in paeds

@AliceS1994 big move for me but not sure I can physically carry on in current clinical area for the next 10 years. I shadowed a community nurse for a morning in Jan this year and really enjoyed it. Not sure if that was a realistic experience though 😢

It's different form the ward (obviously) - more autonomy and you basically are a lone worker, which is what I find that nurses who come from a ward find most difficult - patients are often still unwell and although you have a back up via phone, your emergency call bell is 999, plus the pressure to do all you can to keep people at home and make decisions that you wouldn't necessarily be expected to make on some wards. Plus some people live in quite challenging circumstances, which can be hard to manage. The plus side is also that you see daylight rather than being stuck on a ward, and if you've had a hard visit, some loud music in the car is an option

There's lots of variety. It's probably less physical than ward nursing inasmuch as you aren't on your feet all day, but still physical - sometimes on the floor to bandage legs for example, moving and handling people who are end of life, or helping them to role on to their side for wound care (as examples).

And it's not necessarily any less busy, stressed or pressured than a ward, just different. Depending on what happens in your area, you might not do nights, and probably less weekends / unsocial hours so it can affect your pay.

Can you do another shadow shift - if you were going to apply for a job, I would have though the employing area would be happy to support you coming and shadowing for a morning again. I find that there is a misconception that community nurses don't do anything complex (just legs and cups of tea), which couldn't be further from the truth.

Sorry I can’t offer any advice but can hopefully make you laugh by sharing that I thought this thread was going to be about women sharing breastfeeding different baby’s 😂

@PinkPlantCase 😝
@Iliketeaagain thanks for that. I currently work on ITU so very different environments. We are used to having medics on hand a lot of the time and I probably didn’t calculate how not having colleagues around for advice would impact me.
There’s a lot to mull over…

By the way, I wasn't trying to put you off - I think it's the best nursing job going.

But ime hospital nurses do struggle with the lone working aspect - that doesn't mean you shouldn't go for it, just be aware that it's a normal response and prepare to feel a bit out of your depth for a few months - and give it time, don't leave after a few weeks thinking you've made a mistake. I think it's like any job - you're currently on ITU and probably very experienced, know lots about intensive care nursing, and you can go to a completely different area and feel like a newly qualified nurse again. It can just be hard, but if you go in with your eyes open, prepared that you'll go back to feeling like you know nothing (and btw - you know plenty and have lots of transferable knowledge - nursing principles are the same no matter where you work, it will just feel like you don't know it because it's in a completely different environment).

I did community for a while and really struggled with the lone working and the caseload, constant rushing. Very heavy palliative care caseload in my area which I found horribly hard. Not for me.

I work in community evening team and love it but we do work in pairs.
Have you thought about practise nurse?

Would you consider a move out of the NHS?

There are jobs working for pharma companies as community IV/enteral/respiratory/neuro nurses.
You tend to get a company car, fuel card and expenses paid for things such as lunch, NMC etc.

Pay is loosely equivalent to band 6 with enhancements for weekend and overtime. Usually a good ish private pension and half decent sick and mat pay.

I’m mental health too and wouldn’t consider community. It is a huge responsibility in mental health who there is no one to share the load.

I guess in some respects, while different, that level of autonomy and holding risk alone will be the same in other areas of nursing. Not having that emergency back up and having to take full responsibility for all the decisions isn’t for me.

Which is completely ridiculous because im a ward manager and all the responsibility does lie with me🤦‍♀️ I’ve done ward work for my whole 21 year career though so I know it inside out! The stress is real but manageable for the moment.

Wont be nursing into my 60’s though! Plan to take a big step back in my late 50’s.

Its not any easier or quieter than many nursing roles. The workload is huge and often never ending as there isn't anyone else to do it.

Its 24/7 365 days so not necessarily a pattern working pattern. You are a lone worker, delivering nursing care in uncontrolled settings- very different to ITU.

You're required to be autonomous, resourceful and a problem solver.

