District Nurse, 2012-Style

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-By John Boley

Fresh from celebrating its 100th birthday last year, Ballarat District Nursing and Healthcare (BDNH) is this year moving forward with a spring in its corporate step that belies its centenarian status – much like some of its clients.

BDNH is a not-for-profit, community managed organisation that has been providing care in the Ballarat community since 1911 and aims to be a leading provider of responsive health care services, working with the community to promote independence. The purpose of the organisation is to provide high quality health care services, supporting the independence of clients and communities in Ballarat and surrounding areas. This former gold-rush town some 100km to the west of Melbourne (its name understood to derive from the indigenous words meaning ‘rest place’) is, with its population of 100,000, Australia’s fifth-largest inland conurbation.

“We are the largest stand alone district nursing service in the western part of Victoria,” says BDNH chief executive Joanne Gell, although of course in comparison with state hospitals it’s relatively ’boutique’. The organisation employs around 100 staff, mainly nurses, and has a turnover of some $5.5 million. “We are a small service but in terms of the impact that we make on the local community, preventing people from going into residential care or hospital through the emergency department or as an in-patient, we save the system about four million dollars a year.”

One of the emerging priorities for the care of older people is their desire to avoid ‘going into a home’. People do wish to stay in the surroundings that are familiar to them. Joanne says the recent Federal Government enquiry into aged care revealed quite clearly that older people want to stay in their own homes. “They are more aware of their rights and responsibilities and have greater expectations than they had in the past. We need to be adapting our service models to meet those needs.”

Joanne regrets that she is not seeing any change in funding models to support that shift. “Health insurance companies fund hospital-related service delivery but are reluctant to support any service provision that is not in hospital.” She believes there has to be a shift in the way services are funded, including the move towards telecare (telemonitoring, of which more later).

District nursing in general and BDNH in particular is not only about caring for old people. “We support all people coming out of hospitals – it could be children or somebody who has just had a routine operation and needs some aftercare. We do see the full age range and in addition we have podiatry services and diabetes education services that we provide to any age group.”

But much of the business is to do with people who need nursing services in their own homes. “We receive referrals largely from GPs and hospitals. We have very good relationships with our referrers to ensure appropriate service and care coordination behind the scenes,” says Joanne. In terms of BDNH’s profile, “Our physical presence remains our cars that go round visiting people.” That said – and acknowledging that district nursing tends to be the ‘poor cousin’ in the health system because it doesn’t have the sort of profile that hospitals do and the focus of government always seems to be on hospitals and waiting lists – “we were delighted when the state government said it recognised the value of the role that we play in the health system and wanted to increase funding to see that role expanded. We have been fundraising for quite a number of years” for an extension to the BDNH building to enable the organisation to offer a wider range of services and increase the nursing workforce. Construction is due to start in September and Joanne is understandably excited about the prospect. “It’s a green building so we are hoping that even though the building footprint is larger, the energy costs will be lower. That will mean we can spend more money on service delivery rather than what we currently do in an energy inefficient building with its huge heating and cooling bills.”

District nursing is a career that attracts people who enjoy being “independent practitioners… Our nurses pull up in their cars and have to assess the safety of the situation and they are walking into sometimes ‘complex’ family situations.” Initial impressions are important when entering someone’s premises. “You can get quite a fast perspective of whether a client is coping as soon as you walk in.”

Fortunately, district nurses tend to be very loyal. “Because of the nature of the work that they do, we have a lot of long standing staff members here and that is vital for the patient relationship as well. There is also a good team work ethic and this helps staff satisfaction.” Staff turnover is around the 13 per cent mark, which for the health sector is exceptionally low. “I can’t comment on how that compares with the private sector, but it’s a figure we are certainly proud of.”

Joanne and her team spend a lot of time applying for funding, organising fund-raising events and encouraging donations from private and corporate entities in order to add more value to the BDNH service. Currently, she is targeting telemonitoring – an extension of online diagnosis in which patients can be monitored for a variety of conditions – keeping a check on blood pressure, blood glucose levels, weight and many other items – via internet or mobile phone (or a wireless tablet set up in the kitchen, or one of many other delivery methods that could be used). Indeed, this is one organisation that is unreservedly looking forward to the advent of the National Broadband Network which will extend the effectiveness of this technology.

Joanne says this use of IT, which is self-evidently of patient benefit in terms of prevention and also acute medicine, is not intended to replace or reduce face-to-face meetings with the nurse. Rather, “it’s about making sure we are supporting the clients that would benefit most from this type of service.” It will take in the region of $300,000 to set up the IT involved; offers of part or all of this sum would certainly be most welcome.

Joanne says it is important to increase awareness of the role played by her district nurses – and all the others around the country. It’s a service that many people just don’t know about – until they need it themselves. In addition, she says, “we are incredibly proud of the service we provide.” In a short space of time BDNH’s nurses have gone from leaving written notes for the next visitor to sophisticated medical statements on laptop PCs. “We’ve come a long way from two nurses on bicycles. We had a great year last year, celebrating our 100 years, and part of that was writing our history and reflecting on how we have come from one nurse and a second-hand bicycle to nearly 100 nurses and a fleet of vehicles.

“But now it is time to move on and gear ourselves set up for our next challenge, which is really how we are going to support the baby boomer population.”

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

January 18, 2019, 3:37 AM AEDT