ADVANCED NURSING PRACTICE IN PRIMARY CARE

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ADVANCED NURSING PRACTICE IN PRIMARY CARE

• Ruth Taylor RGN., BNS., MSc
• Advanced Nurse Practitioner (Primary Care)

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HOW DID IT ALL BEGIN?

• Circular 5/89 (DoHC 1989)
• Commission on Nursing (DoHC 1998)
• Development of the National Council for Nursing
  Midwifery
• Primary Care Strategy (DoHC 2001) recommends
  the development of primary healthcare teams and
  sees the ANP as an integral part of the nursing
  team in primary care.

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PRACTICE PROFILE

• Rural, single-handed, dispensing general practice
• Employs to job-sharing receptionists, 2
  job-sharing nurses (1 practice nurse, 1 ANP)
• Practice is situated in a multi-disciplinary
  primary care centre with day care centre attached
• PHN, community nutritionist, chiropody, dentist,
  psychology, behavioural therapy
• Practice population is approximately 3,000 both
  GMS/private
• Primary Care Team in development

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GEOGRAPHICAL INFLUENCES

• 14 population in HSE West (Sligo/Leitrim
  Donegal LHOs) are over 65 (11.4 national
  average)
• 6.4 population in HSE West (Sligo/Leitrim
  Dongal LHOs) are over 75 compared with 4.8
  nationally
• 31.4 of people live alone compared with 25.8
  nationally

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DEVELOPMENT OF ANP ROLE IN PRIMARY CARE

• The practice nurse/CNS role in this practice
  primarily focused on caring for patients with
  chronic illness, adult immunisations, patients on
  anti-coagulant therapy, patients requiring ear
  care
• Given the increase in diabetes, asthma and CHD
  and the increase pressure for service provision,
  it was decided to develop the nursing role to
  ANP level

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• Caseload identification- patients with asthma,
  COPD, diabetes, CHD, hypertension, patients who
  require ear care, adult immunisations (influenza
  and pneumococcal), patients on anti-coagulant
  therapy
• Development of guidelines for good practice
  assist in the determination of scope of practice
• Development of referral criteria

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• Development of referral pathways within primary
  and secondary care
• Develop and increase awareness about the role
  within the practice population practice
  information leaflet, practice newsletter

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Nursing and Medical Roles within Primary Care
RGN WITH POST GRADUATE QUALIFICATION IN PRACTICE
NURSING
PN
CNS
RGN WORKING FROM NOVICE TO COMPETENT
GP

ANP RGN WITH MSC IN NURSING QUALIFICATION
(Taylor 2005)
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OPERATIONAL ISSUES OF ANP SERVICE

• Patients are seen by the ANP for the required
  service chronic illness, ear care, immunisation
  etc
• Chronic illness disease registers are
  maintained to ensure patients are offered regular
  reviews of their condition
• Patients may self-refer or be referred to the ANP
  by the GP, PHN and other health professionals
  (community/secondary care)
• Due to the nature of chronic illness, patients
  are not discharged

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CHALLENGES

• ANP role vs medical role
• Expansion and extension of nursing roles
• Raising awareness of practice nursing and working
  within primary care

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POSITIVES

• Highlighted teamworking within the practice
• Links with the National Council for the
  Professional Development ogf Nursing Midwifery

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FUTURE DEVELOPMENT OF THE ANP IN PRIMARY CARE

• Dynamic and challenging role which challenges the
  existing structures in the community
• Currently 2 ANPs approved in primary care
• Support systems need to be put in place to
  support and encourage practice nurses to choose
  ANP as a clinical career pathway
• Nurse prescribing

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Acknowledgments

• Staff within the practice and the
  multidisciplinary team
• Jenny Hogan
• NMPDU Dublin Northeast

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Thank you for listening!!
Questions??