Dutch district nurses rediscover 'complete care' role
Cora Duinkerken is a district nurse in west Amsterdam. She works for a not-for-profit homecare firm, Buurtzorg.
She typically carries out about four home visits a day. That may sound like a light workload, but her responsibilities go beyond the usual clinical tasks.
On a routine visit to an elderly woman with dementia, she began by clearing up the kitchen, checking the fridge, chucking out old food, and feeding the cat.
It was only after she had made some coffee and chatted over breakfast that she got on with the "clinical" task of preparing medication for the coming week.
Even then the visit was far from over. She washed the patient in the shower, then helped her dress and put on some make-up.
The atmosphere was serene. There was no rush, just gentle, respectful care.
The idea here is that in a single unhurried visit a highly trained nurse can accomplish much more than several health and homecare workers popping in to do their allotted tasks.
So the costs per hour may be higher, but patients need thirty-to-forty per cent fewer hours of care. Cora Duinkerken says it's a great way to work.
"We choose to work maybe under our level but with that we can give the client complete care. That's better for the client, but it also makes our job a lot more diverse. You get a much closer relationship with the client because you spend a lot more time with them so they eventually will share a lot more with you."
The nurses work in teams of 10, each serving a neighbourhood of about 10,000 people. The teams run themselves - there are no managers. They are available round the clock and - working closely with GPs - they organise all the supporting care, drawing in families, friends, and volunteers. They see themselves as community-builders.
In Amsterdam, Buurtzorg nurses run a weekly radio show - Radio Steunkous - which translates as radio "support-stocking". It offers health advice, provides information on local services, and puts people in touch with each other. One of the nurses Marjolijn Onvlee, says the show complements their day-to-day work.
"It's all about having contact with people, sharing experience and that's what people need, and it makes them feel better".
The company was set up six years ago by Jos de Blok, who doubles up as managing director and part-time community nurse.
"We had 100 nurses in 2007. And now in 2013 we have 6,500 nurses. So 60% of the community nurses in the Netherlands are now working for Buurtzorg. And what you see is a lot of other homecare organisations are changing their models into more self-steering teams. And it's had a big impact on the national policy of elderly care."
He insists it is the quality and timing rather than the amount of homecare support that counts.
"It's very critical that you do the right things at the right moment and support patients in their self-confidence, in a way that they feel they can do more than they thought they could do".
He says that means people can stay at home for longer. Some are able to come back from nursing homes. And there are fewer hospital admissions. Rieta van Staalduine from the Dutch health insurance firm Achmea says Buurtzorg has established a valuable model of care.
"If you look at the way we are talking now - the government, and insurers, we all say it's necessary for people in neighbourhoods to develop more caring communities. Such a caring community should be helped by professionals. The professionals at Buurtzorg are the first to say, 'We'd like to do that.'"
There is growing international interest in Buurtzorg's model of professional empowerment.
Jos de Blok says he has gone "back to the future" by re-instating the autonomy he enjoyed as a district nurse in the 1980s.
He says he wants to rebuild public faith in the profession.
"What we want to show is that if you have the autonomy, if you develop your skills and craftsmanship, then it's the most beautiful job you can find."