Advanced Nurse Practitioner by nikeborome

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									Advanced Nursing Practice
Developing an Advanced Nurse
Practitioner role in mental health

   Gordon Lynch                             Noeleen Price

Advanced Nurse Practitioner              Director of Nursing
 Child & Adolescent Mental          Child & Adolescent Psychiatry
           Health                            HSE SWA
        HSE Kildare                       Dublin / Kildare


                        NCPDNM 20.09.2006
       Advanced Nursing Practice
        Developing an Advanced Nurse
        Practitioner role in mental health

                    Noeleen Price
                      Director of Nursing
                 Child & Adolescent Psychiatry
                          HSE SWA
                       Dublin / Kildare


Noeleen Price            NCPDNM 20.09.2006
         Developing an Advanced Nurse
               Practitioner Post
• Professional Practice           • Awareness of expertise
  within Services.                  within nursing cohort
• Baseline of CNS posts           • Logical progression
• Desire to develop clinical      • Service needs
  Career pathways
• Leadership for Clinical
  Practice




Noeleen Price           NCPDNM 20.09.2006
       Benefits / Challenges for Service
• New Level of nurse               • Commitment needed to
  practice                           develop post / post
• Expanded scope of                  holder
  practice                         • Risk management
• Increased autonomy               • Ongoing supports /
• Development of nurse               development for post
  expertise                        • Growing scope of post
• Better quality service for
  clients

Noeleen Price            NCPDNM 20.09.2006
                   How to --
• Decide to develop post        • Seek wider support-
• Research service needs          MDT; Human
• Consult NCNM                    Resources;
  documents                       Financial;Legal
• Consult with other areas      • Begin Site preparation
  who already have ANP –        • Begin paperwork trail
  none in Mental Health!
                                • Drive process!




Noeleen Price         NCPDNM 20.09.2006
           How can ANP Post be used
• To lead / develop nursing practice
• To energise nursing as an entity within the MDT
• To lead research in the field of nursing practice
• To deliver highest quality care in a practical,
  realistic and effective manner
• To provide clinical career pathway for staff



Noeleen Price        NCPDNM 20.09.2006
    Director of Nursing - ? How was it
                 for you
•    Time consuming!                  •    Learn from colleagues
•    Challenging                      •    Get paper work together
•    Exciting
                                      •    Pursue HR / Finance
•    Frustrating
•    Never ending
                                      •    Get important
                                           stakeholders on side
•    Rewarding
                                           quickly – CD, Admin
•    Great sense of achievement
                                           Manager, LHO etc.,
                                      • Don’t take no for an
                                        answer!
Noeleen Price               NCPDNM 20.09.2006
                Practical Steps 1
• Prepare Business Case –           • Develop scope of practice
  show service need                       – Identify spectrum of referrals
• Develop Job Description /               – Identify sources of referrals
  Person Specification                    – Clarify system for catagorising
• Demonstrate benefits of post              referrals
• Get Form A completed and                – Clarify what constitutes
  signed off properly                       inappropriate referral
• Get position Number                     – Clarify range of ANP’s own
                                            work / approach
• Get approval to have this as
                                          – Get Scope of Practice signed
  a completely new, fully                   off by Management Team;
  funded post                               HSE and Clinical Team


Noeleen Price             NCPDNM 20.09.2006
                 Practical Steps 2
• Work with NCNM – follow guidelines to the letter!


• Secure Clinical Indemnity from the State Claims Agency –
  Clinical Indemnity Scheme.*

• Secure Non Clinical indemnity from Irish Public Bodies Mutual
  Ltd.,* - work with your Insurance Manager HSE SS*

• Prepare site

• Identify supports – equipment, IT, clerical,Book allowance, etc.,

Noeleen Price               NCPDNM 20.09.2006
                 Practical Steps 3
• Meet with stakeholders             • Identify potential
• Keep actively in touch with          candidate(s)
  relevant personel                  • Work with them to
• Drive process                        develop ideas / prepare
• Identify roadblocks – remove         portfolio
  or renegotiate                     • Provide practical
• Invest in education / training       supports / facilitate
  to improve portfolios                candidate in preparation
                                     • Research and adopt
                                       framework for post

