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


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

  1. 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. 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. 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. 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. 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. 6 Scope of PracticeScope of Practice • AssessAssess • DiagnoseDiagnose • TreatTreat • DischargeDischarge • Refer to other appropriate serviceRefer to other appropriate service
  7. 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. 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
  10. 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. 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. 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. 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. 14 ISSUES IN PRACTICEISSUES IN PRACTICE •Radiology •Prescribing
  15. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 34 Role Development :Role Development : Getting StartedGetting Started • NO QUICK FIXNO QUICK FIX • NOT A CHEAP OPTIONNOT A CHEAP OPTION
  35. 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. 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. 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. 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. 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:
  40. 40. 40 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.