creating and implementing a model of care for an acute care advanced nurse practitioner within...
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Creating and implementing a model of care for an acute care
Advanced Nurse Practitioner within Colorectal Surgery
Imogen FecherLower GI ANP
ANP: Drivers for Change
•EWTD (DOH 2009)
•Reduction in numbers junior doctors
•Reduced surgical training opportunities
•Increased patient acuity
•Shortening lengths of stay
•Increasing pressures on nursing staff
Background
• First NP’s graduated 1992
• Role developed within primary care
• 2002 first RCN guidance on NP role
• 2008 RCN Advanced Nurse Practitioner competency document
• 2011 ANP’s throughout primary, secondary and tertiary settings
ANP Definition
“A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master's degree is recommended for entry level”
(International Council of Nurses 2001)
SGH Colorectal Team
Cons Cons ConsCons Cons Cons Cons
SPR SPR SPRSPR
FY1
SHO
FY1FY1
SHO
FY1
ANP
CSN
LEAD GI CNS
Cons
Junior Doctors Survey Results April 2010
• FY1’s working 50-80 hr weeks• SHO’s finish late 4 out of 5 days• 1-2 ward rounds a week carried out by SHO
and FY1 alone• None of juniors able to attend all teaching
available• SHO’s only able to attend treatment centre
theatre once a month
Expanded practice roles identified by junior doctors as potentially beneficial
• Prescribing• Discharge facilitatation• Unwell patient assessment• X-ray ordering• ABG;s• Colonoscopy requesting
• Advance Practice Qualification MSc Level• Examination and History Taking • Non Medical Prescribing• Advanced Communication Skills • Venepuncture and Cannulation• Male Catheterisation• Advanced Life Support • Interpretation of ECG’s Training
Qualification’s and training required for ANP to undertake expanded practice
Expanded Scope of Practice
• Prescribing intravenous fluids where required for pre and post operative patients
• Writing discharge summaries and TTO’s• Assessment and management/escalation of
patients who have activated the “Modified Early Warning System” (MEWS).
• Requesting chest and abdominal x-rays.• Requesting colo and flexi sigmoidoscopies as
directed by a consultant.• Taking of Arterial Blood Gasses
April – December 2010
• SMART Objectives
• Time table
• Extended Practice documents
• Governance
• Training
• Assessment
• Competence
Repeat doctor survey
• FY1’s working 50-60 hour weeks• SHO late finish 3 out of 5• 100% senior cover onward rounds• Juniors able to attend most of teaching available• SHO’s attending treatment centre theatre up to
three times a month• ANP role found to benefit team
Challenges
• Junior doctor change over
• Division expectations
• Line management
Future Challenges
• Audit to monitor expanded practice, junior doctors working hours, patient satisfaction.
• Introduction of ANP’s into other surgical specialities at SGH
• 24 hour ANP service
Conclusion
• An ANP can provide a range of extended roles previously provided by the junior medical team
• The addition of an ANP to colorectal surgery benefits patient’s, doctors and nurses
• Further work is needed to audit:– Clinical impact of the expanded practice
– Patient satisfaction
References
• Department of Health (2009) The European Working Time Directive - UK notification of Derogation for doctors in training.
• International Council of Nurses (2001)• http://www.icn.ch/publications/publications/ • Nursing and Midwifery Council (2006) Standards of Proficiency for
Nurse and Midwife Prescribers.• Royal College of Nursing (2008) Advanced Nurse Practitioners: An
RCN guide to the Advanced Practitioner Role Competencies and programme accreditation.
• RCN Advanced Nurse Practitioner Forum
