Nursing: Community Nursing: A Trend for the Future

Community nursing: A feast or a famine of nursing care

Community nursing is one realm of professional health care that appears to be emerging as a trend for the future, because it is growing in leaps and bounds. For those who are currently training as registered nurses, it is one of many, possible pathways to pursue in nursing. Community nursing presents unique, interesting and increasing nursing care challenges for professional registered nurses around the world. Currently, there is a growing demand for community nursing care everywhere. In many, third world countries, large cities and remote areas, there is a distinct shortage of community nurses.

What do we mean when we say community nursing? What does it entail?

Examining the role of community nurses will show why the field of community nursing will continue to expand its horizons, in the future.

Community nurses are called visiting nurses because they visit patients in their homes. In community nursing, the task of registered nurses becomes that of going out into the community, directly into patients' homes, in order to administer the professional nursing care that is needed, rather than taking care of them in hospitals, nursing homes or other health care facilities.

Nursing patients in their own homes does have distinct advantages. It allows registered nurses to enter into the real world of their patients, as opposed to the sterile environments that patients are subjected to when they are nursed in health care facilities. It presents an opportunity for them to get to know patients and their families, more personally.

The realm of physical, mental, emotional and spiritual nursing care is enhanced in home environments, because patients are happier and more comfortable. They are able to relax because they are familiar with their surroundings and have their loved ones around them.

Another advantage is the reality that patients do not have to leave their homes, in order to receive the professional nursing care they need. The community nurses come to their patients, instead of having their patients come to them. In each situation, the environment can be different and each scenario is unique.

In some instances, community nurses work independently or are self- employed, but many community nurses are employed by professional nursing agencies. The income that they generate from the professional nursing care that they give to their patients, goes to the agencies and the registered nurses are paid on a salaried basis.

Community nurses are sent out to patient's homes with medical instructions issued by the physicians, in conjunction with pertinent, patient information and nursing care directive from hospitals or other health care facilities. The task of the community nurses becomes that of providing high quality, professional nursing care for the patients assigned to them.

While registered nurses enter the homes of their patients to administer professional nursing care, they stay only for the length of time that is required for the actual nursing care. The community nurses assess and evaluate their patients and may administer intravenous therapy, give them different kinds of treatments, carry out various procedures, change dressings, administer injections or give medications. Often there is patient and family counseling involved.

A visit by community nurses, can take approximately twenty minutes to several hours, depending upon the level of professional nursing care required. Normally, this does not involve twenty-four hour care, but if necessary, that can be arranged.

Community nursing care visits can be scheduled at any time, during a twenty four hour period. Visits may be as often as every three or four hours and there can be any number of visits, on the same day. The number of community nurse visits, depends upon the nursing care needs and general health status of the patients. An appropriate time for visits is worked out between the community nurses and their patients. If possible, visits by the registered nurses are arranged between six am and eleven pm.

One of the reasons why community nursing is interesting work for registered nurses is because no two days are ever alike, depending upon the assigned case loads. What takes place each day depends upon the caseload requirements.

There are often high demands placed on community nurses, as there are a wide variety of professional nursing skills required. Community nurses must continually maintain and upgrade their skills sets. 

Interpersonal relationship and counseling skills are important for community nurses because they are dealing with patients and their family members, other health care givers, spiritual advisers, as well as health care related organizations, at the same time.

Emergency care may be necessary for their patients and sometimes patients have to be re-admitted to hospital.

Community nurses never know what to expect, when they enter their patient's homes.

Community nursing agencies may assign registered nurse caseworkers to do the initial evaluations and assessments of patients, prior to regular visits by other, community nurses. They may offer advanced training sessions for the community nurses. In the evening or at night, community nurses have to work independently. It becomes their responsibility to assess the patients' scenarios, determine the appropriate nursing care required and administer the actual nursing care.

Community nurses usually schedule patient visits during the day and evening, if possible. They go out to their patient's homes, regardless of the weather. They wear uniforms and carry a case containing nursing supplies of things that are needed for patient assessment and care, like blood pressure cuffs, blood glucose testing equipment and thermometers, as well as paperwork or medical supplies that may be needed, but are not available in patients' homes. Community nurses may assume the responsibility for ordering medical supplies, equipment or medicine for patients.

Medical records are kept on each patient visited. This allows the documentation of actual visits. The charts include changes in orders, medications administered, on going records of the assessment and evaluation of patients, dressings, procedures and treatments.

Community nurses often travel with a road map in one hand, as they may not always be familiar with the areas to which they are assigned. Finding their assigned patients in busy cities or remote settings can present a challenge. It is important for community nurses to have a good sense of direction and an excellent sense of humor. The advent of cell phones is definitely an asset for community nurses, but there can be times, when cell phones are out of range, particularly when home visits are needed in remote, country settings.

Community nurses can visit many different homes, in one day. Sometimes they see patients only once, but 

there are usually ongoing visits. Over time, community nurses become familiar with regular patients, their homes and neighborhoods. Even neighbors begin to recognize and welcome the visiting nurses.

Community nurses assume the responsibility for their own vehicles, as well as the cost to maintain and insure them. Community nursing agencies cover the cost of gasoline determined by mileage.

One of the major concerns in community nursing is the lack of a sterile environment, so community nurses have to learn how to create a sterile environment, particularly when there are dressings or treatments needed. Infections spread easily. Taking appropriate, preventative measures to curb the spread of cross-infection is always important.

Another concern for registered nurses has to do with disease prevention, in the community. Community nurses must take appropriate precautions to prevent the spread of various diseases, from one home to another.

A third concern has to do with the safety of the registered nurses who must travel after dark.

Why does community nursing work?

Perhaps community nursing is so effective, because the registered nurses are highly dedicated to their profession. They are committed to providing and maintaining a high quality of nursing care, for patients in their homes. Most community nurses establish an excellent relationship with their patients, grow to love them and enjoy their work. Community nurses are welcomed into patients' homes on a professional level and as friends, particularly when nursing care involves long term cases.

Community nursing is not always heavy work for registered nurses, but there can be heavy caseloads or patients who require a lot of assistance with moving, lifting and transferring, from beds to wheelchairs. At times, assistance by family members or other caregivers may be needed.

For community nurses, this kind of work is pleasant, but demanding at the same time. The community nurses must be flexible with regard to schedules and the hours that they work, as case loads vary. Sometimes, it can be like having either a feast or famine of nursing visits. The caseloads are unpredictable.

Sometimes the role of the community nurse becomes that of teaching, orienting or training new registered nurses. They may be assigned to teach or train non-professional caregivers and family members with respect to the administration of appropriate nursing care. This allows the community nurses to work on other acute cases.

For registered nurses who have a high level of dedication to nursing, a lot of energy and excellent nursing skills, as well as the ability to relate well to people and work independently, community nursing can be an ideal occupation. This is one role in which nurse practitioners can function also, although at this time, this level of nursing is not required.

As the world population continues to grow, so will community nursing. It is definitely an anticipated trend of the future.