Carers UK Forum

Hi

Just wondered what your experiences of District Nurses have been like and what ,if anything you do to get the best out of the service?

My father has only had visits for the past six weeks and I’ve been really disappointed. They haven’t turned up on a number of ocassions (are meant to administer insulin - so I’ve had to go and do it).

For a week they were administering more insulin that he was meant to have - although they had received a letter from his hospital diabetic consultant saying they were concerned that his dose was too high and may be causing hypos : they refused to act until I got the GP to write saying exactly the same. I can understand that they have procedures to follow but once you have received a letter from a hospital consultant querying the dose I think it’s reasonable to expect that they might follow it up within a week?

More recently, this evening my father collapsed after dialysis (I am writing this from Resus). The District Nurse was present - I expected this was when we would see her at her finest but at first she just froze (I had to carry my father to a bed alone - he had collapsed in my arms) and shout at her to call an ambulance. She was hopeless - she kept trying to get him to eat biscuits (i assume thinking it was hypo even though his blood glucose level was ok). She was completely out of her depth: at first she simply didn’t speak and stayed in the living room and then shouted at me to feet out of the way (I was taking his blood pressure to give to the crew as we normally do ) so she could monitor his breathing : he was breathing fine. The ambulance crew said they think she wasn’t very experienced, panicked and that given my fathers many complications just didn’t know what to do. It is quite scary - I thought they would be very well trained in responding to emergencies at home.

I don’t know if it’s just because we are in London but every health service or social care agency we come into contact with just seems quite poor (inexperienced and quite often not very able staff - many here temporarily). It’s really worrying. I do appreciate that with everything else that has been going on I may just be being hypersensitive/ aware. It would be good to know if any of you have had better experiences, especially in London, and what,if anything, you did to achieve this. Thank you.

Hello Faye. I've had experience with District Nurses (or community nurses) when looking after mum. You can tell how experienced she/he by their uniform ie dark blue are the most senior etc. In my experience all were polite and friendly but the level of experience varied every time. One nurse came to take a blood test and she said she hadn't been trained yet, at least she did successfully take one. Kind regards, Nicholas

Hi, thanks for your helpful response. I’m glad you’ve had a good experience - I suppose it’s still early days and I just need to give it a chance. The District nurses that come to see my father wear shorts and a T-shirt and the student nurses a white top with the name of their university on them. Will look out for any uniform differences in future!

Faye_1506 wrote: ↑

Mon Jul 22, 2019 8:41 pm

Hi

Just wondered what your experiences of District Nurses have been like and what ,if anything you do to get the best out of the service?

My father has only had visits for the past six weeks and I’ve been really disappointed. They haven’t turned up on a number of ocassions (are meant to administer insulin - so I’ve had to go and do it).

For a week they were administering more insulin that he was meant to have - although they had received a letter from his hospital diabetic consultant saying they were concerned that his dose was too high and may be causing hypos : they refused to act until I got the GP to write saying exactly the same. I can understand that they have procedures to follow but once you have received a letter from a hospital consultant querying the dose I think it’s reasonable to expect that they might follow it up within a week?

More recently, this evening my father collapsed after dialysis (I am writing this from Resus). The District Nurse was present - I expected this was when we would see her at her finest but at first she just froze (I had to carry my father to a bed alone - he had collapsed in my arms) and shout at her to call an ambulance. She was hopeless - she kept trying to get him to eat biscuits (i assume thinking it was hypo even though his blood glucose level was ok). She was completely out of her depth: at first she simply didn’t speak and stayed in the living room and then shouted at me to feet out of the way (I was taking his blood pressure to give to the crew as we normally do ) so she could monitor his breathing : he was breathing fine. The ambulance crew said they think she wasn’t very experienced, panicked and that given my fathers many complications just didn’t know what to do. It is quite scary - I thought they would be very well trained in responding to emergencies at home.

I don’t know if it’s just because we are in London but every health service or social care agency we come into contact with just seems quite poor (inexperienced and quite often not very able staff - many here temporarily). It’s really worrying. I do appreciate that with everything else that has been going on I may just be being hypersensitive/ aware. It would be good to know if any of you have had better experiences, especially in London, and what,if anything, you did to achieve this. Thank you.

Hi, Faye,

I don't think you are being hypersensitive, rather you are being a very good carer, doing what you can, and sometimes certain services need a good kick in the pants. My own experience with district nurses, and other support services, has been quite similar to yours; lateness or not turning up at all, and when it is something that could be considered time-sensitive (which I would consider insulin administration to be), then it is up to the care coordinators to work with the district nursing team in your area to work out a realistic schedule, and time-sensitive calls have to be given priority.

There is NEVER any excuse for them taking a whole week to get up to speed with a different dosage. Everything is put onto a computer, and when a dosage is changed, and hospital/doctor who has made that decision knows district nurses are responsible for administering meds, the new dose should be given the very next visit.

