Identifying Community Nurses’ Contributions to End-of-Life Care

Why was the research needed?

Policy makers and commissioners of services do not have a clear picture of how much end-of-life care community nurses provide or whether important work is left undone or deferred. Understanding this is essential to make sure timely, patient-centred and safe care can be provided at home.

What did we do?

We carried out a UK‑wide survey asking community nurses about the end‑of‑life care they provide each day and whether any of their work is left undone. The survey aimed to show what proportion of their daily workload involves caring for people in the last year of life and reveal the extent to which this work is being deferred or cancelled.

What did we find? 

A total of 1,471 community nurses across the UK responded to the survey. 

End-of-life care makes up a substantial share of community nurses' daily work. Nurses in community and district nursing services spent a median of 23.5% of their last shift caring for people in their last year of life.

Some of this care is being left undone. Over one in ten nurses (11.6%) reported deferring or cancelling at least one end-of-life visit on their last shift. Deferral was significantly more common among specialist palliative care nurses (24%) than community and district nurses (10.4%). Half (52%) of nurses who provided end-of-life care on their last shift reported delivering one or more aspects of it below the standard they were professionally satisfied with, due to workload and capacity pressures. Staff shortages and demand exceeding capacity were among the systemic barriers driving this.

How are we working with communities, services and organisations?

We worked closely with community nurses through the Queen’s Institute of Community Nursing Research Forum, involving them as active partners throughout the study. Community nursing colleagues from across the UK helped analyse findings and interpret the relevance of the findings for practice and policy. This approach brought in voices that are often under-represented in research and helped community nurses to become more research active.

What will the impact and benefits of this research be? 

This study gives commissioners, service managers and policy makers evidence of how much end-of-life care community nurses actually provide, and how often that care is deferred, cancelled or compromised by capacity pressures. It quantifies both the scale of the contribution and the extent of care left undone across all four UK nations.

These findings directly inform decisions on planning and resourcing community nursing services and make the case for sustained investment in core and specialist nursing capacity to meet rising demand for end-of-life care at home. The study supports the wider goal of timely, person-centred and safe care at the end-of-life.

How will we share and apply the findings? 

We have shared our findings at various conferences, including presenting at the European Association for Palliative Care Conference, organising a national workshop at the Palliative Care Congress bringing policy makers from NHS England and Wales to change local support services available for community nurses, delivering the keynote speech at the Queen’s Institute of Community Nursing annual conference, and presenting at the Association of District Nursing Education and International Home Care Nurses Organisation annual conference. 

We have shared our findings with ICB leaders to inform their workforce plans to improve the delivery of timely end-of-life care in the community.