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

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  • 1. The DevelopmentThe Development of an Advanced Nurseof an Advanced Nurse PractitionerPractitioner RoleRole The Realities in PracticeThe Realities in Practice A Joint PresentationA Joint Presentation April 12April 12thth 20052005 Valerie Small.Valerie Small. Siobhan RothwellSiobhan Rothwell St James’s HospitalSt James’s Hospital Our Lady of Lourdes HospitalOur Lady of Lourdes Hospital DublinDublin DroghedaDrogheda
  • 2. 2 IntroductionIntroduction • Development of an ANP role in twoDevelopment of an ANP role in two Emergency DepartmentsEmergency Departments • Outline of education programmesOutline of education programmes available in Irelandavailable in Ireland • Update on post’s and accredited ANP’sUpdate on post’s and accredited ANP’s • Getting startedGetting started
  • 3. 3 St James’s Hospital 1996St James’s Hospital 1996 Pilot Project:Pilot Project: • AIMAIM – To train a suitably qualified, experiencedTo train a suitably qualified, experienced emergency nurse to independently assess,emergency nurse to independently assess, diagnose, treat, discharge / refer patients withdiagnose, treat, discharge / refer patients with a range of common injuries which present toa range of common injuries which present to the emergency department.the emergency department.
  • 4. 4 RationaleRationale • To develop a clinical career pathwayTo develop a clinical career pathway for experienced emergency nursesfor experienced emergency nurses • To enhance the quality of serviceTo enhance the quality of service delivered by the multi-disciplinarydelivered by the multi-disciplinary team (MDT) to patients with minorteam (MDT) to patients with minor injury and illnessinjury and illness • To provide a timely, but safe, serviceTo provide a timely, but safe, service for patients leading to improvedfor patients leading to improved patient satisfactionpatient satisfaction • To release physician time to dealTo release physician time to deal with increasingly acute workloadwith increasingly acute workload
  • 5. 5 ED ActivityED Activity • Located inner city Dublin,IrelandLocated inner city Dublin,Ireland • Catchment area:Catchment area: ¼¼ millionmillion patientspatients • 50,000 New Patients annually50,000 New Patients annually • Primary health care facility forPrimary health care facility for many patientsmany patients • Initiative on nurse practitionerInitiative on nurse practitioner service proposed & piloted 1996service proposed & piloted 1996
  • 6. 6 Scope of PracticeScope of Practice • AssessAssess • DiagnoseDiagnose • TreatTreat • DischargeDischarge • Refer to other appropriate serviceRefer to other appropriate service
  • 7. 7 Patient CaseloadPatient Caseload Types of InjuryTypes of Injury • Minor HeadMinor Head & Facial& Facial InjuryInjury • Laceration face, trunkLaceration face, trunk & limb& limb • Skeletal & Soft tissueSkeletal & Soft tissue injuryinjury • Initial management ofInitial management of fracturesfractures • Hand & fingertip InjuryHand & fingertip Injury • Minor burns < 2%Minor burns < 2% TBSATBSA • Soft tissue infectionSoft tissue infection • Incision & drainageIncision & drainage abscessabscess Referral ArrangementReferral Arrangement • RadiologyRadiology • OOPDPD • PhysiotherapyPhysiotherapy • Occupational therapyOccupational therapy • Social Work DepartmentSocial Work Department • Primary care providerPrimary care provider • Outside AgenciesOutside Agencies Homeless, Drug treatmentHomeless, Drug treatment services, woman's aidservices, woman's aid
  • 8. 8 AuditAudit • Daily activity documented sinceDaily activity documented since 1996 and collated monthly1996 and collated monthly • Annual activity publishedAnnual activity published • Continuous Audit on clinicalContinuous Audit on clinical aspects of care & patient outcomeaspects of care & patient outcome • Quantitative & Qualitative researchQuantitative & Qualitative research on range of aspects related toon range of aspects related to serviceservice • 36,500 Patients treated 1996-200536,500 Patients treated 1996-2005
  • 9. DEVELOPING AN ADVANCED NURSEDEVELOPING AN ADVANCED NURSE PRACTITIONER SERVICE INPRACTITIONER SERVICE IN EMERGENCY NURSINGEMERGENCY NURSING THE SITE PREPARATION PROCESSTHE SITE PREPARATION PROCESS SIOBHAN ROTHWELLSIOBHAN ROTHWELL
