The transition from acute care to the community

Monday, December 20, 2021

When I look back on my transition from working in an acute hospital setting to working as a community nurse, I can clearly remember the vast difference between each of the two roles.

My role in a complex care ward was intense, fast-paced and unpredictable at times. I relied on not only my nursing skills and knowledge but the team I worked with as well. There were many stressors in the hospital ward environment, being short on staff, equipment, beds; and being reactive to the ward and hospital management depending upon the need at that time.

Even though I valued working with my nursing colleagues, who were very experienced and compassionate individuals, my hospital nursing career started to feel less individual and patient-focused. It felt more about how quickly we could complete a task and move on to the next emergent or reactive action.


Why did you transition from the hospital setting to community care?

I transitioned to community nursing care because of my personal needs for my family and my hope that I would be able to use a holistic approach to my work. In contrast to the acute hospital setting, I felt that transitioning to the role of a community nurse would give me far more opportunities to develop my clinical skills further.

When I previously worked in the hospital, I noticed how many patient admissions occurred. But, with the appropriate actions in place, most hospital admissions didn't need to happen. The patients could have received the care in their own homes and local communities. 


How is community care different from acute care?

In the community, nurses can give clients the highest quality of care, just like in a hospital. Community nurses and healthcare assistants have the equipment and skills to carry out the specialist level of care and support in the comfort of the client's home. From a client’s perspective, receiving care in their home makes their experience more personal and relaxed as they are in a familiar and safe environment with their loved ones.


Can you maintain your skills working in the community?

There is a common misconception about skills maintenance and building when working in the community as a nurse or healthcare assistant. Many believe that working in the community means you will only utilise a few of your skills and not learn new ones. At Thornbury Community Services (TCS), growing and maintaining skills is a priority.

Our workers can book a range of Continual Professional Development (CPD) training courses that support their professional development and enable them to maintain and learn new skills.

To ensure our nurses can work with our complex clients, we can offer upskill training for nurses who are already competent in a specific skill. They will attend training with a dedicated clinical lead and will then be signed off to deliver the skill in the package of care.

At TCS, our healthcare assistants can carry out clinical training to maintain their knowledge and further their skills to work with complex clients and deliver similar care as nurses. Our clinical leads will carry out an annual sign off with the healthcare assistant to ensure they remain competent. 


Why I chose to work in the community

When I started my role as a community nurse, I already had the technical and medical skills and knowledge due to my experience of working in an acute hospital setting.

I knew that I would be working autonomously, but with support from a distance. Although the support was not as readily accessible and as my ward colleagues had been, I was able to receive any information I needed at any time.

In my first few weeks, I spent my time shadowing a highly experienced community nurse; She gave me the knowledge to develop my nursing skills in the following areas:

●         Change and manage male and female catheters

●         Manage and discharge caseloads

●         Manage and change male catheterisation

●         Medication and IV therapy and support for Renal patients

●         IM Z track and regular subcutaneous injection therapy

●         Hickman line management and phlebotomy

●         End of life support 

I also learned about the level of sensitivity required when working in clients’ homes. I always had to consider this and also how to be professional during my shift.

One factor I learned during my first few weeks was that communication is crucial in the community. Some families find it difficult to have someone else in their home taking care of a loved one. The community nurses taught me how to manage difficult situations between myself and the clients' families. I learnt many new skills of how to handle difficult situations and ensure the client’s health and safety was always at the forefront of our focus.


What type of support does the community offer?

At Thornbury Community Services, we offer our healthcare professionals a range of support and platforms to ensure they have the best possible career with us.

Our workers have 24/7 access to our Wellbeing and Support Hub, an online portal tailored to their mental health, wellbeing needs and professional development. In the hub, they can view topical workshops related to mental health, stress and resilience. They can also book on to a vast range of CPD training courses relating to their professional development.

We also have an external Employee Assistance Programme, a personal support service available 24/7 that provides practical advice on everyday issues.

Our Supervisions and Appraisals team are available for confidential wellbeing calls. The calls provide our workers with a safe space to receive welfare and pastoral support. The team also offers revalidation support and guidance to our nurses.

Our operations, compliance and clinical teams are available to provide advice and support when needed. A clinical lead is also on call in case any further support is required whilst on shift.


Level of care in the community vs level of care in hospital

When you work in a client's home, you need to consider your safety as well as theirs. You will need to know where all of the exits are in the building, including the fire exits and general exits, just in case an incident did occur.

You will also need to know about the location of the home. Depending on the area, there may be obstacles preventing you from getting there.

There are many situations that you have to expect as a nurse, there are usually things that would not happen in a ward, but common sense often prevails and having a good sense of humour always helps. Working in the community can be isolating at times, but having clinical knowledge and self-regulation will most certainly help.

As a community nurse, I’ve always had a team lead to support me with clinical and personal concerns. They would always be available to talk to and had our daily route to hand to ensure our safety.

Your client is always dependent upon your clinical support and judgement, it can be stressful, but there is always someone to seek advice from on the other end of the phone.

When working on a ward, there is always the intensive level of care needed, whereas working in the community can be managed fully by having greater flexibility to suit the needs of the client and the nurse.


Why are more people choosing to have complex care in the home?

Care in the community has changed vastly in the last few years, as the client's acuity is at a much higher level, it makes the nurses' role more complex and demanding of time. Clients who have long term conditions can be cared for at home because the skill set required for them to do so has increased. Our care can help clients live fulfilled lives and achieve personal goals whilst being in the comfort of their own homes.


If you are interested in receiving care from us and would like to find out more about our services, please contact a member of our care coordination team on 0345 120 5310 or send a message on our contact us page here.

If you’re interested in joining our team of healthcare professionals, register with us using the form below.