Clinical Research Nursing and Advanced Practice

1
Clinical Research Nursingand Advanced Practice

• Helen Pidd and Gail Holmes

2
Overview of presentation

• National Context
• What is Advanced Practice?
• Manchester Context why and how
• MSc in Advanced Practice Health and Social care
  an overview

3
(No Transcript)
4
Wheres the starting point?

• Benefits of the Job
• The conduct of research to international
  standards
• Travelling to investigator meetings and
  conferences nationally and internationally
• Eating at good restaurants to discuss the
  research project/s and to network
• No shift work
•  
• Drawbacks of the Job
• Drowning in a sea of research jargon
• Frequently working in isolation
• Other nurses view the CRN as a data collector
• Short term contracts
• Sometimes have to arrange holidays around studies
  in progress

5
Historically

• Worked in isolation from their professional
  colleagues
• Convenient whilst raising a family, not having to
  work weekends and evenings
• Mere data collectors
• Short term contracts
• Lack of line management support
• Invisible to trust personnel systems
• Extended and specialised role

6

• Birmingham
• Manchester
• Cambridge
• Southampton
• Newcastle
• London
• McMichael Centre
• UCLH
• Somers GOSH
• Guys St Thomas
• Hull York
• Manchester Childrens
• Sheffield
• Sheffield Childrens
• Birmingham Childrens
• Oxford
• Peninsula

Clinical Research Facilities
Biomedical Research Centres

• Aberdeen
• Dundee
• Glasgow
• Edinburgh
• Newcastle
• Manchester
• Liverpool
• Cambridge
• Oxford
• London
• Great Ormond St
• Guys St Thomas
• Imperial
• Moorfields
• Royal Marsden
• UCL

Inverness
Aberdeen
Dundee
Glasgow
Edinburgh
Newcastle
Belfast
Galway
York
Dublin
Hull
Leeds
Manchester
Liverpool
Sheffield
Biomedical Research Units
Nottingham

• Leeds
• Liverpool
• Sheffield
• Nottingham
• Leicester
• Birmingham
• Oxford
• Bristol
• London
• Royal Brompton
• Barts
• Southampton

Experimental Cancer Medicine Centres
Cork
Birmingham
Leicester

• Edinburgh
• Glasgow
• Belfast
• Newcastle
• Leeds
• Manchester
• Liverpool
• Sheffield
• Leicester
• Birmingham
• Cambridge
• Oxford
• London
• Barts
• ICR
• Imperial
• KCL

Cambridge
Oxford
Cardiff
Bristol
London
Surrey
Southampton
Peninsula
Brighton
7
NIHR Clinical Research Networks
NIHR Clinical Research Networks
NIHR Dementias Neurodegenerative Diseases
Research Network
NIHR Diabetes Research Network
NIHR Medicines for Children Research Network
NIHR Mental Health Research Network
NIHR Comprehensive Clinical Research Network
NIHR Stroke Research Network
NIHR Primary Care Research Network
NIHR National Cancer Research Network
8
NIHR Comprehensive Research Network
9
Clinical Research Nurses

• Newcastle
• year n
• 2006 - 93
• 2007 - 120
• 2008 - 140
• 2009 - 180

100 Increase over 3 years
10
Similar Picture Across the Country

• AHP/STUDY COORDINATORS
• Cambridge 26
• Sheffield 21
• Manchester 13
• Norfolk Norwich 8
• NUMBERS INCREASING
• YEAR ON YEAR

• NURSES
• Cambridge 148
• Sheffield 173
• Manchester 168
• Norfolk Norwich 56
• Newcastle 180
• Birmingham 87 (Trust)
• Scotland 411

2012/13 10,000
11
Changes since 2001

• National- including Developing the Best Research
  Professionals (Finch) 2007, Competency document
  version 2, Training GCP, Informed Consent, new
  roles emerging
• Networks- Induction Portfolios, local training,
  information sharing - UKCRF Network
  www.ukcrfnetwork.co.uk
• Trust- Lead Nurse Appointments, Local Training

12
Opportunities
Clinical
Academic
Management
13
(No Transcript)
14

• Advanced Practitioner
• The definition used widely by the DOH outlines
  that an advanced practitioner is a clinically
  autonomous practitioner, defines the scope of
  practice of others and continuously develops
  clinical practice within a defined field.
• Experienced non-medical registered
  professional who has developed his or her
  knowledge to a very high standard in a specific
  and often high level of practice. This high
  standard is such that not only is the individual
  the expert in the base domain-but can also
  accept the full responsibilities for providing
  those services hitherto supplied by others, in
  defined circumstances.
• (J. Sargent 2003)

15
Core Characteristics of Advanced Practice

• Work across organisations and different agencies
• Provide advanced levels of practice, knowledge
  and skills
• Clinical focus - Clinically autonomous.
• Empowered to make high-level decisions.
• Be self directed, manage risk, have high levels
  of communication skills and be a member of a
  wider clinical/ service team.
• In many cases the person will have their own
  patient/client caseload with decision making
  responsibilities
• In many cases manage medications including
  assessment, review and prescribing.
• Undertake a physical examination and history
  taking, diagnosis and plan care and treatment.

