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Masterclass Tullamore 2005.ppt - The Development of an Advanced ...

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  • 1. The Development of an Advanced Nurse Practitioner Role The Realities in Practice A Joint Presentation April 12th 2005 Valerie Small. Siobhan Rothwell St James’s Hospital Our Lady of Lourdes Hospital Dublin Drogheda
  • 2. Introduction • Development of an ANP role in two Emergency Departments • Outline of education programmes available in Ireland • Update on post’s and accredited ANP’s • Getting started 2
  • 3. St James’s Hospital 1996 Pilot Project: • AIM – To train a suitably qualified, experienced emergency nurse to independently assess, diagnose, treat, discharge / refer patients with a range of common injuries which present to the emergency department. 3
  • 4. Rationale • To develop a clinical career pathway for experienced emergency nurses • To enhance the quality of service delivered by the multi-disciplinary team (MDT) to patients with minor injury and illness • To provide a timely, but safe, service for patients leading to improved patient satisfaction • To release physician time to deal with increasingly acute workload 4
  • 5. ED Activity • Located inner city Dublin,Ireland • Catchment area: ¼ million patients • 50,000 New Patients annually • Primary health care facility for many patients • Initiative on nurse practitioner service proposed & piloted 1996 5
  • 6. Scope of Practice • Assess • Diagnose • Treat • Discharge • Refer to other appropriate service 6
  • 7. Patient Caseload Types of Injury • Minor Head & Facial Referral Arrangement Injury • Radiology • Laceration face, trunk • OPD & limb • Physiotherapy • Skeletal & Soft tissue injury • Occupational therapy • Initial management of • Social Work Department fractures • Primary care provider • Hand & fingertip • Outside Agencies Injury Homeless, Drug treatment • Minor burns < 2% services, woman's aid TBSA • Soft tissue infection • Incision & drainage abscess 7
  • 8. Audit • Daily activity documented since 1996 and collated monthly • Annual activity published • Continuous Audit on clinical aspects of care & patient outcome • Quantitative & Qualitative research on range of aspects related to service • 36,500 Patients treated 1996-2005 8
  • 9. DEVELOPING AN ADVANCED NURSE PRACTITIONER SERVICE IN EMERGENCY NURSING THE SITE PREPARATION PROCESS SIOBHAN ROTHWELL
  • 10. IDENTIFICATION OF SERVICE NEED – Analysis of Emergency Department statistics – Review of range of injuries and conditions – Adult and paediatric service needs – Waiting times – Quality of service – Career pathways in nursing 10
  • 11. EDUCATION • MSc Nursing – T.C.D. • Clinical Module – St James’ Hospital ‘Clinical Diagnositic Skills for Advanced Nurse Practitioners (Emergency Nursing)’ 11
  • 12. SCOPE OF PRACTICE • Adult Minor Injuries • Paediatric Minor Injuries - Significant service need - Consultant led education and supervised practice • Clinical Protocols developed collaboratively 12
  • 13. SCOPE OF PRACTICE • Limb injuries – STI, fractures etc • Wounds • Foreign bodies • Facial injuries – Fractures, wounds, dental etc • Eye injuries 13
  • 14. ISSUES IN PRACTICE •Radiology •Prescribing 14
  • 15. SITE PREPARATION AND JOB DESCRIPTION • Working group established following a meeting with the National Council • Comprised of: DONs (Region) ED Consultant Representative NMPDU Practice Development Nurse Nurse Managers ED Nurses pursuing Accreditation 15
  • 16. SITE PREPARATION • Health needs • Laws, rules, regulations and guidelines governing nursing and midwifery practice • Vicarious Liability • Guidelines for good practice • Benefits to patients from the ANP service • Consistency of service within Organisational Philosophy 16
  • 17. SITE PREPARATION cont/d • How change will meet the service plan • Location of the service • Integration of the ANP into the multidisciplinary team • Definition of the role content within the framework of nursing • Resource implications 17
  • 18. JOB DESCRIPTION • Background to post - Generic Background - Specific Background - Evolution of the role of the Advanced Nurse Practitioner - Effects of policy changes on Professional Practice in the Region 18
  • 19. JOB DESCRIPTION cont/d • Geographical aspects of the service/demographics of the region • Service Need • Purpose of the post 19
  • 20. SCHEDULE OF EVENTS • Guidance from the National Council • Bi-monthly meetings of the working group • Goals identified and set • Time frames highlighted • Objectives achieved 20
  • 21. TIME FRAME • June 2003 – Met with NCPDNM • November 2003 – 1st draft of Site Preparation and Job Description document • January 2004 – 2nd Draft sent to NMPDU 21
  • 22. TIME FRAME • March 2004 - Met with NMPDU to review document and prepare for final submission • April 2004 – Submission of document • May 2004 – Review by Accreditation Committee • September 2004 – Site Visit • Submission of Personal Portfolio 22
