The Development of an Advanced Practice Role in Emergency Nursing ...


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The Development of an Advanced Practice Role in Emergency Nursing ...

  1. 1. The DevelopmentThe Development of anof an Advanced Nurse PractitionerAdvanced Nurse Practitioner RoleRole Valerie Small.Valerie Small. RGN. RNT. MSc. PG Dip CHSE.A&E Cert.RGN. RNT. MSc. PG Dip CHSE.A&E Cert. Advanced Nurse Practitioner (Emergency)Advanced Nurse Practitioner (Emergency) St James’s HospitalSt James’s Hospital DublinDublin
  2. 2. 2 ResumeResume • Registered General NurseRegistered General Nurse • Registered Nurse TutorRegistered Nurse Tutor • SpecialisedSpecialised in A&E Nursing: 20+ yearsin A&E Nursing: 20+ years • Post registration qualification in A&E NursingPost registration qualification in A&E Nursing • Masters in Nursing, Trinity College DublinMasters in Nursing, Trinity College Dublin • Post-graduate diploma in Clinical Health SciencesPost-graduate diploma in Clinical Health Sciences Education, Trinity College DublinEducation, Trinity College Dublin • Member of National Council for ProfessionalMember of National Council for Professional Development of Nursing & MidwiferyDevelopment of Nursing & Midwifery • Developed first accredited ANP site in IrelandDeveloped first accredited ANP site in Ireland • First accredited Advanced Nurse PractitionerFirst accredited Advanced Nurse Practitioner • Lecturer/course coordinator advanced nurseLecturer/course coordinator advanced nurse practitioner programmepractitioner programme
  3. 3. 3 IntroductionIntroduction • International Development of AdvancedInternational Development of Advanced Practitioner RolesPractitioner Roles • Framework for establishment/development ofFramework for establishment/development of Advanced Practitioner Roles in IrelandAdvanced Practitioner Roles in Ireland • Experiences of Developing ANP Sites inExperiences of Developing ANP Sites in Emergency Nursing in IrelandEmergency Nursing in Ireland • Educational ProgrammesEducational Programmes • Emerging ANP Roles in IrelandEmerging ANP Roles in Ireland • Role Development-Getting StartedRole Development-Getting Started
  4. 4. 4 International DevelopmentsInternational Developments • New South WalesNew South Wales • Western AustraliaWestern Australia • New ZealandNew Zealand • CanadaCanada • UKUK
  5. 5. 5 • Statutory body established 1999 to oversee continuingStatutory body established 1999 to oversee continuing professional development of nursing & midwiferyprofessional development of nursing & midwifery • Establish definitions of Clinical Nurse/MidwifeEstablish definitions of Clinical Nurse/Midwife Specialist/Advanced Nurse/Midwife PractitionerSpecialist/Advanced Nurse/Midwife Practitioner • Monitor development of specialist roles in association withMonitor development of specialist roles in association with NPDU’sNPDU’s • Fund continuing education programmes for nurses andFund continuing education programmes for nurses and midwivesmidwives National CouncilNational Council for thefor the Professional Development ofProfessional Development of Nursing and MidwiferyNursing and Midwifery (NCNM)(NCNM)
  6. 6. 6 National CouncilNational Council for thefor the Professional DevelopmentProfessional Development ofof Nursing and MidwiferyNursing and Midwifery • Framework for establishment of ANPFramework for establishment of ANP Nursing/Midwifery roles (2001)Nursing/Midwifery roles (2001) – Site Preparation and Approval of PostSite Preparation and Approval of Post – Accreditation of Advanced PractitionerAccreditation of Advanced Practitioner
  7. 7. 7 Site PreparationSite Preparation • Service Need IdentifiedService Need Identified • Collaboration of Key StakeholdersCollaboration of Key Stakeholders • Funding of post identified within serviceFunding of post identified within service planplan • Principle of Vicarious Liability AcceptedPrinciple of Vicarious Liability Accepted • Understanding of legislation, rules,Understanding of legislation, rules, guidelines relating to nursing (guidelines relating to nursing (non-non- nursing stakeholdersnursing stakeholders))
  8. 8. 8 Site PreparationSite Preparation • Job Description/ Scope of Practice AgreedJob Description/ Scope of Practice Agreed • Reporting Relationships established.Reporting Relationships established. • Audit Procedures OutlinedAudit Procedures Outlined • Location of Service/Clinical Space/Access toLocation of Service/Clinical Space/Access to ITIT • Integration of role within nursing/midwiferyIntegration of role within nursing/midwifery serviceservice • Integration of role within multidisciplinary teamIntegration of role within multidisciplinary team • Other Resource Implications (training, studyOther Resource Implications (training, study leave, clerical supportleave, clerical support))
  9. 9. 9 Personal CriteriaPersonal Criteria • RGN/RMRGN/RM • Masters Degree (or Higher)Masters Degree (or Higher) • 7 years post-registration experience (57 years post-registration experience (5 specialist area)specialist area) • Substantive hours at supervisedSubstantive hours at supervised advanced practiceadvanced practice • Have competence to exercise higherHave competence to exercise higher levels of judgment and decision makinglevels of judgment and decision making in the clinical areain the clinical area • Demonstrates Competence in specialistDemonstrates Competence in specialist areaarea • Evidence of Continuing ProfessionalEvidence of Continuing Professional DevelopmentDevelopment
  10. 10. 10 Development of ANP Roles inDevelopment of ANP Roles in Emergency NursingEmergency Nursing • St James’s Hospital – 1996 (pilot project)St James’s Hospital – 1996 (pilot project) • MaterMater Hospital - 2000Hospital - 2000 • James Connolly Memorial Hospital - 2000James Connolly Memorial Hospital - 2000 • AMNCH - 2001AMNCH - 2001 • Our Lady of Lourdes - 2002Our Lady of Lourdes - 2002
  11. 11. 11 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.
