The transition from acute care to the community

Thursday, May 28, 2020

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 those of the team I worked with as well. There were many stressors in the ward environment, being short on staff, equipment, beds; And being reactive to the ward and hospital management depended upon the need at that time.

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


How is community care different to acute care?


My personal needs for my family and my hope that I would be able to use a holistic approach to my work, was my reason for transitioning from acute care to the community. In contrast to the acute setting, I felt that transitioning to the role of a community nurse would give me far more opportunity 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 of the hospital admissions didn't need to happen. The patients could have received the care in their own homes.

In the community, nurses can give patients the highest quality of care, just like in a hospital. Community nurses have the equipment and skills to carry out the sophisticated level of care, in the comfort of the client's home. From a client’s  perspective, receiving care in the home makes their experience more relaxed for them and their family.



Why I chose to work in the community

When I started my role in the community, 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 not so easily available as my ward colleagues had been, I was still able to receive any information I needed.

 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. Some families find it difficult having someone else in their home taking care of a loved one. Therefore communicating with both the client and their family on a regular basis made the situation calmer.

The nurses taught me how to manage intense situations between myself and the clients' families. Under the circumstances, it would be completely normal for an incident to occur.



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

When you work in patients' homes, 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 out in the community can be isolating at times, but having the clinical knowledge and self-regulation will most certainly help.

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

Working autonomously in the community meant that I could potentially be the last person that saw the patient alive that day. Whereas in a hospital ward, a team will care and manage the individual patient.

Your patient 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 home has changed vastly in the last few years, as the patient acuity is at a much higher level, therefore making the nurses' role more complex and demanding of time. Patients 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 patients to live fulfilled lives whilst being in the comfort of their own home.

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

Or if you are a nurse or healthcare professional looking to work with us, please contact us on: 0333 323 3762 and a member of our team will be in touch shortly.