Working Together to Advance Nursing Practice

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Working Together to Advance Nursing Practice
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Good Afternoon Ladies and Gentlemen
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• Our deepest fear is not that we are inadequate,
  our deepest fear is that we are powerful beyond
  measure. It is our light not our darkness that
  most frightens us. We ask ourselves who am I to
  be brilliant, gorgeous, talented, fabulous?
  Actually who are you not to be? Your playing
  small doesnt serve the world.

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There is nothing enlightening about shrinking so
that other people wont feel insecure around you.
We are all meant to shine as children do. As we
let our own light shine we unconsciously give
other people permission to do the same as we are
liberated from our own fear, our presence
automatically liberates others. Nelson
Mandela
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Developing New Roles to Advance Nursing
Midwifery practice

• Management Team Decision
• National Policy
• Evidence Base
• Local Involvement/Experience
• Education

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Current Position

• We have 6 ANP designate posts within the Western
  Health Board.
• - 1 in Oncology
• - 2 in Diabetes
• - 1 in AE
• - 1 in Urology
• - 1 in Pain Management
• The funding for site preparation received from
  the National Council was matched by the Western
  Health Board.

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Distinguishing Features of Advanced Practice

• Bridging care and cure
• Referrals to from other disciplines
• Conducting nursing research
• Lobbyist on health policy
• Level of decision making - generalist
• Autonomous management of episodes of care
• Negotiator of new practice boundaries

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Desirable Characteristics of A.N.P

• Clinically experienced in the area in which they
  are working
• Willing to seek advice
• A life long learner
• Enquiring mind
• Self starter
• Determined - resilient
• Good communicator
• Dr. Susan Reed Marie Robert-Davis
• Sheffield University

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Contracting for Change Introduction of New Roles

• Common objectives/purpose of ANP
• Nursing leadership is key support
• Respecting contributions/valuing diversity
• Agreed processes-bridging care and cure
• Breaking down professional barriers
• Creating time out to teamwork-articulate
  boundaries of new role
• Provision of consultant advice to colleagues

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Frameworks to Facilitate Site Preparation

• Multi-professional clinical audit
• Evidence-based practice
• Clinical supervision
• Clinical risk management
• Clinical incident reporting
• Continuing professional development
• Clinical leadership development
• Patient/client feedback systems

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Useful Questions

• Are the right frameworks in place?
• Are they working well?
• How could they be improved - 360º consultation?
• Points for action?
• What difference will happen for clients?

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Key Issues Being Addressed

• Definition of roles referral system
• Team structure
• Management roles
• Skill mix
• Professional boundaries
• Rewards and responsibilities
• Facilitation of effective team working

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Dilemma 1

• Using a Template
• Clear pattern
• Sense of predictable control
• Ignores uniqueness
• Repeats mistakes

• Growing a Hybrid
• Customised outcome
• High involvement and commitment
• Less predictable outcome
• Provokes anxiety
• Time consuming
• Mohrmann et al 1989

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Dilemma 2

• Changing Attitude
• Using existing staff functions
• Feels familiar as management
  technique
• Little evidence that changed attitudes lead to
  organisational changes by themselves

• Changing Structures.
• Jobs, pay decision-making behaviour
• More lasting
• Generates fear upset, anger by altering
  employment relations
• Mohrmann et al 1989

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Programme Development

• The need for the Advanced Practice programme was
  identified by the Directors of Nursing based on
  workforce planning and strategic projection of
  needs
• Steering Group included Directors of Nursing,
  N.M.P.D.U., Director of Nursing Studies,
  Lecturers and Deans

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Programme Development

• Steering Group
• Policy, principles which underpinned the design
  and approved all content, learning outcomes,
  practice requirements, entry criteria
• Working Group
• Development of all content, modules, curriculum
  document
• Ms. Kathy Murphy Adrienne Mongommery

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Programme Design

• The core modules are shared with students on the
  other masters strands
• Focus of advanced practice modules is on the
  advanced clinical role
• Programme is modularised, part-time, but not
  distant learning at present
• Set up student links with other advanced practice
  programmes

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Organisational Impact

• Celebrate existing team working
• Ownership of developments
• One size does not fit all
• Outcomes focused research gives individual
  nurses/midwives an opportunity to advance their
  practice
• Population size as an indication of opportunity
  for ANP roles

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Organisation Learning

• Our experience of team working matches the
  literature reviews
• We need to commit long-term to develop team
  working
• There are likely to be improved service outcomes
• Team working is a key pillar of our corporate
  strategy

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Support Structures

• Guidelines and protocols in place prior to
  introduction of change
• Identified staff released to develop protocols
  and guidelines
• Interfacing I.T. systems in all wards,
  departments and community units to facilitate
  transfer of information and reduce duplication
  and administration is in progress.

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Next Steps

• Reach concensus on future service opportunities
  in each discipline
• Where are the current gaps?Paediatrics,
  Gerontology, Learning Disability and Mental
  Health Nursing
• Educate for task interdependence to avoid further
  fragmentation.
• ANPs role will be developed based on a gap
  analysis focusing on regional demographic
  information.

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Framework for Gap Analysis for future
development

• Client Group Specific Domain e.g. Homeless
  People, Travellers, Gerontological Specialist
  (Generic)
• Area Specific Domain e.g. A E, Minor Injuries
• Community Clinical Nursing Domain e.g. Family or
  General Practice/Primary Care Nursing,
  Occupational Health Nursing,
• Public Health Nursing Domain e.g. School Health
• Dr. Susan Reed Marie Robert-Davis
• Sheffield University

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• In the long history of humankind, and animal
  kind too, those who learned to collaborate and
  improvise most effectively have prevailed
• - Charles Darwin

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Staff of the N.M.P.D.U

• Anita Donoghue Anne McCarthy Anne Lavelle
• Brid Feighery
• Dymphna Mac Cana Helen Duffy Joe Mullen
• Josie Doolan-Ruane Mary Courtney
• Marita Fogarty
• Mary F.O'Reilly Stephanie Canny Teresa Moore

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• Thank you
• Any Questions?

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Working Together to Advance Nursing Practice