Reflections on the Advanced Practice Pathway

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Reflections on the Advanced Practice Pathway

• PAULA THOMPSON
• Hospital At Night
• Advanced Nurse Practitioner
• NHS Ayrshire and Arran

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Objectives

• Motivations for participation
• An overview of my initial aims vs my actual
  outcomes as
• Leadership
• Facilitating Learning
• Advanced Clinical Practice
• Research and Development
• As a Learner

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My Background

• 2002 AE (SGH)
• 2002 Ordinary Degree (Nursing Studies)
• 2004 Honors Degree (Specialist Practice)
• Pathophysiology
• Ethics
• 2006 H_at_N (Crosshouse and Ayr)
• 2006 Clinical Assessment
• 2007 Independent Nurse Prescribing
• Pharmacology (hons level)
• 2008 MSc Advance Practice
• 2008 NES Advanced Practice Pathway
• 2009 ANP clinical nurse manager

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Motivations

• Contribution to the creation of a replicable
  pathway
• Funding and accelerated learning opportunity
• Creation of an academic trail
• Overcoming the insecurities that come about with
  becoming an ANP
• Loss of status
• Loss of confidence
• Questioning ability

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The Role of the Advanced Nurse Practitioner

• Do not be content with mediocrity. Do your job
  so well that nobody could do it better. Martin
  Luther King

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Pathway Tools and Outcomes

• Training Needs Analysis tool
• Critical companion
• Action learning
• Academia

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Expectations of Leadership

• Challenging the status quo
• Msc level Clinical Leadership module
• Improving existing practice
• Audit and research/development
• Clinical Governance
• Introducing evidence based practise to the shop
  floor
• Improving communication
• Patient handover
• Linking Nursing/Medical staff
• Facilitation

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Pathway Tools and Outcomes

• Completion of Masters level Leadership module
• TRANSLATION TO PRACTICE
• Successful integration into a training grade
  medical rota
• Strong clinical leader
• Aspirin PGD
• Handover guidelines
• Involvement in the Safer Patient initiative
• Falls assessment guideline

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Expectations of Facilitating Learning

• Bridging the theory practice gap
• Direct supervision of nursing/junior medical
  staff
• Inspiring creativity and innovation
• Creating the learning environment
• Promoting health
• Patient centred education

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Pathway Tools and Outcome

• Advanced Life Support GIC
• Clinical Supervision discussions
• Mentor for Post Grad Cert
• Regular Teaching session for nursing/medical
  staff
• Teach Physical examination
• Lecturer at UWS in neurology
• Examiner for the Scottish Ambulance Service

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Expectations of Advanced Clinical Practice Skills

• Clinical Assessment
• Diagnosis and intervention
• Managing the acutely unwell adult
• Independent Nurse Prescribing
• Clinical Supervision
• Clinical Leadership
• Service Development
• Opportunity for Research

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ANP, advanced practitioner or mini medic?

• Did I really grasp the concept of gaining
  competence

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Multi faceted Clinical Support from Critical
Companion

• Competence Framework
• Log Book / System Electronic
• OSCE and Simulator
• Training Needs Analysis Annually
• CPD including Non Medical Prescribing

• Critical incident debrief
• Case note review
• Msc Advanced Practice

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Clinical Competence FrameworkEvidencing
Competence

• Completion of HaN framework
• Based on national template
• Used and implemented with great success
• Development of HaD with Critical Companion

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Case Note Review

• Performed by nursing and medical consultants
• Safe and Effective practice
• Autonomy

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Expectations as a Researcher

• Msc level qualification in research
• Ability to change and affect practice by RD

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Outcomes as a Reasearcher

• Completion of Msc Module
• Development of research proposal looking at the
  efficacy of SBAR as a communication tool
• 4 audits of HaD workload
• Infection control
• National non medical prescribing survey

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Expectations as a Learner

• Masters level education
• Diagnosis and Intervention
• To Support and further current practice
• Pathophysiology
• Clinical Leadership
• Formal Teaching Qualification
• Research and Development

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How has the pathway helped me learn?

• Academia
• Experience
• Reflection
• Peer review
• Critical Companion working
• Opportunity for the implementation of theory to
  practice
• Action learning sets

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Summary

• I started on the pathway with my outcomes steeped
  in academia
• The pathway and critical companion working has
  given me the opportunity to ground learning by
  linking theory to practice and evidence
  competence
• It has broadened my understanding of advanced
  practice
• I had an idea of the destination, however I my
  expectation of the academic journey has been very
  different and the pathway has helped to enrich
  and focus my practice as a nurse

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Conclusion
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• Thank you!