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Overview of the role

Caring for patients with a wide range of health conditions

District nurse

Details of standard

Occupation summary

This occupation is found in health care. District Nurses work with adults of all ages and communities. They work across numerous different organisations and settings for example; primary care, social care, third sector organisations, hospitals including mental health, hospices, prisons and other community services to ensure that patients get the right care, at the right time, every time.

The broad purpose of the occupation is work with individuals and populations. This can mean working with people in their own home (which could be an individual’s house, a care home, a hostel, a prison, hotels etc.), a healthcare setting e.g. GP practice, hospital, hospice etc. or even the streets in the case of the homeless population. District Nurses assess and care for patients with a wide range of health conditions and are accountable for a large varied complex caseload where they prioritise care, assess risk, prescribe medication, dressings and appliances in accordance with legislation, manage changing local demands which require very careful oversight and case management. They plan, provide and monitor complex community nursing care and services. They manage a caseload of complex patients and families/carers, either with long-term conditions over a protracted period or those with acute short episodes of care, by leading a clinical team who often work in isolation without immediate and direct access to medical advice. They influence and lead change management initiatives within the service, for example, new ways of working, new models of care.

They are responsible for delivery of care across a 24 hour period 365 days a year anticipating problems and crises and proactively planning to prevent unnecessary hospital admission and facilitating timely discharge across a range of patient pathways e.g. end of life care, tissue viability etc.

In their daily work, an employee in this occupation interacts with patients, their carer’s and relatives and a wide variety of health and social care professionals including GP’s, social workers and hospital staff. District Nurses work with adults of all ages and communities. They work across numerous different organisations and settings for example; primary care, social care, third sector organisations, hospitals including mental health, hospices, prisons and other community services to ensure that patients get the right care, at the right time, every time. An employee in this occupation will be responsible for their own work as an autonomous, independent practitioner, whilst contributing and leading collaborative work with other health and care professionals. In addition the occupation will be responsible for a caseload of patients and the team responsible for delivering care to that caseload.

Typical job titles include:

District nurse

Entry requirements

It is a requirement of the Nursing and Midwifery Council (NMC) that those training to become a District Nurse are already registered nurses on Part 1 of the NMC register


Occupation duties

Duty

Criteria for measuring performance

KSBs

Duty 1 Provide advanced case management for people with highly complex unpredictable needs including those nearing and at the end of their lives.

Plan and implement effective case management strategies
Asses, plan, implement and evaluate safe and effective care to the caseload and individuals

K1 K2 K3 K4 K5 K6 K7 K8

S1 S2 S3 S4 S5

B1 B2 B3 B4 B5 B6

Duty 2 Holistically assess heath needs and make diagnostic decisions for people, including those nearing and at the end of their lives with highly complex unpredictable needs.

Effectively assess the physical and mental health needs of individuals and make decisions to support the needs of individuals
Work effectively with individuals, groups, health professionals and stakeholders

K9 K10 K11 K12 K13 K14 K15

S6 S7 S8

B1 B2 B3 B4 B5 B6

Duty 3 Lead a team to manage a complex, dynamic and unpredictable caseload.

Implement effective organisational strategies
Provide effective leadership and manage the team through change
Maintain accurate records to inform service delivery

K16 K17 K18 K19

S9 S10 S11

B1 B2 B3 B4 B5

Duty 4 Take responsibility and accountability for care delivery, anticipatory care planning to avoid unnecessary admission and facilitate timely discharge.

Conduct effective workload and workforce planning to meet identified needs

K20 K21 K22

S12 S13

B1 B2 B3 B4 B5 B6

Duty 5 Promote health education and self-care to individuals’ to achieve their health outcomes.

Facilitate health promotion
Identify resources required to deliver the strategy
Refer individuals to correct services

K23 K24 K25 K26 K27

S14 S15

B1 B2 B3 B4 B5

Duty 6 Proactively lead, engage, challenge and empower the team in quality assurance, service improvement and change management.