In the current climate expect to be out of pocket too with the cost of fuel.

Previous Community Band 5 for 6 years.

It is certainly not less stressful than the wards.

I’m a community nurse and I absolutely love it. Although I’ve never worked on a ward so
can’t compare the two.
It can be incredibly busy but I wouldn’t say i’m ever ‘rushing around’. I have a very supportive team who help each other out with visits and things are moved if capacity doesn’t allow.

it is a lot of lone working but if any concerns are raised at all the patient is put as a double up so that’s not much of a concern. Lots of services at hand if I need help, I’ve only had to call paramedics about 3/4 times

autonomy is good, I can plan my day myself (bar emergencies that come on). I love being out and about, I can nip to drop a parcel off, to the doctors etc if I need. I’ve never missed any of dc’s school events, I can work them into my day (but again our team allows this)

We feel the staffing crisis like all parts of the NHS, some days we have 1 nurse and 1 healthcare on which is obviously not enough but we get buy

families can be intimidating which can be difficult when you’re on their home. Plus some houses are very neglected

theres SO much paperwork. I have to be strict to only do my admin in working hours otherwise I can be doing 2/3 hours a night.

I love the variation. This week i’ve
-verified 2 deaths
-set up and replenished several syringe drivers
-lots and lots of leg dressings
-set up an iv
-MDT with social services, GP and police service
-several wounds of all different kinds/varieties
-drain management

plus diabetics, reviews, care plan updates and so many things more. Some days are rubbish and I’ve needed a big drink when I got in but 99% of the time I love it!

Although of course I have days where I don’t have a minute to myself. Don’t have time for lunch, am going from patient to patient without having time for a wee, drink. But when I’m with a patient they are the only thing I need to focus on, I haven’t got 8 other patients in a bay. But im
VERY lucky my team and management are very supportive and we all go above and beyond (ie I was with a poorly patient for 2 hours after my shift 2 weeks ago) so the band 7’s/8’s are happy for us to have a bit of flexibility

Watching this with interest. I'm a year 2 student and I'm tending towards community- I work well on my own, I've always had roles where I'm
Autonomous. The one thing making me hesitant is someone told me it could be limiting if I intend to do my masters and progress to ACP or equivalent. What are peoples experiences?

It's not my experience that it's limiting at all. I work with many RNs who are advanced assessors / prescribers, all supported to undertake MSc or MSc level modules while working in community practice - and it's not just district nursing, there is a huge variety of community nursing practice.

If anything, my personal opinion is that there is going to be a continuous push for highly skilled nurses in the community because of the need to keep people out of hospital (yes now we need to get them out, but the push is definitely to stop people going to hospital in the first place).

If you want a career in hospital, then do that. If you want a career in community based practice, start in the community. It drives me a bit crazy that students nurses are still being told that hospital is the place to start. If you want a career in the community, you don't ever have to work in a hospital (I didn't, and neither did many of my colleagues).

Ah @Iliketeaagain that is bloody lovely to read! I've had placements in hospital and quite frankly I knew in day one it wasn't for me. I am getting to the point where I need to chose my elective and would very much love to see how the community teams in the dales area work - I've got strong ties to the farming community and nursing in this sort of environment with the additional challenges is inherently interesting to me.
Thank you!

I've been a District Nurse for 15 years. I love it. It's hard work though, and it's getting busier and busier every day, with more complex patients being cared for at home and more palliative care. Despite how hard it can be at times I will never go back to a ward to work. If leave the community I leave nursing. The community is not an easy ride though. I've have students come to us on placement and be surprised at how busy it is and how much we do. Apparently the uni make out its a nice little job to do before you retire. Umm, no I don't think so. You are on your own and you do need to be able to make decisions when there is literally no one there to help you.

I'm not a nurse but do work with community nurses.

It's a hard job. Very under staffed and extremely busy. I'd say physically harder than working on a ward especially if your knees are not what they were, if you are over 50.