District Nurse Lone-Working Visit: ERA

Experience

I visited a patient for wound care at his home, a visit I had done weekly for a month without concern. On this occasion his adult son was present, visibly intoxicated, and became increasingly hostile while I worked - standing close behind me, questioning what I was doing, and becoming louder when his father asked him to stop. I made a judgement to shorten the visit: I completed the essential wound care to a safe standard, skipped the non-urgent elements, kept my tone neutral, and left calmly with my equipment packed as I went rather than at the end. In the car I reported the incident to my team leader by phone. We recorded a risk flag on the address, and subsequent visits were arranged as doubles until a review with the family agreed the son would not be present during care.

Reflection

The honest version of this reflection starts with what I nearly did, which was carry on as normal. The visit had a month of safe history, the patient needed his dressing changed, and walking out felt like abandoning him - I now recognise that as the thinking that keeps community nurses in rooms they should leave. What I actually felt in my body was unambiguous well before my clinical brain caught up, and the gap between the two is the lesson: I was negotiating with my own risk assessment because the task was unfinished. Shortening rather than abandoning the visit was, I think, the right middle path this time, but I am wary of learning it as a rule, because it worked partly through luck. I also noticed afterwards how little of our lone-working procedure I was actually using day to day - my whereabouts were on the board, but no check-in was expected between visits, and nobody would have raised an alarm for hours. The procedure existed; the practice had evaporated.

Action

I now do a doorstep reassessment on every visit - who is in the house, and does anything feel different - explicitly overriding the visit's history, because familiarity was exactly what nearly silenced my judgement. I raised the check-in gap at our team meeting, and we have reinstated a buddy text system after any visit flagged as higher risk, which I have agreed to champion for the team. I have also rewritten this patient's visit plan with the agreed conditions and an explicit exit threshold, so that a colleague covering my caseload inherits the risk knowledge and not just the wound care plan. Escalation, next time, will not wait for the dressing to be finished.