District Nurse (DN)
DISTRICT NURSE – District Nursing
In Northern Ireland, a District Nurse is a Registered Nurse with a NMC recorded Specialist Practice Qualification (SPQ) (District Nursing Pathway) and is employed as a District Nurse.
The District Nurse proactively leads the team and manages a caseload within a designated community area aligned to a GP practice using collective leadership skills and in line with the Delegation Framework (NIPEC 2019). The District Nurse assists people to make autonomous decisions about their care by co-ordinating and delivering person and family centred care in their home or in the community. The District Nurse uses a population health-based approach and proactively works with GPs, other health and social care professionals, as well as individuals, families, carers and voluntary agencies.
The District Nurse has specialist competencies and works autonomously with individuals who have a wide range of conditions and complex care needs, including palliative and end of life care. They enable people including those living with long term conditions to be cared for safely in their home and where possible reduce unnecessary hospital attendances or admissions. The District Nurse also promotes self-care and independence, mental and physical health and well-being and prevention of ill health.
Listen to the District Nurse describing their role in District Nursing by clicking on their name.
The specific core competencies and education requirements relevant for District Nurses are presented below.
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The District Nurse is a clinical expert who leads the District Nursing Team in the provision of quality, person and family centred care for the caseload population in a variety of community settings using a population health-based approach. They are accountable and responsible for the District Nursing service they provide. The role is complex and requires expertise in caseload management, care coordination, clinical decision making and implementation of service developments
The District Nurse will:
- Provide specialist clinical care, expertise and advice on safe, effective, person and family centred care.
- Use person-centred assessment skills to determine a person’s holistic needs utilising a range of evidence-based tools to inform decision-making.
- Co-produce care plans with individuals, families and/or carers, develop therapeutic relationships that promotes informed decision making and self-management.
- Supervise the delivery of co-produced care plans by the District Nursing Team, ensuring regular evaluation of care.
- Promote the holistic health and well-being of people and provide anticipatory care to enable independence, reduce avoidable Emergency Department attendance, hospital admission and facilitate timely discharge.
- Undertake evidenced based prescribing from the appropriate formulary and according to professional and legislative frameworks and local policy.
- Fulfil the Palliative Care Key Worker role and function
- Make a timely referral to another team/service, as necessary, whilst maintaining overall responsibility for management and co-ordination of care.
- Ensure clear lines of accountability with respect to delegation, supervision and mechanisms for the assurance of clinical and care governance.
- Develop and implement person-centred risk assessment and management strategies taking account of people’s views and responsibilities and promote safeguarding of individuals.
- Know when to apply safeguarding and mental capacity legislation.
- Work collaboratively to source and utilise e-Health technology and technology assisted learning systems to proactivelyenable care and individuals to self-care
 All reference to safe, effective, person-centred care in this document assumes care is evidenced-based.
EDUCATION AND LEARNING
The District Nurse recognises personal development requirements and identifies and facilitates learning for themselves, the District Nursing Team, other healthcare professionals, students, individuals, families and carers.
The District Nurse will:
- Accept responsibility for own continuous professional development and the maintenance of professional competence and NMC revalidation.
- Engage in a range of learning activities and reflective supervision to improve care and practice.
- Supervise and support others, adopting a strengths-based approach, within the scope of each individual’s role and competence.
- Facilitates appraisals and Personal Development Plans, mandatory and job specific training for the Team.
- Identify and participate in the development, delivery and evaluation of educational initiatives that address the needs of individuals, their families/carers.
- Cultivate a positive teaching/learning environment that develops the capability and capacity of staff and others to care for people in the community.
- Promotes a positive teaching/learning environment that supports individuals, their families/carers to make informed decisions and to self-manage their care.
- Disseminate learning and implement relevant actions from incident reporting to facilitate the delivery of safe, effective person-centred care and services.
- Participate and contribute to local, regional and national clinical forums and/or professional and strategic groups
RESEARCH AND EVIDENCE-BASED PRACTICE
The District Nurse has an enquiring approach to practice and updates their knowledge to ensure quality care is provided within service constraints.
The District Nurse will:
- Critically appraise research and available evidence to enhance the quality, safety, and effectiveness of person-centred care.
- Implement evidenced–based public health initiatives to enable people to maximise their holistic health and well-being to “make every contact count”.
- Lead on the implementation of the regionally agreed District Nursing Quality Indicators and other best practice guidelines, within the District Nursing Team.
- Utilise specialist knowledge to identify, contribute to and participate in audit, quality improvement and research and use findings to inform decision making.
- Implement and disseminate audit, quality/service improvement and research findings through team meetings, Trust presentations, regional events, and publications.
- Engage with people and use the feedback from their experience of care to improve outcomes and service delivery.
LEADERSHIP AND MANAGEMENT
The District Nurse leads, challenges and empowers the District Nursing Team to deliver safe, effective, person-centred care within a local community and aligned to General Practice. They are accountable and responsible for effective resource management.
The District Nurse will:
- Demonstrate the value and unique contribution of the District Nurse within the Primary Care multi-disciplinary team.
- Apply the relevant political, social and health economic strategies/policies to enable the provision of a person and family centred, responsive service.
- Use quality improvement methodologies to support service improvement and innovation.
- In partnership with relevant health and social care professionals, involving the community and voluntary sector, undertake and maintain a local Population Health Profile and Community Health Needs Assessment, to prioritise service delivery for health improvement.
- Advocate for and actively engage with individual’s families and carers who require a District Nursing service.
- Promote and model effective team working through collective leadership and apply the principles of human factors, environmental factors and strength-based approaches to problem-solve and foster a caring, safe and supportive environment.
- Manage the District Nursing Team’s resources through effective and efficient allocation and monitoring.
- Lead, manage, and monitor the caseload, delegating for safe, effective, person-centred care delivery, using information systems.
- Demonstrate effective performance management of staff against local policies and procedures.
- Lead and foster a culture of openness, recognising duty of candour and act on concerns raised.
- Develop own resilience to manage the demands and challenges of leading and managing the District Nurse team and use appropriate organisational support systems.
- Use information systems to inform strategic decision making, workforce planning, safe staffing and workloads.
- Work collaboratively with others to: