dr adeline wu and grainne lowe, box hill hospital: evaluating the role of the nurse practitioner...
DESCRIPTION
Dr Adeline Wu, Emergency Department Physician and Grainne Lowe, Emergency Nurse Practitioner at Box Hill Hospital delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is designed for organisations and managers looking to better understand, utilise and grow the role of the nurse practitioner in their health service. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/nursepractitionersconferenceTRANSCRIPT
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Two perspectives of NP in an ED setting:
medical and nursing
Grainne Lowe Adeline Wu
Nurse Practitioner Consultant
Emergency Department Emergency Department
Box Hill Hospital Box Hill Hospital
Where we started
• Submission to DHS 2003/04
– Challenge to existing processes
– Look at new ways
– Improving pt journey
– Improving KPI’s
– Decrease frustration
Identify needs
• Services
– Create equitable delivery for patient groups
• Workforce
– Build capacity
– Strengthen capability
– Gaps in delivery of services
Politics of change
• Change is political
– Tactics
– Negotiation
– Lobbying
– Compromise
Stakeholders • Key partners working together
– Day to day colleagues
• Medical
• Nursing
– Pharmacy
– Pathology
– Radiology
– In/out patient units
Drivers/Champions
• From the top down
– Executive level support
• Across channels
– Referral pathways
• Community access
– Pt knowledge
Eastern Health
• 4 NP positions in ED
– all Endorsed
• Other positions
– Stroke Management
– Mental Health x 5
– Renal
– Palliative
NP as resource
• NP is “...”
• Compliment existing services
• Growth of decision making capability
• Pt satisfaction with access
• Increase volume of timely consultations
Key components
• Role clarity
– Identity
– Scope of practice
– Extensions to practice
– How the role “fits”
Key components
• Professional
• Leadership
• Recognition
• Collaboration
• Integration
Support for NP
• EH NP group
– Sharing ideas
– Problem solving
– Reducing isolation
– Regular meeting with DON
• Strengthening structure
• Professional issues
Future
• EH Nursing Scope of Practice Committee
– Various group representation
– EH Chief Nurse as chair
– Submission of interest
Scope of Practice
• NP scope of practice
– Locally determined
– Practical
– Constructive
– Without undue restriction
– Taking account of extensions to practice
Scope of practice ED
• Initially governed by CPG’s
– To structure extended practice
– Guide development of role
– Multi-disciplinary sign off
• Problems
– Restrictive
– Review and resvision ???
Model of Care • Minor injury / minor illness model
• Fast track guidelines
– Exclusion criteria
– Structure of ED
• Autonomous Collaborative
• Based on need
Value add to ED
• Increase efficiency
• More timely treatment
• Lower acuity presentations
• Increase patient satisfaction
• Provide resource for other staff
– Nursing
– medical
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Doctor’s Perspective
My first thoughts….
• “if they want to practise medicine, then
they should go to med school”
Other concerns
• missed diagnoses
• Unnecessary or inappropriate
pathology/radiology requests and
specialist referrals
Other concerns
• ongoing training of junior medical staff
– in particular interns
• Emergency Medicine is a compulsory term to
complete internship
• fear of employment of NPs will eventually
replace medical staff
Resulted in
• specialist units refusing referrals from
nurse practitioners
• ED staff confusing roles of NPs
• perceived competition for patients
Other problems
• extent of scope of practice
– what can you do?
• lack of NP coverage
• loss of skilled nurses to become NPs
Acceptance is a BIG hurdle
In reality
• training of junior medical staff OK
– NPs now teaching
– gaps in rostering still provide opportunities
• NPs will see what they are comfortable
with
Other Benefits
• more cohesive clinical team
– NPs stay longer than interns/RMOs
• frees medical staff to see other patients
– may increase flow through the emergency
department
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Key Performance Indicators
• 4 hour discharge KPIs
• waiting times
• patients who did not wait
• MORE DATA NEEDED
Key Performance Indicators
• pt satisfaction
• unscheduled representations
• adverse events
My Opinion
• NPs are safe
– they are clear who they will and won’t see
My Opinion • NPs have a role in the ED
– increased patient satisfaction
• but further study is needed if there any effects on
ED flow
– greater teamwork
– will not replace doctors
• doctors should not feel threatened
My Opinion
• Teething problems
– training
– initial difficulty in acceptance
• Better education amongst non-NP staff
about scope of practice
Future for Other Departments
• Currently- NPs/NPCs in
– neurology
– psychiatry
• Increasing role in health care
– more widespread acceptance
– doctor shortages
