My DCHS Blog

Anneka’s story – life as a community nurse in Derby City

Anneka Johnson is a community staff nurse based at the Village Community Medical Centre in Derby.  She joined DCHS in October 2015. Anneka chatted to us about her life as a community nurse: she describes a typical day and why she loves the DCHS approach, Toughbooks and SystmOne!   

How long have you worked for DCHS?
I qualified as a district nurse two and a half years ago and joined DCHS soon after that.  I did my management placement with the Charnwood team and loved it!  That experience inspired me to apply and I got lucky! 

What is it about working in the community that works for you?
I really like visiting patients in their own homes; the patients become ‘people’ and appear a lot more settled.  I love the way you can build up a relationship with them over a period of time, and really get to know them.  But I think I also really like being ‘autonomous’; working on my own, making decisions and making things happen for the people I care for.  For me, the DCHS approach of individualized care really makes sense – one size doesn’t fit all.

But surely it can’t be marvellous all of the time?
[Laughs … well no, of course not! But it is most of the time]  Sure there are days when you are really aware that the number of patients that need seeing will mean that everyone in the team will be under pressure; the staffing ratios are not always perfect, but we get by.  And, the days you finish on time are few and far between … but even so I love it.

What do you think about Toughbooks?  Are you a fan?
I TUPEd in from Derby City where we had been on a paper based record system and I LOVE SystmOne!  It is brilliant to have all the relevant information in one place; you can see everyone’s input (so long as all the opt-ins/outs are in place).  It feels truly multi-disciplinary and that you can get the best picture of what is happening with each patient. It is great to be able to see referrals too and to know what you don’t need to ask … as it is all written down in front of you.  It always felt uncomfortable asking if a patient was palliative ….now I don’t have to as it is in the notes.  I’m also really pleased you don’t have to become a spy able to decipher code [people’s handwriting] and the fact that there is a very clear audit trail.

What does an average day look like for you?  Can you talk me through it?
We basically work one of three shifts – early 8am- 4pm, day 8.30am – 4.30pm or late 10am – 6pm.

If I am on the early shift I go to the office and collate al of the faxes, and requests from the over-night services and care homes, triage and task colleagues to deal with these patients.  Then I download my list, and Mobile Working so I have a back-up system, work out my route and set off to see patients.

If I am on the day or a late shift I log on at home via the VPN, check my allocation (download my list), plan my day ahead and my preferred route.  We have a traffic light system to help me prioritise my work flow red - if I don’t treat them urgently their situation could be life threatening; amber – these are patients I need to see daily or as a follow up from an urgent visit and green – these are non-urgent patients, although they will become amber or red if I fail to see them within a couple of days.  I use my clinical judgement to assign a flag to my patient allocation.

I go back to base for the 1.30 handover meeting.  This is a really important part of each day.  We discuss who we have seen and share any important information from our morning visits – for example information about individual patients who may need a repeat visit later in the day; re-distribute lists, collect dressings or other equipment and then go out on afternoon visits.I don’t go back to base again until the following day.

How do you feel about using SystmOne in patients’ homes?
I don’t really have a problem with it.  I have been trained to use it properly and feel there is a way to use it successfully with patients of all ages.  I generally log on in a patient’s home, chat to the patient whilst I wait for the SystmOne to load, particularly the Live version and then involve my patient in the process of checking the record or updating information.  It is quite easy to get in to the habit of it becoming part of what you do rather than a barrier.  I’m lucky as I work in an area where we have good signal, but I never worry as I am familiar with using the Mobile Working version and know how to switch to it if I need to.

I’ve just discovered ‘sticky notes’ – which I love because it makes it really easy to jot down notes. [Laughs …  I can’t remember the last time I actually used a pen or pencil at work!]

What about the battery life?
The Toughbook? – it generally lasts the whole shift when I remember to charge it properly.  I always have my charger with me and top it up when I am at the base at the handover meeting. On the rare occasion that my battery is really low I know I can use MW, or make notes on sticky notes and wait until I can plug in to input fuller notes.  Whatever happens the final back up plan is to make use of ‘skinny notes’ – the version that is left in patient homes.  This is what our bank staff use at the moment until we have worked out how they can also use S1.

The phone? – again it generally lasts the whole shift, and I make sure I have my charger with me and can top up the charge at the handover meetings. I’ve noticed a difference since we have been on SystmOne – a positive difference!  I really don’t use my phone as much as I can send e-referrals through S1 or task colleagues.

I know the GPs prefer tasking/e-referrals, particularly with our non-urgent cases, as they can receive the message when it suits them and don’t have to struggle to call us back.  I think it is the same with other clinical colleagues – like the TVN team.  All in all a much more efficient way of working.

Fewer phone calls is a good thing!  I find it has helped me prioritise knowing when to answer the phone; I now know if it rings it will likely be urgent.

If I was to ask you to give a S1 non-user three reasons to be positive about SystmOne, what would you say?

  1. Communication
    You can view and communicate with the MDT, including the GPs which is a real bonus.  All the information is in one place.

  2. Safety and support
    You can see how your team are coping with their lists – makes it easy to see if you need to offer support or can request help, plus I find it comforting as a lone worker to know that my day is being monitored by the system.

  3. Clinical governance and IG

    I can relax and trust that I am not breaching any clinical or information governance expectations or regulations because everything is in one place and there are clear audit trails.  I don’t need to use pen and paper or a diary.