Stretched community nurses admit missing aspects of care

Community nursing is under severe strain, but that is nothing new to Catherine Rotte-Murray, a public health nurse in Co Waterford.

There were 1,690 public health nurses in 2009 and today there are 1,490 struggling to cope with earlier acute care discharges and more complex cases.

The Irish Nurses and Midwives Organisation yesterday launched a report that points to the lack of much-needed reform in community nursing.

Over half of the public health nurses interviewed for the study admitted there were areas of care they had missed in the previous week.

Most missed care is in health promotion, particularly concerning older people and chronic disease management.

The report recommends the establishment of an independent commission that would report within a year on the role of the community nursing workforce in primary care.

Ms Rotte-Murray, who is chairwoman of the INMO’s public health section, said community nursing was largely invisible.

“Most people do not know what public health nurses do until they need us. A lot of my friends would not have a clue about what my role entails.”

The report found care of older people on the risk register is a particular challenge — over 70% of public health nurses said they were unable to address this issue in the previous week.

“Of course, I am worried about the missed care. It is frustrating, and it impacts on job satisfaction,” said Ms Rotte-Murray, a public health nurse since 2003.

She previously worked as a general practise nurse for five years after spending 20 years in development aid.

“I love being at the frontline caring for people, seeing them recover and giving them the tools to stay at home.”

But because public health nurses prioritise direct patient care, administration gets pushed sideways.

“Ours is the only service in the community that does not have a waiting list — we are expected to respond to referrals almost immediately,” she said.

Mary Leahy, a public health nurse in Galway and a member of the INMO’s executive council, said that almost 80% of public nurses were unable to complete their administrative work.

“It is very scary for a lone worker like me to realise that every day I go to work, my license is at risk because I have not completed my documentation.”

She pointed out that just 5% of the country’s nurses were delivering primary care in the community, compared to 15% in Britain and 14.6% in Canada.

INMO general secretary, Liam Doran, said the number of public health nurses appointed in recent years was nowhere near enough to meet future needs.

“It can’t be a coincidence that the number of emergency department attendances has gone up by 9% this year when the volume of missed care in the community is so high.”