  • 10. 10 IDENTIFICATION OF SERVICEIDENTIFICATION OF SERVICE NEEDNEED – Analysis of Emergency Department statisticsAnalysis of Emergency Department statistics – Review of range of injuries and conditionsReview of range of injuries and conditions – Adult and paediatric service needsAdult and paediatric service needs – Waiting timesWaiting times – Quality of serviceQuality of service – Career pathways in nursingCareer pathways in nursing
  • 11. 11 EDUCATIONEDUCATION • MSc Nursing – T.C.D.MSc Nursing – T.C.D. • Clinical Module – St James’Clinical Module – St James’ HospitalHospital ‘‘Clinical Diagnositic Skills forClinical Diagnositic Skills for Advanced Nurse PractitionersAdvanced Nurse Practitioners (Emergency Nursing)’(Emergency Nursing)’
  • 12. 12 SCOPE OF PRACTICESCOPE OF PRACTICE • Adult Minor InjuriesAdult Minor Injuries • Paediatric Minor InjuriesPaediatric Minor Injuries - Significant service need- Significant service need - Consultant led education- Consultant led education and supervised practiceand supervised practice • Clinical Protocols developedClinical Protocols developed collaborativelycollaboratively
  • 13. 13 SCOPE OF PRACTICESCOPE OF PRACTICE • Limb injuries – STI, fractures etcLimb injuries – STI, fractures etc • WoundsWounds • Foreign bodiesForeign bodies • Facial injuries – Fractures, wounds, dental etcFacial injuries – Fractures, wounds, dental etc • Eye injuriesEye injuries
  • 14. 14 ISSUES IN PRACTICEISSUES IN PRACTICE •Radiology •Prescribing
  • 15. 15 SITE PREPARATION AND JOBSITE PREPARATION AND JOB DESCRIPTIONDESCRIPTION • Working group established following a meeting withWorking group established following a meeting with the National Councilthe National Council • Comprised of: DONs (Region)Comprised of: DONs (Region) ED ConsultantED Consultant Representative NMPDURepresentative NMPDU Practice Development NursePractice Development Nurse Nurse Managers EDNurse Managers ED Nurses pursuing AccreditationNurses pursuing Accreditation
  • 16. 16 SITE PREPARATIONSITE PREPARATION • Health needsHealth needs • Laws, rules, regulations and guidelinesLaws, rules, regulations and guidelines governing nursing and midwifery practicegoverning nursing and midwifery practice • Vicarious LiabilityVicarious Liability • Guidelines for good practiceGuidelines for good practice • Benefits to patients from the ANP serviceBenefits to patients from the ANP service • Consistency of service within OrganisationalConsistency of service within Organisational PhilosophyPhilosophy
  • 17. 17 SITE PREPARATION cont/dSITE PREPARATION cont/d • How change will meet the service planHow change will meet the service plan • Location of the serviceLocation of the service • Integration of the ANP into the multidisciplinaryIntegration of the ANP into the multidisciplinary teamteam • Definition of the role content within theDefinition of the role content within the framework of nursingframework of nursing • Resource implicationsResource implications
  • 18. 18 JOB DESCRIPTIONJOB DESCRIPTION • Background to postBackground to post - Generic Background- Generic Background - Specific Background- Specific Background - Evolution of the role of the Advanced Nurse- Evolution of the role of the Advanced Nurse PractitionerPractitioner - Effects of policy changes on Professional- Effects of policy changes on Professional Practice in the RegionPractice in the Region
  • 19. 19 JOB DESCRIPTION cont/dJOB DESCRIPTION cont/d • Geographical aspects of theGeographical aspects of the service/demographics of the regionservice/demographics of the region • Service NeedService Need • Purpose of the postPurpose of the post
  • 20. 20 SCHEDULE OF EVENTSSCHEDULE OF EVENTS • Guidance from the National CouncilGuidance from the National Council • Bi-monthly meetings of the working groupBi-monthly meetings of the working group • Goals identified and setGoals identified and set • Time frames highlightedTime frames highlighted • Objectives achievedObjectives achieved
  • 21. 21 TIME FRAMETIME FRAME • June 2003 – Met with NCPDNMJune 2003 – Met with NCPDNM • November 2003 – 1November 2003 – 1stst draft of Sitedraft of Site Preparation and Job DescriptionPreparation and Job Description documentdocument • January 2004 – 2January 2004 – 2ndnd Draft sent toDraft sent to NMPDUNMPDU
  • 22. 22 TIME FRAMETIME FRAME • March 2004 - Met with NMPDU to reviewMarch 2004 - Met with NMPDU to review document and prepare for final submissiondocument and prepare for final submission • April 2004 – Submission of documentApril 2004 – Submission of document • May 2004 – Review by Accreditation CommitteeMay 2004 – Review by Accreditation Committee • September 2004 – Site VisitSeptember 2004 – Site Visit
