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Not all our patients are able to come into hospital to receive the treatment they need — whether that’s because it’s not safe for them to move around outside their home, or they aren’t able to get out of their bed. That's when our dedicated district nurses come in: they bring the hospital to them.
Part of North Mid community services, the team of more than 100 specialist nurses operate a 24/7 service delivering world-class care in the homes of hundreds of housebound patients across Enfield.
The service works closely with local authorities, GP surgeries and community services to bring care into the community, helping to reduce hospital admissions and appointments.
They receive between 450 and 500 referrals each month from hospitals, GPs and patients themselves.
From wound dressing to medication administration, the wide range of care these nurses can provide means patients receive support in the best place for them: their own home.
The Rowan Court district nurses, based at Pine Lodge at St Michael’s Primary Care Centre, shared with us the peaks and surprising challenges that come with providing treatment outside the hospital setting.
Forging bonds and giving holistic care
When starting their shift at their base, the nurses and healthcare workers receive their list of patients to visit. Mercy Amoako-atta, advanced community nurse practitioner, started her career in district nursing as a healthcare assistant in 2013.
Explaining what the team’s work involves, she said: “We treat patients with long-term conditions; diabetic patients who need help administering their insulin; palliative care patients who have chosen to die in their own home; patients needing wound therapy or wound dressing. Most of our patients are over the age of 65 and housebound.
“When we visit them, we do a holistic assessment. You might see a patient for one thing but treat them for something else too once you observe them. If we find something that we can’t manage, we escalate this and call an ambulance if needed."
Healthcare support worker Marta Zelzik said: “Apart from the clinical care, we also support patients. Some patients don’t have anyone else visiting them, so are happy to see us. We end up becoming like their family.”
They see around 10 to 12 patients a day in their sector and also have an on-call service for emergency visits, which can come at any time.
Ama Arthur, caseload manager, is the team lead for the Rowan Court nurses. She explained how some people can misunderstand their line of work: “We can be seen as an emergency service and receive requests to see patients there and then, but that isn’t how we work. We prioritise emergency visits that come through via our on-call service, but we usually have a time slot in which to see each patient.”
In total, the district nurses travel up to 10,000 miles every week visiting patients across Enfield.
Pet peeves
Visiting patients’ homes comes with its own unique set of challenges, such as unexpected pets and locked doors.
Adisa Adam is one of the newest district nurses in the team, joining three months ago after university. Explaining one of the challenges she’s already experienced, she said: “Some patients don’t want to be seen and initially don’t open the door to you. You have to have patience and explain that they need care.”
Nurse Margaret Nanyongn shared her personal challenge with felines. She said: “I have a fear of cats which I have to conquer every single day!”
Healthcare support worker Yevdokilya Shkar, known as Victoria, has worked in the district nursing team for seven years. “You never know what you’re going to be facing each day,” Victoria said. “You have to work alongside families, sometimes in cluttered environments and you have to do it under pressure. It can be very challenging, but I love my job.”
Honing skills
Margaret worked on hospital wards before making the move to community nursing. She said: “It’s totally different and you get to acquire a lot of different skills on the job.”
Practice development nurse, Becky Balakrishnan, said: “There’s a lot of variety in the role which people enjoy. We help our nurses perform at their best and train them with a wide range of skills.”
Chinwe Iwuagwu, caseload manager, explained the additional pressure they can be under: “District nursing means lone working. You’re travelling alone and have to make clinical decisions by yourself.”
Continuity of care in the clinic
As well as going out to visit patients, the team also manage a clinic four days a week at St Michael’s for patients on the community care caseload who are able to make it into the clinic for an appointment.
Carmella Craig, caseload manager, has worked at North Mid for 15 years and has led the clinic since its inception in 2018. She shared: “The importance of the clinic is that it provides that continuity of care – you see the same patient and you can notice any deterioration and act on it. I’ve got a lot of rapport with patients that come here. They get to know me and get more comfortable.”
A passion for community care
The passion the district nurses have for their work shines through. Adisa shared why she chose community nursing: “I get to spend more time with patients and build a relationship with them.”
Ama said: “We all make life better. We have an impact on patients and our presence at home makes the families feel safe. Some families find solace in us.”
Mercy added: “Seeing patients in the comfort of their own home and making them feel well is fulfilling. I especially enjoy working with the elderly – the little things you do, which you see as a job, mean such a lot."
First image: Ama Arthur, caseload manager.
Second image: the Rowan Court district nursing team.
Third image, left to right: healthcare support workers Marta Zelzik and Kelly Petro.