  12. 12. 12 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
  13. 13. 13 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
  14. 14. 14 Scope of PracticeScope of Practice • AssessAssess • DiagnoseDiagnose • TreatTreat • DischargeDischarge • Refer to other appropriate serviceRefer to other appropriate service • AuditAudit • ResearchResearch
  15. 15. 15 Scope of PracticeScope of Practice 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
  16. 16. 16 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 • 29,000 Patients treated 1996-200329,000 Patients treated 1996-2003
  17. 17. 17 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%
  18. 18. 18 Audit of Activity 98-03Audit of Activity 98-03 ANP Activity 1998-2003 0 200 400 600 800 Jan Feb MarAprMayJun JulAugSep OctNovDec Month Numberof Patients 1998 1999 2000 2001 2002 2003
  19. 19. 19 Current ActivityCurrent Activity • 4 Advanced Nurse Practitioner Sites4 Advanced Nurse Practitioner Sites and Posts approved by NCNMand Posts approved by NCNM • 4 Accredited4 Accredited ANP’sANP’s (Emergency)(Emergency) • 2 Further applications to NCNM- Site2 Further applications to NCNM- Site Approval /AccreditationApproval /Accreditation • Expansion in range of activities/scopeExpansion in range of activities/scope of practiceof practice • Research clinical issues/professionalResearch clinical issues/professional developmentdevelopment
  20. 20. 20
  21. 21. 21 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)
  22. 22. 22 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
  23. 23. 23 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 Hours clinically supervised practice in500 Hours clinically supervised practice in students ED prior to formal signing offstudents ED prior to formal signing off
  24. 24. 24 Developing Sites (Emergency)Developing Sites (Emergency) • 5- St James’s Hospital (+1)5- St James’s Hospital (+1) • 4- Mater Hospital4- Mater Hospital • 2- James Connolly Memorial Hospital2- James Connolly Memorial Hospital • 1- AMNCH1- AMNCH • 1- Our Lady of Lourdes Hospital1- Our Lady of Lourdes Hospital
  25. 25. 25 Emerging ANP RolesEmerging ANP Roles • GeneralGeneral Breast CareBreast Care Pain ManagementPain Management EmergencyEmergency Cardiac SurgeryCardiac Surgery DiabetesDiabetes Chest pain assessmentChest pain assessment Intensive Care(Outreach Service)Intensive Care(Outreach Service) • PsychiatryPsychiatry AddictionAddiction Family InterventionFamily Intervention Child & Adolescent ServicesChild & Adolescent Services Liaison (Emergency)Liaison (Emergency) BereavementBereavement Behavioral TherapyBehavioral Therapy
  26. 26. 26 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
  27. 27. 27 Accredited ANP’sAccredited ANP’s • 4- Emergency4- Emergency • 1-Sexual Health1-Sexual Health • 1-Rheumatology1-Rheumatology
  28. 28. 28 Role Development :Role Development : Getting StartedGetting Started • NO QUICK FIXNO QUICK FIX • NOT A CHEAP OPTIONNOT A CHEAP OPTION
  29. 29. 29 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
  30. 30. 30 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
  31. 31. 31 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:
  32. 32. 32 Relevant SitesRelevant Sites • American Academy of Nurse Practitioners-American Academy of Nurse Practitioners- • Australian Nurse Practitioner’s AssociationAustralian Nurse Practitioner’s Association • Department of Health (WA)-Department of Health (WA)- • The Nurse Practitioner Association of Ontario-The Nurse Practitioner Association of Ontario- • New South Wales Health-Nurse PractitionerNew South Wales Health-Nurse Practitioner,,noract.html • New Zealand Nursing Council-Nurse PractitionerNew Zealand Nursing Council-Nurse Practitioner • Nurses Board of South AustraliaNurses Board of South Australia • NHS.National Institute of Clinical Excellence.NHS.National Institute of Clinical Excellence.