Homeless hospital discharge nursing – towards system leadership

The Burdett Trust for Nurses recently granted the Pathway charity a 15-month leadership grant to identify, network and support all nurses working across the UK in the emerging discipline of homeless hospital discharge. Senior representatives from the Royal College of Nursing, Queens Nursing Initiative, and the London Homeless Health Programme provided a steer to the project.

Homeless hospital discharge nurses work in partnership with patients experiencing homelessness to achieve timely, holistic and compassionate assessment, treatment and discharge plans that improve health and housing outcomes. Most of these nurses work in hospitals, although in some cases this is an in-reach intervention from community-based services. So far, around 30 specialist nurses in the UK have been identified who are involved in homeless hospital discharge. However there are likely to be more nurses in this role in the future, prompted by the Homelessness Reduction Act (2017), which conveys a ‘duty to refer’ on Accident and Emergency Departments and inpatient services, and the NHS Long Term plan (2019) which cites homeless hospital discharge teams as an example of good practice to reduce health inequalities.

Through shadowing and observation, interviews, and 3 group workshops, the project has attempted to define the homeless hospital discharge nurse role clearly, including providing a breakdown of the knowledge, skills and experience required for the role with specimen job descriptions.  An early vision for best practice has been defined, and local innovations have been highlighted. Continuing professional development needs have been analysed, and voluntary standards for practice are being developed. Finally, and perhaps most importantly the project has helped the nurses to develop a shared vision of quality, and has defined this in terms of the value of a safe, effective and compassionate discharge, rather than by cost reduction per se (although the need to deliver efficiency has been taken into account). The project has also enabled the nurses to support each other to resolve the current challenges they face.

Overall the project has profiled how these nurses naturally throw a light on the challenges of the system for our most disenfranchised patients, and gradually chip away to deliver systemic culture change. These nurses have exceptional skills in clinical advocacy, patient empowerment, motivational interviewing, health and housing rights, and the concept of ‘making every contact count’. They are also experts at developing and delivering integrated services, and crossing the primary / secondary boundaries, and teaching and influencing all levels of staff – whilst battling the system on behalf of the underdog every single day. Finally, these nurses are nearly always the most senior inclusion health specialist in their organisation, underlining their importance to their organisations.

This Burdett funded project has created a national clinical network of homeless hospital discharge nurses, and has helped this group of nurses’ value themselves and develop a shared collective vision for their role, and. Feedback from nurses regarding the project has been universally positive, and has helped underline the importance of sharing in linking up in an isolated discipline.

Fantastic networking and sharing of experiences. Really motivational and inspirational to be here. Great to feel part of a wider network and feel like there are others out there who understand the struggle. Thank you.’

‘Fantastic day, so helpful to share knowledge and make connections. This has given me so many ideas going forward.’

If you would like a copy of the project report, would like more information on this leadership development project, or are interested in the area of homeless hospital discharge please get in contact with the project lead:

Samantha Dorney-Smith, Nursing Fellow, Pathway
samantha.dorney-smith@nhs.net

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