Effectively project manage service improvement and change
Maintain audit requirements of the service
Ensure teams engage in quality improvement activity
Contribute to the development of effective business cases to support change

K28 K29 K30 K31 K32 K33

S16 S17 S18 S19

B1 B2 B3 B4 B5 B6

Duty 7 Develop practice to respond to the public and community health needs.

Effectively collect and interpret data on health and wellbeing
Provide evidenced based care to individuals, groups and communities

K34 K35 K36

S20 S21 S22 S23

B1 B2 B3 B4 B5

Duty 8 Participate in and undertake research and evaluation to improve care and services for the people and communities.

Conduct and implement effective research
Communicate the outcomes of data analysis and research
Advance district nursing practice through research, audit and feedback

K37 K38 K39 K40

S24 S25

B1 B2 B3 B4 B5

Duty 9 Develop and implement risk assessment and management strategies taking into account people’s views, choices and responsibilities, whilst promoting safeguarding of individuals, carers and staff.

Deploy and evidence effective risk management strategies
Minimise risk to all service users
Carry out effective risk based approaches

K41 K42 K43 K44

S26 S27 S28

B1 B2 B3 B4 B5

Duty 10 Manage increasing demands on the service, deliver and manage change to meet the evolving shape of services through flexibility, innovation, strategic and operational clinical leadership.

Implement effective organisational strategies
Provide effective leadership and manage the team through change
Maintain accurate records to inform service delivery

K20 K45 K46

S29 S30

B1 B2 B3 B4 B5 B6


KSBs

Knowledge

K1: The complex causes, signs, symptoms and impact of interacting physical and mental health conditions Back to Duty

K2: The principles of delivering and evaluating safe and effective palliative and end of life care including the principles of managing symptoms and involving carers Back to Duty

K3: The principles, concepts and theories of evidence-based therapeutic interventions Back to Duty

K4: How to apply the principles of case management Back to Duty

K5: The principles of risk stratification Back to Duty

K6: How to recognise, manage and evaluate the deterioration of patients in order to decide effective anticipatory care Back to Duty

K7: The principles of managing long term conditions and interactions between long term conditions Back to Duty

K8: The complex risks to patients in transition between services Back to Duty

K9: How to use assessment and decision making models and proactive case management for effective care planning Back to Duty

K10: Advanced communication skills to develop therapeutic relationships Back to Duty

K11: The principles of advocacy and acting as the patients advocate in complex situations whilst also respecting the patient’s autonomy and ensuring ethical principles are upheld Back to Duty

K12: The local and national policies, regulatory frameworks and guidelines for care e.g. prescribing Back to Duty

K13: Pharmacotherapeutics relative to your scope of practice Back to Duty

K14: The range of advanced physical, psychological and population based assessment methods and the application of pathophysiology to underpin assessment and diagnosis Back to Duty

K15: The principles of social prescribing Back to Duty

K16: The strategies and methodologies for effective teaching, learning and staff development Back to Duty

K17: The local and national policies and procedures within your role and the NMC code Back to Duty

K18: The principles and concepts of accountability in the role of District Nurse team leader and how to delegate responsibility Back to Duty

K19: The theories, techniques and models of leadership, management and team working and how these can be applied across professional boundaries in health and social care Back to Duty

K20: The principles of workload and workforce planning and application to practice including when to make the case for service changes Back to Duty

K21: How to avoid unnecessary admission and facilitate timely discharge when there are many interacting factors Back to Duty

K22: The range of appropriate places of care and how to facilitate and justify access to these Back to Duty

K23: The principles of consent and capacity in relation to the mental capacity act and deprivation of liberties Back to Duty

K24: Core assessment skills to assess mental wellbeing within the scope of the role and the limits of competence Back to Duty

K25: The theories, methods and principles of health promotion and prevention Back to Duty

K26: The range of advanced health promotion tools available for use Back to Duty

K27: The theories, methods and principles underpinning self-care e.g. motivational interviewing and advanced communication skills Back to Duty

K28: The theories, methods and principles of quality assurance, service improvement and change management Back to Duty

K29: How to formulate specialist business cases for service change and improvement Back to Duty