  • 23. SUBMISSION DOCUMENT • Developed collaboratively • Different service needs identified • National Council Framework Document (2001) used as a template • NCNM provided support and direction • Drafts x 2 submitted before completion of final document 23
  • 24. SUBMISSION DOCUMENT cont/d • Site preparation and job description • Relevant appendices • Reference list • Clinical Protocols • Application form • Letters from DON and NMPDU • Financial approval form 2 COPIES – 1 BOUND AND 1 UNBOUND 24
  • 25. PERSONAL PORTFOLIO • Template on the NCNM website • Personal details • Education record • Competencies relevant to the role • Professional development 2 COPIES – I BOUND AND 1 UNBOUND 25
  • 26. PLANS FOR THE FUTURE • Increase in number of ANPs in Emergency Nursing in the North Eastern Health Board • Expansion of Scope of Practice as determined by service need • Cross-site research and audit to add to the body of knowledge and enhance the quality of patient care • Involvement in teaching on pre- and post- registration programmes 26
  • 27. Education Programmes (Advanced Practice Strand) • The University of Dublin, Trinity College • University College, Dublin • University College, Galway • University College, Cork (In progress) 27
  • 28. Advanced Practice Strands • Clinical Diagnostic Skills for Advanced Nurse Practitioner (Emergency) in Association with TCD • Generic MSc programme with advanced practice strand-UCD, UCG, UCC 28
  • 29. Clinical Diagnostic Skills for Advanced Nurse Practitioner (Emergency) • Module on MSc in Nursing, Trinity College Dublin • Stand alone option: criteria applied for entry • 10 weeks theory/applied anatomy • 10 weeks observation of expert practice • Clinical Competency Assessment • Theoretical Assessment • 500 taught hours on course St James’s Hosp • 500 Hours clinically supervised practice in candidates ED prior to formal signing off 29
  • 30. Development of ANP Roles in Emergency Nursing • St James’s Hospital – 1996-2005 (6posts) • Mater Hospital – 2000-2001-2002(4posts) • James Connolly Memorial Hospital – 2000(3posts) • AMNCH – 2001(1post) • Our Lady of Lourdes – 2002-2004 (2posts) • Waterford Regional – 2004 (2posts) • Monaghan(1 post) • Portiuncula(1 post development phase) • Letterkenny(1 post development phase) • Sligo (1post development phase) • Cork (project officer appointed) • Limerick (early development) 30
  • 31. ANP APPROVED SITE’s • Emergency • Sexual Health • Rheumatology • Breast care • Diabetes • Chest pain assessment • Primary Care 31
  • 32. Emerging ANP Roles • Care of the Elderly Stroke Care Rehabilitation • Midwifery Midwifery led care hospital/community • Neonatal Neonatal Intensive Care • Paediatric Emergency Cystic Fibrosis Haematology/Oncology 32
  • 33. Emerging ANP Roles • General Pain Management Cardiac Surgery Intensive Care (Outreach Service) Practice Nursing • Psychiatry Addiction Family Intervention Child & Adolescent Services Liaison (Emergency) Bereavement Behavioral Therapy 33
  • 34. Role Development : Getting Started • NO QUICK FIX • NOT A CHEAP OPTION 34
  • 35. Role Development • Identify Service Need- Audit – Service driven – Client group identified – Stakeholder ‘BY IN’ • Identify Resources- (personnel & Finance) – Change Agent (not always MSc prepared) – Motivation – Experience – Ability to succeed 35
  • 36. Audit of Patient Flow Attendance Time %Patients 00:00-04:00 11.88% 04:00-08:00 6.39% 08:00-12:00 21.60% 12:00-16:00 25.86% 16:00-20:00 18.84% 20:00-00:00 15.43% TOTAL 100.00% 36
  • 37. Audit of Activity 98-04 ANP Activity 1998-2004 800 Number of Patients 700 1998 600 1999 500 2000 400 2001 300 2002 200 2003 100 2004 0 ov ar ay l n p Ju Ja Se M N M 37
  • 38. Role Development • Establish ‘working group’ (MDT) – Set Goals – Specify action steps – Establish timelines – Identify indicators of success • Network with established ANP sites • Contact NCNM for advice and assistance 38
  • 39. Useful Contacts National Council Executive • Kathleen Mac Lellan: Head Professional Development • Mary Farrelly :Professional Development Officer (psychiatry) • Jenny Hogan : Professional Development Officer (general) • Christine Hughes: Professional Development Officer (Mental Handicap) • Georgina Farren : Professional Development Officer (Midwifery) • www.ncnm.i.e. • Email: admin@ncnm.ie 39
  • 40. Relevant Sites • American Academy of Nurse Practitioners- www.aanp.org • Australian Nurse Practitioner’s Association www.nursing.aust.edu.au • Department of Health (WA)- www.nursing.health.wa.gov.au • The Nurse Practitioner Association of Ontario- www.npao.org • New South Wales Health-Nurse Practitioner www.health.nsw.gov.au/nursing,noract.html • New Zealand Nursing Council-Nurse Practitioner www.nursingcouncil.org.nz/nursepractioner.html • Nurses Board of South Australia www.nursesboard.sa.gov.au/ • NHS.National Institute of Clinical Excellence. www.nice.org.uk/ 40