As for their being this weird 'pecking order', different uniforms denoting status of nurse, they should ALL be competent enough to be carrying out their job. District nursing is no doubt very challenging, and we have often had student nurses coming out with experienced ones, and sometimes even the more experienced ones have had to ring other members of their team and even the 111 NHS line for further advice, when something unexpected has happened.

You can and should speak to your own doctor, or hospital consultants when you feel their wishes are not being followed, and you can also contact your local health authority, which I certainly have had to do on more than one occasion, and they do generally have a "patient feedback" email you can send comments to, good or bad, and our information can/should help them to see where there are training opportunities.

At the end of the day, the patient's well being must come first, and surely it is in the best interests of everyone to work as hard as possible to prevent the need for your father to need admission to hospital.

My brother, for whom I provide care, is an insulin-dependent diabetic, with only use in one arm, and while he does prefer to administer his own insulin, there is much communication between himself and a diabetic nurse at the hospital. I do the lion's share of seeing to his other care needs; I had no desires to be a nurse, but I do know from bitter experience that there are many people who are meant to be supporting my brother and others in my community (and around the country) that see a family/friend carer in place, and attempt to cut corners, using the excuse that they have limited budgets and are over-stretched. This may be true, but they are paid quite well to better manage their time, and their stresses should not be passed down to us.

I have found paramedics have been by far the most professional, kind, caring people who have been involved at times in my own brother's care.

These things are sent to try us. Stay strong. I think you are doing an amazing job.

I'd have to say that ours are pretty good when they get here, they don't always come when they say they will, but will come at another time and even phone to tell you.

If you want them for an emergency, there doesn't seem to be any urgency shown: my wife's Urethral catheter was in the habit of popping out fairly regularly due to spasms and the two options then were to leave her sat on the commode (not very comfortable) or on the bed, sat in wee while you wait for the DN. One time we waited from about 9:30 am to 11:00pm.

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I find them variable. We had them twice a week for husbands pressure sores/ moisture lesions then down to once a week due ot his 'non compliance' re the advice given.

It is a very hard job and I have had to point out to them that i have no medical training and can only do what the last visiting nurse tells me to. I have often had conflicting advice. I had to push to get a swab done as I felt the head wound was infected and i was right both times. At the end of the day, most do their best.

Thank you for all your comments and advice. It’s really interesting to read about your different experiences.

One thing I did want to add was that I agree very strongly with the comments about paramedics. I have to say that every time I have encountered one they have been utterly fantastic. Very calm, reassuring , kind and really know their stuff. I wonder if it’s their training or how they select their people but they really are impressive. I don’t know what we’d do without them. It’s a shame we can’t bottle whatever it is that they have and share it!

Thank you.

Hi Faye, overall the district nurses did a very good job with mum. They treated mum's bedsore, did catheter care, often on an emergency basis when the catheter became blocked and fitted her for continence pads. We saw many of them. A trainee was accompanied by an experienced nurse.

I did complain when 999 services sent nurses from the wrong area, despite my saying that mum's nurses didn't work nights. Two nurses arrived and the more experienced one noticed mum was being treated by the neighboring borough where her GP was located, and not the ones from the borough in which she resided. They ummed and errrred so long mum told them to do something and I told them to do the job or leave and I'd get someone who could. They changed the catheter but neither checked that the valve into the bag was open! Of course I complained and insisted on retraining(!!!!). I was impressed at the thoroughness of the written report in which they agreed with the retraining and to the fact that the dispatch service was wrong to have sent them in the first place.

Apart from all the emergency callouts, the district nurses came whenever they pleased, so no issue about giving meds on a timely basis.

Mum and were in SE Greater London.

I've found them to be a bit and miss to be honest.

Had a lot of experience with them last year when my own mother needed some short term nursing care with changing dressings on a weeping wound. Rarely saw the same nurse twice, lots of newly qualified types came out. Most were very friendly, a few were downright rude and bordering on aggressive when it came to how they handled my mother.

I always asked for a quick phone call when they were headed to her house, so I could get there to let them in, wound up having to rescheduled my entire life around the treatment program, missed a lot of work and eventually had to try working from (her) home to insure I was there to see to them, because they never called and arrived at completely random times during the day, anything between 8am and 4pm most days. So I'd end up having to sit in with her just waiting for them to arrive and do what I could have done for her myself but wasn't allowed.

I know in most places they are seriously overstretched, so I tried not to get grumpy about it, (and it was easier than having to get her to the doctors/hospital every day, twice a day) but it is an additional burden as a carer if you have other responsibilities to attend to. I think it's a rare thing to find any "outside care service" that appreciate the caree may be housebound, but those who are there to support them and oversee things have things to attend to away from the home and need set times to work to.

As for paramedics, had terrible experiences with them in the past, especially with a friend of mine. One example - three arrived to help him after a nasty fall. One went off snooping around the house, then started questioning his son (while his father was being stretchered out) about how he could look after his dog (that he absolutely worships and is the only thing he wants to live for) and assumed he couldn't manage and reported him to the RSPCA for neglect. The RSPCA came out, looked at the dog and was furious her time had been wasted. The dog is better looked after than some people's children are haha!