K30: How to apply the audit process and change management theories related to district nursing practice Back to Duty

K31: How to critically analyse, interpret and evaluate data and information Back to Duty

K32: How to foster a culture of openness and learning Back to Duty

K33: The theories, methods and principles of leadership Back to Duty

K34: How to use the public health outcomes framework Back to Duty

K35: How to critically analyse, interpret and evaluate wider public health and demographic data Back to Duty

K36: How to create a community profile Back to Duty

K37: The complex range of evaluation and audit methods used in clinical practice Back to Duty

K38: Critical appraisal techniques and how to apply them to clinical practice Back to Duty

K39: The service evaluation and improvement methodology Back to Duty

K40: Research methodology and how to implement research Back to Duty

K41: The range of evidence-based strategies to manage risk in clinical practice and in relation to the different environments a district nurse works within Back to Duty

K42: The cost benefit and individual analysis of the risks, taking account of individual’s views and responsibilities Back to Duty

K43: Relevant safeguarding policies and procedures Back to Duty

K44: How to apply the principles of confidentiality and information sharing policies Back to Duty

K45: How to influence and the importance of political awareness Back to Duty

K46: The principles of resilience and how this is built within yourself and others Back to Duty

Skills

S1: Manage a caseload of patients in a variety of community settings using a person centred approach including implementation of risk stratification and case management strategies to determine those at most risk of poor health outcomes Back to Duty

S2: Use specialised skills to work collaboratively with the patient and the multidisciplinary team, to improve anticipatory care, self-management, facilitate timely discharges and reduce avoidable hospital admissions to enable care to be delivered closer to, or at home Back to Duty

S3: Manage and co-ordinate programmes of care, for individuals with complex acute and long term conditions, striving to make the patient journey seamless between mental and physical health care, hospital and community services and between primary and community care Back to Duty

S4: Assess when a referral is required and maintain overall responsibility for the management and co-ordination of care Back to Duty

S5: Manage the delivery of service whilst critically evaluating the capacity and demand and being mindful of patient and staff safety Back to Duty

S6: Autonomously assess the complex health needs of people, families and other informal carers to formulate care plans, anticipatory care and care packages Back to Duty

S7: Appropriately manage problems and make decisions in partnership with people, families and other informal carers using advanced communication skills Back to Duty

S8: Use evidence based physical and clinical assessments of individuals with complex health care needs to make accurate diagnostic decisions, including prescribing Back to Duty

S9: Lead and support the clinical team to provide community nursing interventions in a range of settings Back to Duty

S10: Manage clear lines of accountability for the assurance of clinical governance and care quality Back to Duty

S11: Manage the district nursing team within regulatory, professional, legal, ethical and policy frameworks ensuring staff feel valued and developed Back to Duty

S12: Critically analyse, act on and evaluate trends and demands on the district nursing service to inform workload and workforce planning Back to Duty

S13: Work with other services, teams and colleagues to support fewer unnecessary admissions and facilitate timely discharges Back to Duty

S14: Assess and identify the mental capacity of people Back to Duty

S15: Use specialised skills to work in partnership with individuals, formal and informal carers and other services to promote health education, self-care and patient-led care, to maximise the individual’s independence and understanding of their condition(s) Back to Duty

S16: Critically analyse, interpret and evaluate complex data and information to improve patient care Back to Duty

S17: Determine and use specialised skills to influence and negotiate the development of operational plans for the service Back to Duty

S18: Lead a team to deliver service improvement and change management that involves many interacting factors Back to Duty

S19: Quality assure services and make service improvements Back to Duty

S20: Determine and use specialised skills to influence and negotiate the development of public health initiatives Back to Duty

S21: Collaborate with other agencies to analyse and evaluate public health principles, priorities and practice and implement these policies Back to Duty

S22: Participate in the collation of a community profile to understand local assets Back to Duty

S23: Utilise position within the organisation to influence position of community nursing teams in the provision of care for communities under their umbrella Back to Duty

S24: Engage in research activity and develop evidence-based strategies to enhance the quality, safety, productivity and value for money of health and care Back to Duty

