Making the complexity of community nursing visible: the Cassandra project.

The need to effectively promote safe staffing levels in community settings challenges commissioners and providers of services to find rigorous methods of capturing workforce evidence that can be systematically used to shape effective services and skill mix for the future. This article presents a brief review of current approaches and challenges to measuring community nursing workload activity in England. Specifically, it shows phase 1 pilot results using the Cassandra Matrix activity tool and review of ongoing developments and progress to demonstrate scalability for national implementation. As part of a much larger practice development project to develop community nursing, the pilot used mixed methods to collect 10 days of workload activity data from a self-selected sample of band 5-7 nurses working in general and specialist community nursing roles in three community organisations, and to evaluate their experiences of using the tool via an electronic survey. The findings indicate that the tool has significant potential for capturing the complexity and multiple dimensions of nursing work in community contexts, and phase 2 work has led to a community version of the tool being piloted on a larger scale across six community organisations.