  • 23. 23 SUBMISSION DOCUMENTSUBMISSION DOCUMENT • Developed collaborativelyDeveloped collaboratively • Different service needs identifiedDifferent service needs identified • National Council Framework Document (2001)National Council Framework Document (2001) used as a templateused as a template • NCNM provided support and directionNCNM provided support and direction • Drafts x 2 submitted before completion of finalDrafts x 2 submitted before completion of final documentdocument
  • 24. 24 SUBMISSION DOCUMENT cont/dSUBMISSION DOCUMENT cont/d • Site preparation and job descriptionSite preparation and job description • Relevant appendicesRelevant appendices • Reference listReference list • Clinical ProtocolsClinical Protocols • Application formApplication form • Letters from DON and NMPDULetters from DON and NMPDU • Financial approval formFinancial approval form 2 COPIES – 1 BOUND AND 1 UNBOUND2 COPIES – 1 BOUND AND 1 UNBOUND
  • 25. 25 PERSONAL PORTFOLIOPERSONAL PORTFOLIO • Template on the NCNM websiteTemplate on the NCNM website • Personal detailsPersonal details • Education recordEducation record • Competencies relevant to the roleCompetencies relevant to the role • Professional developmentProfessional development 2 COPIES – I BOUND AND 1 UNBOUND2 COPIES – I BOUND AND 1 UNBOUND
  • 26. 26 PLANS FOR THE FUTUREPLANS FOR THE FUTURE • Increase in number of ANPs in EmergencyIncrease in number of ANPs in Emergency Nursing in the North Eastern Health BoardNursing in the North Eastern Health Board • Expansion of Scope of Practice as determinedExpansion of Scope of Practice as determined by service needby service need • Cross-site research and audit to add to theCross-site research and audit to add to the body of knowledge and enhance the quality ofbody of knowledge and enhance the quality of patient carepatient care • Involvement in teaching on pre- and post-Involvement in teaching on pre- and post- registration programmesregistration programmes
  • 27. 27 Education Programmes (AdvancedEducation Programmes (Advanced Practice Strand)Practice Strand) • The University of Dublin, Trinity CollegeThe University of Dublin, Trinity College • University College, DublinUniversity College, Dublin • University College, GalwayUniversity College, Galway • University College, Cork (In progress)University College, Cork (In progress)
  • 28. 28 Advanced Practice StrandsAdvanced Practice Strands • Clinical Diagnostic Skills for AdvancedClinical Diagnostic Skills for Advanced Nurse Practitioner (Emergency) inNurse Practitioner (Emergency) in Association with TCDAssociation with TCD • Generic MSc programme with advancedGeneric MSc programme with advanced practice strand-UCD, UCG, UCCpractice strand-UCD, UCG, UCC
  • 29. 29 Clinical Diagnostic Skills forClinical Diagnostic Skills for Advanced Nurse PractitionerAdvanced Nurse Practitioner (Emergency)(Emergency) • Module on MSc in Nursing, Trinity CollegeModule on MSc in Nursing, Trinity College DublinDublin • Stand alone option: criteria applied for entryStand alone option: criteria applied for entry • 10 weeks theory/applied anatomy10 weeks theory/applied anatomy • 10 weeks observation of expert practice10 weeks observation of expert practice • Clinical Competency AssessmentClinical Competency Assessment • Theoretical AssessmentTheoretical Assessment • 500 taught hours on course St James’s Hosp500 taught hours on course St James’s Hosp • 500 Hours clinically supervised practice in500 Hours clinically supervised practice in candidates ED prior to formal signing offcandidates ED prior to formal signing off
  • 30. 30 Development of ANP Roles inDevelopment of ANP Roles in Emergency NursingEmergency Nursing • St James’s Hospital – 1996-2005 (6posts)St James’s Hospital – 1996-2005 (6posts) • MaterMater Hospital – 2000-2001-2002(4posts)Hospital – 2000-2001-2002(4posts) • James Connolly Memorial Hospital – 2000(3posts)James Connolly Memorial Hospital – 2000(3posts) • AMNCH – 2001(1post)AMNCH – 2001(1post) • Our Lady of Lourdes – 2002-2004 (2posts)Our Lady of Lourdes – 2002-2004 (2posts) • Waterford Regional – 2004 (2posts)Waterford Regional – 2004 (2posts) • Monaghan(1 post)Monaghan(1 post) • Portiuncula(1 post development phase)Portiuncula(1 post development phase) • Letterkenny(1 post development phase)Letterkenny(1 post development phase) • Sligo (1post development phase)Sligo (1post development phase) • Cork (project officer appointed)Cork (project officer appointed) • Limerick (early development)Limerick (early development)
