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The Development of an Advanced Nurse Practitioner Role

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Title: The Development of an Advanced Nurse Practitioner Role


1
The Development of an Advanced Nurse
PractitionerRole
  • Valerie Small. RGN. RNT. MSc. PG Dip CHSE.AE
    Cert.
  • Advanced Nurse Practitioner (Emergency)
  • St Jamess Hospital
  • Dublin

2
Resume
  • Registered General Nurse
  • Registered Nurse Tutor
  • Specialised in AE Nursing 20 years
  • Post registration qualification in AE Nursing
  • Masters in Nursing, Trinity College Dublin
  • Post-graduate diploma in Clinical Health Sciences
    Education, Trinity College Dublin
  • Member of National Council for Professional
    Development of Nursing Midwifery
  • Developed first accredited ANP site in Ireland
  • First accredited Advanced Nurse Practitioner
  • Lecturer/course coordinator advanced nurse
    practitioner programme

3
Introduction
  • International Development of Advanced
    Practitioner Roles
  • Framework for establishment/development of
    Advanced Practitioner Roles in Ireland
  • Experiences of Developing ANP Sites in Emergency
    Nursing in Ireland
  • Educational Programmes
  • Emerging ANP Roles in Ireland
  • Role Development-Getting Started

4
International Developments
  • New South Wales
  • Western Australia
  • New Zealand
  • Canada
  • UK

5
National Council for the Professional
Development ofNursing and Midwifery (NCNM)
  • Statutory body established 1999 to oversee
    continuing professional development of nursing
    midwifery
  • Establish definitions of Clinical Nurse/Midwife
    Specialist/Advanced Nurse/Midwife Practitioner
  • Monitor development of specialist roles in
    association with NPDUs
  • Fund continuing education programmes for nurses
    and midwives

6
National Council for theProfessional
Development ofNursing and Midwifery
  • Framework for establishment of ANP
    Nursing/Midwifery roles (2001)
  • Site Preparation and Approval of Post
  • Accreditation of Advanced Practitioner

7
Site Preparation
  • Service Need Identified
  • Collaboration of Key Stakeholders
  • Funding of post identified within service plan
  • Principle of Vicarious Liability Accepted
  • Understanding of legislation, rules, guidelines
    relating to nursing (non-nursing stakeholders)

8
Site Preparation
  • Job Description/ Scope of Practice Agreed
  • Reporting Relationships established.
  • Audit Procedures Outlined
  • Location of Service/Clinical Space/Access to IT
  • Integration of role within nursing/midwifery
    service
  • Integration of role within multidisciplinary team
  • Other Resource Implications (training, study
    leave, clerical support)

9
Personal Criteria
  • RGN/RM
  • Masters Degree (or Higher)
  • 7 years post-registration experience (5
    specialist area)
  • Substantive hours at supervised advanced practice
  • Have competence to exercise higher levels of
    judgment and decision making in the clinical area
  • Demonstrates Competence in specialist area
  • Evidence of Continuing Professional Development

10
Development of ANP Roles in Emergency Nursing
  • St Jamess Hospital 1996 (pilot project)
  • Mater Hospital - 2000
  • James Connolly Memorial Hospital - 2000
  • AMNCH - 2001
  • Our Lady of Lourdes - 2002

11
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.

12
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

13
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

14
Scope of Practice
  • Assess
  • Diagnose
  • Treat
  • Discharge
  • Refer to other appropriate service
  • Audit
  • Research

15
Scope of Practice
  • 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

16
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
  • 29,000 Patients treated 1996-2003

17
Audit of Patient Flow
18
Audit of Activity 98-03
19
Current Activity
  • 4 Advanced Nurse Practitioner Sites and Posts
    approved by NCNM
  • 4 Accredited ANPs (Emergency)
  • 2 Further applications to NCNM- Site Approval
    /Accreditation
  • Expansion in range of activities/scope of
    practice
  • Research clinical issues/professional development

20
(No Transcript)
21
Education Programmes (Advanced Practice Strand)
  • The University of Dublin, Trinity College
  • University College, Dublin
  • University College, Galway
  • University College, Cork (In progress)

22
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

23
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 Hours clinically supervised practice in
    students ED prior to formal signing off

24
Developing Sites (Emergency)
  • 5- St Jamess Hospital (1)
  • 4- Mater Hospital
  • 2- James Connolly Memorial Hospital
  • 1- AMNCH
  • 1- Our Lady of Lourdes Hospital

25
Emerging ANP Roles
  • General Breast Care
  • Pain Management
  • Emergency
  • Cardiac Surgery
  • Diabetes
  • Chest pain assessment
  • Intensive Care(Outreach Service)
  • Psychiatry Addiction
  • Family Intervention
  • Child Adolescent Services
  • Liaison (Emergency)
  • Bereavement
  • Behavioral Therapy

26
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

27
Accredited ANPs
  • 4- Emergency
  • 1-Sexual Health
  • 1-Rheumatology

28
Role Development Getting Started
  • NO QUICK FIX
  • NOT A CHEAP OPTION

29
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

30
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

31
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

32
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/
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