Noeleen Price              NCPDNM 20.09.2006
                Where to now?
• Audit effectiveness of post / post holder
• Develop post through wider service area
• Promote advanced practice within service and
  elsewhere – encourage colleagues
• Pursue development of 2nd ANP in service




Noeleen Price       NCPDNM 20.09.2006
   Advanced Nursing Practice
   Developing an Advanced Nurse
   Practitioner role in Mental Health

                    Gordon Lynch

                 Advanced Nurse Practitioner
               Child & Adolescent Mental Health
                         HSE Kildare



Gordon Lynch            NCPDNM 20.09.2006
          Summary of presentation
 Personal background
 Service Description

 ANP Post & Position

     • Separate
     • Related
     • Mirror each other




Gordon Lynch        NCPDNM 20.09.2006
               Personal Background
                         training


 Late to Nursing
 Psychiatric Nursing (St Loman’s
  Hospital, Dublin)
 Counselling (Maynooth)

 Management

 Child & Adolescent Analytic
  Psychotherapy (TCD)
 Solution Focussed Brief Therapy

Gordon Lynch         NCPDNM 20.09.2006
               Personal Background
                      professional

 Residential Child Care
 Adult Mental Health. Training & Staff

 C&A Mental Health. Staff Nurse

 Assistant Co-ordinator – Co-ordinator
  C&A Residential Treatment
 a/ACNO (ADON) C&A Psychiatry

 Return to Clinical

 SN – CNS - ANP


Gordon Lynch         NCPDNM 20.09.2006
          Background to ANP post
   Decision to move to advanced practice
   NCPDNM guidelines
   General Nursing experience
   Service Needs
   Advanced practice in other areas
     • UK
     • NZ
     • NI
   Existing Skills
   Continuing professional development

Gordon Lynch       NCPDNM 20.09.2006
                                 The Service
   Kildare Child & Adolescent service (Child &
    Adolescent Psychiatry)
   HSE – SWA – Sth Kildare (Athy, Newbridge,
    Kildare, Monasterevin, Curragh, Castledermot……)
   Population 62,000 approx
      • Under 16 years 21,000 approx
   Referral Rate = 290 in this year*
   Multi-disciplinary Team
*projected on basis of referrals to date




Gordon Lynch                               NCPDNM 20.09.2006
               The Service




Gordon Lynch     NCPDNM 20.09.2006
               The Service




Gordon Lynch     NCPDNM 20.09.2006
               Range of Referrals
    Emotional, Behavioural,
          Psychological,
        Developmental &
        Psychiatric Issues
   Significantly Impacting on
           Functioning


Gordon Lynch        NCPDNM 20.09.2006
               The Problem
 Waiting list - One Year plus and
  growing
 Dissatisfied Clients

 High rate of non-attendance

 Dissatisfied Referral Agents

 Low Staff Morale




Gordon Lynch     NCPDNM 20.09.2006
               The Proposal
 Proposal to MDT
 Utilising Advanced Nurse Practice

 Triage and Therapeutic Assessment

 Solution Focussed

 Client Centered

 Maximise Initial Contacts

 Accessible to Stakeholders



Gordon Lynch      NCPDNM 20.09.2006
         The Proposal/Pilot Project
   All referrals come to Speaker
   Early Initial Meeting
   “Therapeutic” Assessment
   TIME
   Solution Focussed
     • Collaborative & Empowering
   Early Closure
     • Facilitative re-referral if needed
   Therapeutic Letter (all letters to clients)
   Consultation
   Close Liaison with Referrer
     • Known & Accessible face of service
Gordon Lynch         NCPDNM 20.09.2006
                                      ALL
                                   REFERRALS

                                  Screened On Receipt
                                      by Speaker




                                       Initial
                                    appointment
                                     with speaker




               Agreed Plan          MDT Referral        Specialised
                (ref to other         Meeting             Stream
               service, review,
                 discharge)


                                    Allocation to
                                    MDT Member
                                    (Can be ANP)




Gordon Lynch                      NCPDNM 20.09.2006
                  Outcome
   Waiting list reduced to less than 3 weeks
   52% Not being referred to MDT!
   Non Attendance from 33% to 7%
    Consumer satisfaction
   Referral agent satisfaction
   Anecdotal
   Research
   Team regeneration – Other initiatives