  • 31. 31 ANP APPROVED SITE’sANP APPROVED SITE’s • EmergencyEmergency • Sexual HealthSexual Health • RheumatologyRheumatology • Breast careBreast care • DiabetesDiabetes • Chest pain assessmentChest pain assessment • Primary CarePrimary Care
  • 32. 32 Emerging ANP RolesEmerging ANP Roles • Care of the ElderlyCare of the Elderly Stroke CareStroke Care RehabilitationRehabilitation • MidwiferyMidwifery Midwifery led careMidwifery led care hospital/communityhospital/community • NeonatalNeonatal Neonatal Intensive CareNeonatal Intensive Care • PaediatricPaediatric EmergencyEmergency Cystic FibrosisCystic Fibrosis Haematology/OncologyHaematology/Oncology
  • 33. 33 Emerging ANP RolesEmerging ANP Roles • GeneralGeneral Pain ManagementPain Management Cardiac SurgeryCardiac Surgery Intensive Care (Outreach Service)Intensive Care (Outreach Service) Practice NursingPractice Nursing • PsychiatryPsychiatry AddictionAddiction Family InterventionFamily Intervention Child & Adolescent ServicesChild & Adolescent Services Liaison (Emergency)Liaison (Emergency) BereavementBereavement Behavioral TherapyBehavioral Therapy
  • 34. 34 Role Development :Role Development : Getting StartedGetting Started • NO QUICK FIXNO QUICK FIX • NOT A CHEAP OPTIONNOT A CHEAP OPTION
  • 35. 35 Role DevelopmentRole Development • Identify Service Need- AuditIdentify Service Need- Audit – Service drivenService driven – Client group identifiedClient group identified – Stakeholder ‘BY IN’Stakeholder ‘BY IN’ • Identify Resources- (personnel & Finance)Identify Resources- (personnel & Finance) – Change Agent (not always MSc prepared)Change Agent (not always MSc prepared) – MotivationMotivation – ExperienceExperience – Ability to succeedAbility to succeed
  • 36. 36 Audit of Patient FlowAudit 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%
  • 37. 37 Audit of Activity 98-04Audit of Activity 98-04 ANP Activity 1998-2004 0 100 200 300 400 500 600 700 800 Jan M ar M ay Jul S ep N ov NumberofPatients 1998 1999 2000 2001 2002 2003 2004
  • 38. 38 Role DevelopmentRole Development • Establish ‘working group’ (MDT)Establish ‘working group’ (MDT) – Set GoalsSet Goals – Specify action stepsSpecify action steps – Establish timelinesEstablish timelines – Identify indicators of successIdentify indicators of success • Network with established ANP sitesNetwork with established ANP sites • Contact NCNM for advice andContact NCNM for advice and assistanceassistance
  • 39. 39 Useful ContactsUseful Contacts National Council ExecutiveNational Council Executive • Kathleen Mac Lellan: Head Professional DevelopmentKathleen Mac Lellan: Head Professional Development • Mary Farrelly :Professional Development OfficerMary Farrelly :Professional Development Officer (psychiatry)(psychiatry) • Jenny Hogan : Professional Development OfficerJenny Hogan : Professional Development Officer (general)(general) • Christine Hughes: Professional Development OfficerChristine Hughes: Professional Development Officer (Mental Handicap)(Mental Handicap) • Georgina Farren : Professional Development OfficerGeorgina Farren : Professional Development Officer (Midwifery)(Midwifery) • www.ncnm.i.e.www.ncnm.i.e. • Email:Email: admin@ncnm.ieadmin@ncnm.ie
  • 40. 40 Relevant SitesRelevant Sites • American Academy of Nurse Practitioners-American Academy of Nurse Practitioners- www.aanp.orgwww.aanp.org • Australian Nurse Practitioner’s AssociationAustralian Nurse Practitioner’s Association www.nursing.aust.edu.auwww.nursing.aust.edu.au • Department of Health (WA)-Department of Health (WA)- www.nursing.health.wa.gov.auwww.nursing.health.wa.gov.au • The Nurse Practitioner Association of Ontario-The Nurse Practitioner Association of Ontario- www.npao.orgwww.npao.org • New South Wales Health-Nurse PractitionerNew South Wales Health-Nurse Practitioner www.health.nsw.gov.au/nursing,noract.htmlwww.health.nsw.gov.au/nursing,noract.html • New Zealand Nursing Council-Nurse PractitionerNew Zealand Nursing Council-Nurse Practitioner www.nursingcouncil.org.nz/nursepractioner.htmlwww.nursingcouncil.org.nz/nursepractioner.html • Nurses Board of South AustraliaNurses Board of South Australia www.nursesboard.sa.gov.auwww.nursesboard.sa.gov.au // • NHS.National Institute of Clinical Excellence.NHS.National Institute of Clinical Excellence. www.nice.org.ukwww.nice.org.uk//

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