The Development of an Advanced Nurse Practitioner Role

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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

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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

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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

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International Developments

• New South Wales
• Western Australia
• New Zealand
• Canada
• UK

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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

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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

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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)

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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)

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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

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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

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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.

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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

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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

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Scope of Practice

• Assess
• Diagnose
• Treat
• Discharge
• Refer to other appropriate service
• Audit
• Research

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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

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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

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Audit of Patient Flow
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Audit of Activity 98-03
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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

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(No Transcript)
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Education Programmes (Advanced Practice Strand)

• The University of Dublin, Trinity College
• University College, Dublin
• University College, Galway
• University College, Cork (In progress)

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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

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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

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Developing Sites (Emergency)

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

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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

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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

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Accredited ANPs

• 4- Emergency
• 1-Sexual Health
• 1-Rheumatology

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Role Development Getting Started

• NO QUICK FIX
• NOT A CHEAP OPTION

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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

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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

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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

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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/