A ward without walls? District nurses' perceptions of their workload management priorities and job satisfaction.
OBJECTIVE
To explore district nurses' workload management, job satisfaction and the challenges they face.


BACKGROUND
This paper reports qualitative findings from a qualitative and quantitative study to identify a district nursing perspective on use of time, challenges and work satisfaction. District nursing is under increasing pressure because of the increasing shift to care in the community, early hospital discharge and changes in demography with an ageing population and more people with chronic illnesses.


METHODS
Qualitative.


METHODS
The study took place in one Scottish Health Board and data were collected in February and March 2005. The qualitative approach involved a total of 31 district nurses and senior managers in focus group discussions or individual interviews.


RESULTS
Three main themes were identified: (1) the priorities of district nurses and their views on work unrelated to 'hands on' clinical care, (2) aspects of district nursing considered stressful and (3) district nurses' job satisfaction.


CONCLUSIONS
District nurses and managers agree that caring work with patients is the priority for the service and provides job satisfaction. Many nurses feel overwhelmed by their workload and have little control over the admission of patients to their caseload; they are mainly demand led and therefore reactive care providers. A culture of long hours has developed as district nurses struggle to meet the needs of patients. Feeling devalued lowers satisfaction and Agenda for Change is perceived as de-valuing the skills of community nurses.


CONCLUSIONS
More clerical support is required so district nurses can deliver care to patients. District nurses can better represent their workload and how it is managed through expressing the nature of assessing risk and caring for patients as opposed to defining patients care needs by medical diagnoses. Extending the hours of the full district nursing service would benefit patients and staff.
Stuart
Elaine Haycock
EH
Nursing Studies, School of Health in Social Science, The Medical School, Teviot Place, Edinburgh, UK.
Jarvis
Alison
A
Daniel
Katie
K
D006801:Humans; D007588:Job Satisfaction; D009726:Nurses / Q000523:psychology*; D016526:Workload