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I am drawn to extraordinary people. People that do things above and beyond the call of duty. My friendship group comprises sports champions, business entrepreneurs and adventurers. Intelligent, confident people that excel in a multitude of outlets, and rarely follow the norm. Which is why I felt so at home. I was surrounded by a room full of people I felt in awe of. Not sports heroes or boardroom execs but people that show up every day and make the world a better place. People that deal with the deprived, those with complex health issues - physical and mental. They operate calmly in situations that would fill me with fear. The most unsung of heroes. Community nurses.
I am a guest at Future Nurse, an event put together to hear the voice of those out in the field delivering healthcare into communities. A concept to move care out of hospitals in a bid to improve outcomes, save money and ensure people are treated where they should be. The move to a decentralized healthcare model is not new. It's been vocalized for decades, and has been happening, but progress is slow.
Covid catalysed change. People suddenly had to have appointments remotely and this proved that all the care does not need to be delivered all the time. In fact, throwing everything healthcare has to offer at a patient does not necessarily improve outcomes. Elderly patients admitted to hospital often never go home and deteriorate much more quickly than had they stayed put. Very sick or old patients naturally nearing end of life should be at home with their loved ones, not with strangers in an unknown place. Often a kind word and a listening ear is all that is really needed.
Natasha Phillips, Founder of Future Nurse, explained how in her early training she was taught about patient centred care and how healthcare should be built around the needs of the patient. Moving care away from hospitals to treat patients in their own homes, aligned with this ethos. Yet the reality is never straightforward. Leveraging community in place of asylums for example led to patients being treated in custody then incarcerated in prisons instead of receiving care. But there are huge benefits from being treated in the familiarity of home. Being surrounded by people, belongings and beloved pets relieves some of the anxiety from illness and helps to improve outcomes.
Brett Hatfield from Google spoke about his early career as a nurse in acute care. He recalled helping a stab victim, by talking to them calmly about what was happening to them in a terrifying situation. At the end of his shift, he visited the patient to check how they were, and their gratitude truly touched him. Nurses choose their career to help patients like the stab victim, and to feel like they are making a difference. Too many nurses are leaving their careers early due to dissatisfaction and burnout with administrative burdens playing an unwelcome role in their decisions. IT can help. If, it is correctly selected and implemented.
Steph Lawrence from The Queen's Institute of Community Nursing explained that community care is not just about nurses. Doctors, physios and mental health professionals all operate in the field too, but nurses are the biggest workforce and need to be listened to in line with their combined impact. They are being asked to do more, to treat patients where it's best for them, but there is no new money. The only way to balance these forces is to rethink how care is delivered.
As my mind drifts to Zebra, I think how a diverse service delivery is taken for granted in other verticals such as retail. Omnichannel is the buzzword for the choice we have to buy online, click and collect or shop in store. Access to healthcare be it face to face at a hospital, digitally, by phone or delivered to the patient in their home is the healthcare equivalent to omnichannel delivery. Its enabler, digitalization.
Many of the senior nurses present recognise that they began nursing before digitalization. Despite obstacles clinicians have always found ways to make things work. They have learned to keep themselves safe in lone worker visits through common sense, knowing their patients and building trusting relationships within communities. Safety precautions I heard included - never take your shoes off in case you need to get out quickly, don't park on drives or where you can be blocked in, stay under streetlights. I learnt how back up would rarely be to police officers who might aggravate an already tense situation. It was to colleagues who know the patient, the circumstances, the community or just have the experience and skills to settle a situation.
Technology has the power to support these amazing people. But they are burnt from bad experiences. Buying cheap, unfit-for-purpose, inadequate implementation, unsupported tech are just a few of the painful experiences I hear. When asked for one word to describe the tech they have used, the results are really quite sad. 'Clunky, lacking, forced, poor and slow' are the most popular descriptors.
I hear stories of tablets being unused in cupboards as no one knows how to use them in their role. It is heart-breaking as I know the technology is there to make their lives better if it is in their hands with training and support! Rugged, disinfectant proof, mobile computers that scan medicine barcodes and add to EPRs (Electronic Patient Records), cameras to take pics of wounds, secure communication to enable dispersed clinicians to make joint decisions on a patient, duress buttons programmed to call a colleague (not the police). Add EPRs that work offline with AI to transcribe notes, translation apps, connectivity, wearables and our community nurses would be ever more unstoppable.
Essential to success is interoperability. Connecting community nurse, social services and general practitioners’ data all to a single source of truth - the patients EPR. Each service provider adding value as they see a situation from their perspective, as if looking through a diamond. Collaborating to find the best patient pathway together.
Tech is now part of the nursing curriculum. But no one wants digitalization to hardwire in poor process. Nursing culture is built on compliance driven by ticks!! Hundreds of ticks ensure a process is completed. Simply porting paper-based ticks to check boxes and clicks continues the draining administrative burden that is shortening careers. Measuring success to support investment is a positive. But collecting info for the sake of it and sending it to reservoirs of unused data is bad for everyone. If it is not used, don't collect it. Data should only be collected if it enhances care delivery and helps to improve outcomes.
Community nurses need to be empowered as they operate on the frontline. Patients in the community are complex, often with multiple morbidities and many options for care that nurses need to feel confident to advise on. An analogy was given that people think treatment plans are linear, like travelling by train straight from Stafford to Euston as I did to get to the event. But the reality is treatment is more like a tube plan. Lots and lots of destinations with many different ways to get there. A nurse uses experience and intuition to set the patient on the correct route that gets the treatment that is best for them.
The community nurses I spoke to are stretched, beyond what should be reasonably expected of anyone, yet they continue to deliver, on a superhuman scale. I heard stories of a community nurse treating a diabetic drug dealer with insulin in a home where needles were banned. A venomous snake slithering into an appointment. Nurses being exposed to machetes, knives and guns, the mentally unstable, the frightened and the aggressive. Yet in all these situations their response wasn't anger or hate. Just understanding and acceptance and an innate response to care for the patient.
We were there to listen, learn and advise on how technology could help make life easier and safer for nurses out in the field. My biggest realization was that this versatile, brave and resilient work force would do just fine without us. They had been finding workarounds since day dot. But they deserve to have help they can rely on. Digitalization has the capability to reduce administrative burden and give back time to spend with patients. We as a tech industry owe it to these superheroes to give them the power to help others more, that they truly deserve.
