What a difference a year makes: the impact of the district nursing specialist practice programme

District nursing has a long history as a service that provides care for patients in their home environment. Demographic changes and a need to optimise out of hospital care has impacted on the acuity of patients supported and the complexity of caseload management. District nurses, in order to effectively manage such increased demands on their busy service, need to possess excellent, assertive case management skills. This study explores and evaluates the impact of the Specialist Practice Qualification in district nursing on the assertiveness and leadership skills of students. A mixed methods approach was adopted, utilising a quantitative assertiveness questionnaire at three points during the programme across the 12 participating higher education institutions, alongside qualitative semi-structured interviews. Statistical analysis of assertiveness scores demonstrated a statistically significant increase in scores across the duration of the programmes, with no difference related to the academic level of programme studied. Qualitative analysis demonstrated wide ranging positive impacts of the programme, including the acquisition of knowledge of underpinning theory, enhanced leadership skills and the development of a voice to truly advocate for the patient. The Specialist Practice Qualification has a dramatic impact on the professional performance of students selected to undertake the programme. The programme is frequently at risk as a result of cuts in post-registration funding. This study effectively demonstrates the substantial impact of the programme; a programme that should remain an option for future district nurses.