S25: Lead improvements to care service delivery through the implementation of research findings, best practice, outcome of audits and patient feedback Back to Duty

S26: Critically assess and evaluate risk using a variety of specialised tools across a broad spectrum of often interrelated and unpredictable situations, including staff, and people within their home environments Back to Duty

S27: Formulate and implement risk assessment and management strategies that take account of people’s views and responsibilities, whilst promoting patient and staff safety and preventing avoidable harm to individuals, carers and staff Back to Duty

S28: Ensure all staff are able to recognise vulnerability of adults and children and understand their responsibilities and those of other organisations in terms of safeguarding legislation, policies and procedures Back to Duty

S29: Lead the service change required to deliver services and evaluate the outcome Back to Duty

S30: Develop, support and train the team to meet new and evolving requirements in patient care Back to Duty

Behaviours

B1: Treat people with dignity at all times Back to Duty

B2: Respect people’s diversity, beliefs, culture and individual needs Back to Duty

B3: Show respect and empathy for patients, their families and carer’s and those you work with at all times Back to Duty

B4: Be adaptable, reliable and consistent and have the courage to challenge areas of concern Back to Duty

B5: Show flexibility, self-awareness and emotional intelligence when dealing with patients, carers, teams and self Back to Duty

B6: Act as a positive role model for staff and teams Back to Duty


Qualifications

English & Maths

Apprentices without level 2 English and maths will need to achieve this level prior to taking the End-Point Assessment. For those with an education, health and care plan or a legacy statement, the apprenticeship’s English and maths minimum requirement is Entry Level 3. A British Sign Language (BSL) qualification is an alternative to the English qualification for those whose primary language is BSL.

Other mandatory qualifications

PG Diploma for District Nursing with integrated independent prescribing at Level 7

Level: 7 (non-degree qualification)

Professional Recognition

This standard has professional recognition.

Body Level
Nursing and Midwifery Council Level 1 Registered Nurse


Additional details


Regulated Standard

This is a Regulated occupation.

Regulator Body:

Nursing and Midwifery Council

Training provider does not require approval by regulator body

Occupational Level:

7

Duration (months):

24

Review

This apprenticeship standard will be reviewed after three years

Status: Approved for delivery
Level: 7
Degree: non-degree qualification
Reference: ST0709
Version: 1.0
Approved for delivery: 30 September 2019
Route: Health and science
Typical duration to gateway: 24 months (this does not include EPA period)
Maximum funding: £11000
Regulated Standard:
This is a regulated occupation
Regulator Body:Nursing and Midwifery Council
Employers involved in creating the standard: Leeds Community Healthcare NHS trust Airedale NHS Foundation Trust Berkshire Healthcare NHS Trust Blackpool Teaching Hospitals NHS Foundation Trust Bradford District Care NHS Foundation Trust Bridgewater Community Healthcare NHS Foundation Trust Bromley Healthcare Calderdale and Huddersfield NHS Foundation Trust Central Cheshire Integrated Care Partnership Central London Community Healthcare NHS Trust Central Surrey Health City Health Care Partnership Cornwall Partnership NHS Foundation Trust Cumbria Partnership NHS Foundation Trust Dorset Healthcare NHS Foundation Trust East Lancashire Hospitals NHS Trust Hertfordshire Community NHS Trust Kent Community Healthcare NHS Foundation Trust Lancashire Care NHS Foundation Trust Lincolnshire Community Health Services NHS Trust Manchester University NHS Foundation Trust Medway Community Healthcare Mid Yorkshire NHS Trust North Tees and Hartlepool NHS Foundation Trust Northamptonshire Healthcare NHS Trust Oxford Health NHS Foundation Trust Oxleas NHS Foundation Trust Pennine Care NHS Foundation Trust Provide – community services provider in Essex, Cambridgeshire and Peterborough Sheffield Teaching Hospitals NHS Trust South Tyneside NHS Foundation Trust Southern Health NHS Foundation Trust Staffordshire and Stoke on Trent Partnership NHS
LARS Code: 504

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