Initial preparation of practice nurses project

1
Initial preparation of practice nurses project

• Fiona Bell, Project Officer
• Jane Cantrell, Programme Director
• NHS Education for Scotland
• May 2005

2
Initially- Awareness of these issues

• SEHD
• Framework for Nursing in General Practice
• Nurses in practice
• Practice nurse study
• I couldnt have just gone from secondary care
  into primary care without any background
  knowledge, I wouldnt have felt comfortable with
  that.

3
The situation at that time

• Implications of no mandatory preparation
• Limited existing provision
• Lothian General Practice Introductory Course
• Glasgow Caledonian
• Dundee University
• Reflects the rest of the UK
• Nurses expected to be competent from the start
• Implications of in-house preparation and
  skill-mix.
• its just so unpredictable.
• I think it would be a bit of a challenge, it
  would be quite scary at the beginning.

4
The project background

• No mandatory preparation for PN roles
• Nurses entering from a wide variety of
  backgrounds
• Varied skills and knowledge
• Employed by a different professional group
• people really need further training, its like
  any other part of nursing you just cant go into
  a ward youve never worked in and take charge and
  expect to know what you are doing if youve never
  worked in that fieldits just the same

5
The project aims

• To provide recommendations for a course for the
  initial preparation of practice nurses which is
• Scotland-wide
• Flexible and accessible
• Accredited
• Transferable
• Sustainable
• Recognised by nurses, GP employers and practice
  managers
• Meets the needs of nurses, GP employers and
  practice managers

6
Areas of work

• Stakeholder involvement
• Education
• Competence
• Mentorship

7
Progress to date

• Draft educational standards
• Stakeholder consultation
• Flyer and website inviting comment
• Work currently underway to draw these together
  into the educational standards document

8
Stakeholder consultation

• Questionnaire to GPs, Practice managers, CHP
  managers, CHP lead nurses.
• Flyer to Practice nurses- via practice manager
  network
• Flyer to DNs, LMCs, HEIs, PEFs
• Journal news items
• Questionnaire also given to Practice nurses-
  unplanned
• Comments received via questionnaire, phone call
  and email.

9
Stakeholder opinions

• All appreciated the need for educational
  preparation for new practice nurses
• General agreement proposals
• Identified barriers

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Education

• Course of 200 hours student effort- 50
  theoretical and 50 work-based learning over
  around 6 months
• Flexible delivery
• Clinical skills
• Theoretical foundation
• Work-based learning supported by a practice nurse
  mentor

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Stakeholder opinions

• Unanimous support for need for preparation for
  this role from responding stakeholders
• Variation on opinions on theoretical and
  work-based learning division
• Recognition of variation in skills on entry and
  differing rates of learning
• Several wanted PN to be equivalent to District
  Nursing or public health nursing

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Clinical Skills

• Venepuncture
• Ear care
• Immunisation, vaccination and anaphylaxis
• Consultation skills, health assessment,
  diagnostic tests and monitoring
• Introductory principles and skills in chronic
  disease monitoring and care.
• Introductory principles of cervical screening and
  sexual health awareness. Recognising CSBS
  recommendations.
• Wound management
• Travel health awareness.
• Infection control policies guidelines and
  protocols
• Working with vulnerable groups- not previously
  included in courses
• Nurses should also have up to date CPR training
  or access this, in line with local policies and
  arrangements

13
Stakeholder opinions

• General agreement with content
• Some expected higher level of knowledge and
  skills than possible within limitations
• Comments reflected variation between practices
  and local situations
• Majority wanted more included

14
Vulnerable groups

• From draft final document issues considered
• Accountability and professional responsibility
• Patient understanding and consent
• Best practice
• Referral criteria and pathways
• Consultation skills particularly important
• General health issues and reasons for
  vulnerability
• Psychological and physical issues
• Communication/ barriers to seeking and receiving
  treatment/ appropriate action and referral/
  physical examination

15
Theoretical background

• Reflection in practice
• Professional development, mentorship and clinical
  supervision
• Political issues, NHS strategies, changing
  policies in primary care and public health
• Health improvement, health promotion, and
  anticipatory care
• Record keeping and IT
• The patient as a partner in care
• Roles and responsibilities of the PN and
  multidisciplinary team
• Ethical and legal issues, negligence and
  employment law
• Evidence based practice, clinical governance and
  audit
• Challenges associated with equity, diversity and
  vulnerable groups.

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Stakeholder opinions

• Only clinical skills, length and split included
  in questionnaire general agreement
• Minority-
• more practice experience/ less theoretical
• More theoretical/ less practice
• Most of the theoretical issues were included in
  comments as areas which should be included

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Competence

• Utilise domains of competence from Framework for
  Nursing in General Practice and to account for
  knowledge, experience and transferable skills of
  participants
• Management and monitoring of health and illness
• Communication
• Quality
• Learning and professional development
• Accountability

18
Stakeholder opinions

• Need to ensure competence widely recognised
• Work-based learning seen as essential for
  development of competence

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Mentorship

• Criteria
• SPQ in general practice nursing
• Specific mentorship preparation
• A specific minimum time working as a practice
  nurse of two or three years - although there is
  further consideration of the impact of part-time
  working on this experience.
• Evidence of CPD
• Using mentors in GP training practices or QPA
  practices
• Proof of support as a mentor from the practice.
• GP training practice or QPA
• Recommendation of lead nurse or equivalent
• NOTE NMC consultation of mentorship is currently
  ongoing and has the potential to influence the
  recommendations

20
Stakeholder opinions

• Appreciated need for mentorship
• Not all nurses would want to participate
• Need for mentor preparation and
• Need to work with HEI and wanted to feel involved
• Barriers identified
• Money
• Time
• Practice support
• Additional workload

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Limitations of recommendations

• Introductory course
• Large number of important issues
• Balance and reasonableness
• Only awareness of some issues may be the
  achievable outcome at this level

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Moving on

• Final document published June 2006
• Pump priming from NES
• Funding for 30 nurses in Scotland to complete an
  initial preparation course in 2006/7
• Courses in place or planned to start end
  2006/early 2007
• Glasgow Caledonian
• Lothian CPD unit
• Bell College Dumfries
• Robert Gordon University

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Contact Details

• Fiona Bell
• NHS Education For Scotland,
• 3rd floor,
• Hanover Buildings,
• 66 Rose Street,
• Edinburgh,
• EH2 2NN
• Fiona.Bell_at_NES.scot.NHS.uk.