This document discusses nurse-led clinics and essential characteristics of advanced nursing practice. It begins by outlining the learning objectives which are to understand how nurse-led clinics fit within advanced nursing practice, determine the characteristics of nurse-led clinics, and understand how to promote the value of nurse-led services. The document then defines advanced nursing practice and discusses core competencies. It addresses the types of nurse-led clinics and services, essential criteria for clinics, and effectiveness and evidence demonstrating positive outcomes of nurse-led care. The presentation emphasizes that advanced nursing practice contributes to developing the nursing profession while enriching patient care.
Sorcha Mckenna, Head of Healthcare Practice, McKinsey
Essential Characteristics of Nurse-Led Clinics
1. Nursing clinics 2016: Eighth Annual Conference
Essential characteristics of nurse led clinics
Linda Nazarko
MSc, PgDip, PgCert, BSc(Hons), RN, NIP, OBE, FRCN
Nurse Consultant West London Mental Health Trust
London 9th
November 2016
,
2. Learning objectives
To be aware of how :
Nurse led clinics fit within the framework of advanced
nursing practice
To determine the characteristics of nurse led clinics
Understand and promote the value of nurse led
services
Relevance to NMC (2015) Code
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-
publications/nmc-code.pdf
Prioritise people ,Practise effectively, Preserve safety, Promote
professionalism and trust
3. Defining advanced nursing practice
“A registered nurse who has command of an
expert knowledge base and clinical
competence, is able to make complex clinical
decisions using expert clinical judgement, is
an essential member of an interdependent
health care team and whose role is
determined by the context in which s/he
practices”
NMC 2007
5. Core competencies advanced practice
Practicing autonomously
Making decisions and being accountable
Admitting and discharging patients
Ability to take a clinical history
Ability to physically examine patient
Ability to determine diagnosis
Ability to determine when onward referral is
required
Ability to prescribe
7. The continuum of advanced nursing practice
No one is born an expert
We have to develop and nurture expert
practitioners
Nurse clinics can be a safe place for nurses
to develop
8.
9. Scope of practice
The nurse’s scope of practice must be related to his or
her competencies.
There is room within the clinic for expert nurses and
nurses who are developing expertise.
Level of support and supervision is related to level of
expertise.
10. Generic clinical competencies
Practicing autonomously
Making decisions and being accountable
Admitting and discharging patients
Ability to take a clinical history
Ability to physically examine patient
Ability to determine diagnosis
Ability to determine when onward referral is required
Ability to prescribe
11. Specific clinical competencies
Competencies specific to your service
Competencies related to where your service
is delivered
Competencies specific to the client group
14. 14
Definition of a nurse-led clinic
In a nurse-led clinic the nurse has his or her own patient
case load. The service often involves an increase in the
autonomy of the nursing role. The nurse-led clinic
requires the patient to fit into a rigid time slot, often
through an appointment system.
There is the ability to admit and discharge patients from
the clinic, or to refer on to other more appropriate
healthcare colleagues, based on the nurses’ own
assessment.
15. 15
Rationale for nurse led services
Increased efficiency and effectiveness
Increased patient access
An educative role
Psychological support
Monitoring the patient's condition
Empowerment of the patient
16. Types nurse led clinics and services
Generic e.g. frailty clinics, falls clinics, intermediate care,
long term conditions in primary care
Specific e.g. diabetes, chronic heart failure
Follow up e.g. post operative, prostatectomy
Diagnostic e.g. endoscopy
17. Essential criteria
Admission/entry criteria
Exclusion criteria
Referral forms/protocols
Escalation criteria
Referral to other services
Pathways, how often to see patient
Follow up
Discharge
KPIs and reporting
18. Effectiveness and acceptability
“Cost cutting”
“Practicing
medicine without
a license”
“Depriving people
of proper medical
care”
19. Evidence
In heart failure people receiving nurse led care “experienced
fewer hospital admissions for any cause and an increase in
survival and number of participants reaching target dose within
a shorter time period” (Driscol et al, 2015)
In diabetes patients receiving nurse led care demonstrated
better outcomes and costs were reduced (Cook-Johnson et al
2012).
In monitoring people with prostatic cancer nurse led was
acceptable to patients and good coutcomes were demonstated
(Wade et al, 2015)
In caring for people with hypertension nurse led care led to
improved outcomes and reduced costs (Sanders & Guse,
2016).
20. The value of advanced nursing practice
Holistic, innovative, evidence based
Cost effective, increased review of medication
Patient and family centred
Integrated
21. References
Cook-Johnson R et al (2012). The effectiveness of nurse-led care in general practice on clinical outcomes
in adults with type 2 diabetes. JBI Best Practice 16(1) 2012
http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=9255
Driscoll A, Currey J, Tonkin A, Krum H (2015). Nurse-led titration of angiotensin converting enzyme
inhibitors, beta-adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure
with reduced ejection fraction. Cochrane Database Syst Rev. 2015 Dec 21;(12):CD009889. doi:
10.1002/14651858.CD009889.pub2.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009889.pub2/abstract
Sanders J, Guse CE (2016). Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic
Disease Care Versus a Traditional Fee-for-Service Approach. J Prim Care Community Health. 2016 Aug 9.
pii: 2150131916662465. [Epub ahead of print]
Julia Wade, Peter N Holding, Susan Bonnington, Leila Rooshenas, J Athene Lane, C Elizabeth Salter,
Kate Tilling, Mark J Speakman, Simon F Brewster, Simon Evans, David E Neal, Freddie C Hamdy, Jenny L
Donovan , for the ProtecT Study Group (2015). Urology - Research: Establishing nurse-led active
surveillance for men with localised prostate cancer: development and formative evaluation of a model of
care in the ProtecT trial. BMJ Open 5:9:
http://bmjopen.bmj.com/content/5/9/e008953.full
22. Advanced nursing practice
Contributes to
developing nursing
Enables us to nurse
with the hands, the
heart and the head
Enriches the lives of
those we care for
and our lives
23. Thank you for listening
Any questions?
Download on
https://uk.linkedin.com/in/linda-nazarko-1952a746