In Te Tai Tokerau, our district nurses provide an essential service delivering care to patients in their homes who are housebound due to their medical condition and are unable to get out and about.
District nurses coordinate patient care; from admission to the Service until they transfer care back to the GP practice. They work closely with patients and their health team (GPs, podiatrists, physiotherapists, occupational therapists, speech-language therapists, social workers, dietitians, and needs assessment and service coordinators) to ensure they receive the best possible care.
Referrals are accepted by General Practice, Hospitals, Hospice and other health practitioners. Patients cannot self-refer. On acceptance of referral, the nurse will triage and be in contact with the patient within 24 hours of acceptance.
The Service runs from 8am to 4:30pm, Monday to Sunday, with office hours from 8am to 4:30pm, Monday to Friday.
District nurses deliver compassionate care to their patients and a wide variety of nursing needs which adds variety and complexity to their role of supporting and promoting a healthy lifestyle to help people remain independent. This care can include:
• Cleaning and caring for complex wounds and ulcers
• lower limb wound assessment
• stomal and intravenous therapy
• continence service.
To give you an idea of what a day in the life of a DN entails, we shadowed Whangārei district nurse Lesha Wihongi for a morning of visits.
As a mum to three children, Lesha followed a nursing pathway after deciding to study something that would guarantee her work after completion. Since starting her studies at NorthTec, her passion for nursing has continued to develop.
After spending time with the DN Service during her electives, Lesha said when she started working with the Service after completing her degree, she felt like she had a head start.
During her first three months in the role, Lesha went out with another nurse before seeing patients independently, which she said wasn't too daunting because her team were so supportive.
"If I had any issues with a patient, I'd just call one of the team, and they'd guide me over the phone or even turn up at the patient's home to help."
Two years in, Lesha works .8 (32 hours a week), and although no day is the same, she sticks with a similar routine each day.
She begins by checking to see who her patients are, going through their notes and working out how her day will look according to their needs.
The team work on a dot system, which measures time in 20-minute periods. Providing wound management, for example, might take only one dot.
However, a procedure such as lower limb wound assessment may take up to an hour, so Lesha will factor in a patient's needs when preparing her schedule for the day.
Because time is of the essence, Lesha generally plans routes around her patients' locations and tries to work in a loop to avoid having to backtrack.
Once she has her plan in place, she calls each patient with an estimated arrival time to confirm it fits in with their day. Then she gathers all their files together and picks up one of the new Electric Vehicles – which she said the team all love because they no longer waste any of their precious time stopping to fuel up, adding some extra efficiency into their day.
Lesha then whips around to Stores located on-site at Commerce Central, and either one of the DN Health Care Assistants (HCAs) would have prepared dressings, IVs and any medication the patients are waiting for in advance.
Then it's time to hit the road. Lesha said she could visit anywhere from five to ten patients a day. She generally leaves the office around 9 am, and on a good day (which in recent months has been rare), she could be back at the office after lunch. However, as a rule, she usually won't return until late afternoon, when she spends the rest of the day typing her notes. Some DNs dictate notes on their phones as they go, then email themselves so they can copy and paste them in later when they return to the office.
This task will eventually become redundant once the DNs can input patient notes in real-time using laptops instead of lugging all their patients' files around and manually updating their notes later.
It didn't take long to learn from tagging along with Lesha to see how complex the role of a DN might be.
They don't just treat their wounds or change their IVs. The autonomous nature of the role means they have the extra responsibility of reading their patients to work out if they require extra care, which comes from spending time to get to know them and building trust.
The unpredictability of the role goes beyond not knowing how many patients they'll see in a day. They also have to deal with being out and about in the weather, navigating access to properties, coping with irate pets, and ensuring any whānau expectations are met.
Lesha said whānau often gather around to watch what she's doing or ask questions which she knows is all out of care and concern for their loved ones.
Some patients also like to chat, and she'll happily oblige if she's not too busy. However, more often, there's no time, so she cleverly talks to them as soon as she walks through the door, so she can focus on what she's tasked to do and leave as quickly as possible to get to the next patient.
Some walk her out, which she said is often difficult for them. In those cases, she'll jump in the car and leave straight away instead of sitting in the car and making notes, so they're not left standing waiting to wave her off.
This kind of empathy runs throughout her team, and Lesha said if anyone finishes early or finds space in their day, they'll send a message on the DN WhatsApp group to see if anyone needs a hand.
"We all try to help each other so we can leave work around the same time. Finishing at 4.30pm is a 'good day' because paperwork can take a lot of time, so getting the laptops will make us much more efficient."
The WhatsApp group also shares regular updates, including any callouts and requests for help. The phone seemed to be running hot the morning we shadowed Lesha, but she said it was a good day, with 10 DNs on board - which is rare.
"Sickness has really knocked us recently. Sometimes we'll only have five DNs working, and the workload can be overwhelming. So those days are tough."
Fortunately, one of their HCA's, Zarina Ruddell, supports the team on those days to visit some patients before the DN turns up to take dressings off and prepare them for the nurse, saving precious time.
She may also drop supplies off to patients like Dianne Williams to self-manage on those days because her husband Whetu can change her dressings.
Other patients, like Cleveland Edwards, said he's unable to really go anywhere without assistance, so the Service is excellent.
A crucial part of the DN role is working alongside the other services, and in Cleveland's case, DNs and podiatrists have been working together to see him on alternate weeks.
Cleveland was diagnosed as a type 2 diabetic in 1981 and told us he didn't listen to anyone back then, which is how he eventually lost his leg.
"That's the worst thing about being diabetic – you just need to bump something, and it gets damaged," he said, "Especially as you get older."
Cleveland told Lesha during the visit that his next podiatry appointment wouldn't be until December, so she was able to confirm with him that one of her team would visit him each week until then.
Lesha said they would keep the podiatry team up to date with Cleveland's progress by sending photographs of his wounds via the Jade System.
Our final visit for the day was to see Richard Pohe at Parua Bay.
Richard spoke highly of the DNs and said the nurses check areas and wounds on his body he can't see.
He thinks being a 'country' nurse would be the best, and you can see why – getting to visit places like his, sitting atop a hill overlooking the whole coastline from Whangārei Heads down to Bream Bay.
During COVID-19, Lesha said some patients feared someone coming into their house, so they scheduled the same nurses to see high-risk patients. They also established a Red Team to deal solely with patients with COVID, which Lesha joined after recovering from COVID-19 herself.
Lesha's become a bit of a star in the nursing world and has already featured in a breastfeeding video, a NorthTec story about her journey with nursing and, more recently, a story about recycling single-use scissors and metal instruments.
Lesha has had another child since beginning her studies, so life is hectic juggling four children aged 13, 11, 10 and three, and working 32 hours a week. That is why District Nursing works for her because the hours are from 8am-4.30, there is no shift work apart from the odd weekend, and her colleagues all do their share. Plus, she has great support from her family.
After spending time with Lesha, you get some insight into how much responsibility DNs carry, working autonomously. The key to this working is having an incredibly cohesive and supportive team that all have each other's backs.
It's great to know our community is in good hands.