The Development of an Advanced Nurse Practitioner Role The Realities in Practice A Joint Presentatio

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The Development of an Advanced Nurse
PractitionerRoleThe Realities in PracticeA
Joint PresentationApril 12th 2005

• Valerie Small. Siobhan Rothwell
• St Jamess Hospital Our Lady of Lourdes
  Hospital Dublin Drogheda
• 
  
• 
  

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Introduction

• Development of an ANP role in two Emergency
  Departments
• Outline of education programmes available in
  Ireland
• Update on posts and accredited ANPs
• Getting started

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St Jamess 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.

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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

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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

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Scope of Practice

• Assess
• Diagnose
• Treat
• Discharge
• Refer to other appropriate service

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Patient Caseload

• Types of Injury
• Minor Head Facial Injury
• Laceration face, trunk limb
• Skeletal Soft tissue injury
• Initial management of fractures
• Hand fingertip Injury
• Minor burns lt 2 TBSA
• Soft tissue infection
• Incision drainage abscess

• Referral Arrangement
• Radiology
• OPD
• Physiotherapy
• Occupational therapy
• Social Work Department
• Primary care provider
• Outside Agencies Homeless, Drug treatment
  services, woman's aid

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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

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DEVELOPING AN ADVANCED NURSE PRACTITIONER
SERVICE IN EMERGENCY NURSINGTHE SITE
PREPARATION PROCESS

• SIOBHAN ROTHWELL

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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

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EDUCATION

• MSc Nursing T.C.D.
• Clinical Module St James Hospital
• Clinical Diagnositic Skills for Advanced
  Nurse Practitioners (Emergency Nursing)

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SCOPE OF PRACTICE

• Adult Minor Injuries
• Paediatric Minor Injuries
• - Significant service need
• - Consultant led education and supervised
  practice
• Clinical Protocols developed collaboratively

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SCOPE OF PRACTICE

• Limb injuries STI, fractures etc
• Wounds
• Foreign bodies
• Facial injuries Fractures, wounds, dental etc
• Eye injuries

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ISSUES IN PRACTICE

• Radiology
• Prescribing

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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

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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

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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

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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

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JOB DESCRIPTION cont/d

• Geographical aspects of the service/demographics
  of the region
• Service Need
• Purpose of the post

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SCHEDULE OF EVENTS

• Guidance from the National Council
• Bi-monthly meetings of the working group
• Goals identified and set
• Time frames highlighted
• Objectives achieved

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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

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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

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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

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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

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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

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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

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Education Programmes (Advanced Practice Strand)

• The University of Dublin, Trinity College
• University College, Dublin
• University College, Galway
• University College, Cork (In progress)

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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

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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 Jamess Hosp
• 500 Hours clinically supervised practice in
  candidates ED prior to formal signing off

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Development of ANP Roles in Emergency Nursing

• St Jamess 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)

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ANP APPROVED SITEs

• Emergency
• Sexual Health
• Rheumatology
• Breast care
• Diabetes
• Chest pain assessment
• Primary Care

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Emerging ANP Roles

• Care of the Elderly Stroke Care
• Rehabilitation
• Midwifery Midwifery led care hospital/commun
  ity
• Neonatal Neonatal Intensive Care
• Paediatric Emergency
• Cystic Fibrosis
• Haematology/Oncology

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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

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Role Development Getting Started

• NO QUICK FIX
• NOT A CHEAP OPTION

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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

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Audit of Patient Flow
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Audit of Activity 98-04
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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

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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_at_ncnm.ie

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Relevant Sites

• American Academy of Nurse Practitioners-
  www.aanp.org
• Australian Nurse Practitioners Association
  www.nursing.aust.edu.au
• Department of Health (WA)- www.nursing.health.wa.g
  ov.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/