Gordon Lynch        NCPDNM 20.09.2006
Number of Referrals and Waiting
            times
 Period         Number of       Average wait (and          Number not yet
                Referrals       Range)                     offered appt at end
                                in Days                    of period
                                For First Appt.
 2001           147             49.6 days (0-224) 29
 2002           163             129.3 (0-580)              56
 2003           158             122 days (0-449)           62*
 2004           175             38.0 days (0-168) 19
 2005            267            18.36 days (0-43) 0


               *The likely waiting time for the 62 awaiting appts at
               the end of 2003 was 51 weeks
Gordon Lynch                     NCPDNM 20.09.2006
         Developing the ANP Post
   IDENTIFICATION OF NEED
   SITE PREPARATION
   JOB DESCRIPTION
   Director of Nursing
     • Delegation
     • Clinical Input
     • Nurse Practice Development Co-ordinator
   Future Candidate
     • Multi-disciplinary team
   National Council
Gordon Lynch           NCPDNM 20.09.2006
         IDENTIFICATION OF NEED

 Service Users
 Stakeholders / referral agents

 Service

 Organisation




Gordon Lynch     NCPDNM 20.09.2006
       The Post – Site preparation
   The Need        (Audits, research,evidence,
          policy documents, best practice)
   Framework        (legislation, regulations, national
    & local guidelines, areas of nursing development)
   Practical   (insurance, premises, location,
    service plan, integration, role within nursing
    framework – authority & accountability)
   Resource Implications


Gordon Lynch            NCPDNM 20.09.2006
       The Post – Job Description
   Job Title
     • Specific, descriptive but not constricting
   Grade & Hours
   Reporting Relationships
     • Professional
     • Clinical
   Location (Site, service & HSE Region)
   Background
   Purpose

Gordon Lynch           NCPDNM 20.09.2006
      The Post – Job Description             continued




   Clinical Practice
     • Autonomy
     • Expert Practice
   Professional & Clinical Leadership
   Research
   Qualifications
   Experience
   Competencies
     • Core
     • Specific
   Terms of Service
Gordon Lynch             NCPDNM 20.09.2006
      The Post – Material support
 Accomodation
 Admin Support

 IT & Communications

 Budget

     • Literature
     • Education
     • Other


Gordon Lynch        NCPDNM 20.09.2006
 Position – Developing the Portfolio
               Candidate Requirements

   General - NCPDNM criteria

   Specific - Need to match the post




Gordon Lynch          NCPDNM 20.09.2006
               NCPDMN criteria
   Registration
   Masters +
   Post Registration Experience
     • 7 years +
     • 5 years + specialist
   Supervision
   Competence – advanced level –
      demonstrate - context
   Continuing Professional Development

Gordon Lynch           NCPDNM 20.09.2006
                  Competencies
   Core Concepts
     •   Autonomy in Clinical Practice
     •   Expert Practice
     •   Professional & Clinical Leadership
     •   Research
   Specific
     •   Qualifications & Training
     •   Experience
     •   Continuing professional development
     •   Professional activity


Gordon Lynch             NCPDNM 20.09.2006
               Scope of Practice
   Context
     • Protocols
     • Evidence base
     • Supporting references
   Clinical Presentations
   Referral pathways – In
   Referral pathways – Out
   Clinical Interventions
   Be Comprehensive

Gordon Lynch          NCPDNM 20.09.2006
               Portfolio – don’t forget
   Detailed Indexing           (Including references and
    addenda)
 Course Transcripts
 Certification (Claimed qualifications must
    have certs)
 Clinical Experience
 Supervision arrangements and
  history details
 3rd level links


Gordon Lynch           NCPDNM 20.09.2006
                   In Conclusion
   Identify the Need
   Use advanced practice to meet the need
   Make it Something that will bring support
     •   Service users
     •   MDT
     •   Stakeholders
     •   Management
   Job description
   NCPDNM guidelines
   Be concise and clear
   Avail of support
Gordon Lynch             NCPDNM 20.09.2006

								
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