16
Advanced Practice in Manchester

• Modernising workforce
• European working time directive
• Patient centred seamless care
• PARTNERSHIP 2004
• Strategic Health Authority
• 13 Acute and
• Mental health Trusts
• University of Bolton (primary care)
• University of Salford (acute)

17
Advanced Practice in Manchester

• Greater Manchester SHA initiative Delivering
  the Workforce
• Advanced and Assistant Practitioners
• Need identified by Trust, application to GMSHE
• Trainee roles commissioned and funded through
  GMSHA
• Supported by an education programme

18
Application Process

• Rigorous process
• Trust and WTCRF commitment to the role
• Detailed proposal form submitted to SHA
• Decision to support application sits with SHA

19

• The Proposal
• Executive sign off
• Role description
• Reason for developing role
• Needs analysis
• Skills and competencies
• Facilitation of WBL
• Identification of mentor/assessor/line manager
• Safety, effectiveness. governance
• Funding arrangements and sustainability
• Organisational track record

20
The Role - Overview

• To develop advanced knowledge and skills in the
  identified theme areas and assist both new and
  established investigators to efficiently carry
  out their studies and enable them to achieve
  study targets by providing continuity of service.
  
• In partnership with the Clinical team manager
  provide clinical leadership to the team of
  nurses, focusing on enhanced practice development
• To develop nurse led research and support the
  development of clinical academic roles.

21
The Role - Expectations

• Lead on participant care for the duration of a
  study, including assessment for inclusion in a
  study, medical history taking, medical
  examinations, management of drug infusions,
  prescribing and reviewing and refining
  participant care throughout the study
• Provide medical cover for identified
  cardiovascular and paediatric studies
• Undertake informed consent for Clinical Trials of
  Investigational Medicinal Products

22

• Demonstrate enhanced clinical skills including
  arterial bloods, biopsies, management of central
  lines, minor surgical procedures, ultrasound in
  the vascular system, management of anaphylaxis,
  pulse wave analysis, analysis and decisions
  relating to test results
• Lead on the development of nurse led research and
  enhanced clinical practice
• Provide advice and guidance to PIs on study
  efficacy and safety
• Participate in the development and testing of new
  devices and approaches to health care for patient
  benefit

23
MSc - Programme

• 2 years (part time)
• 45 weeks per year (3 semesters).
• 2 learning days per week.
• Thursdays taught day.
• Thursdays and some Fridays sem 1 and 2
• Attendance at University greatly reduced year 2.
  - WBL
• Second day student choice for clinical/work based
  needs.
• 90 days per year clinical application.

24
University of Salford, MSc Advanced practice
(Health and Social Care Pathway) Programme
Overview
Semester 1 Semester 2 Semester 3 Credits
Year 1 Principles of Advanced Practice (30) Application of Life Sciences (30) Principles of Advanced Practice (30) Application of Life Sciences (30) Contextualising Advanced practice (30) 90
Portfolio Individual Learning Pathway Tripartite Agreement core and bespoke skills Organisational pathway analysis
Year 2 Research Methods (30) AP1 Practitioner competence (30) AP2 Clinical Reasoning (30) AP1 Practitioner competence (30) AP2 Clinical Reasoning (30) 90

25
Portfolio of EvidenceYear 1

• Job description
• Individual Learning Pathway
• Clinical Skills Learning Agreement
• Bespoke Skills identified and agreed
• Objective and subjective evidence for sub
  elements of the Elements of Advanced Practice
• Achievement of skills at level 2 on Taxonomy of
  Achievement
• Organisational pathway analysis
• 360 degree feedback

26
Portfolio of EvidenceYear 2

• Cases (formative and summative)
• Triangulated evidence for many sub-element of
  Elements of Advanced Practice
• Completed skills log (core and bespoke) at level
  2 and 3
• 40 case assessments
• Completion of Individual Learning Pathway
• 180 credits at level M

27
Programme Support

• Mentors
• Stay with student for 2 years
• Understand programme and learning requirements
• Advocate in Trust on behalf of student
• Assessors
• Objective judgement on performance throughout 2
  years
• May delegate some work to supervisors of
  appropriate standing

28
Programme Support

• Trust
• Mentor
• Line Manager
• Assessors
• Supervisors

• University
• Personal Tutor
• Academic Supervisor
• Programme lead
• Student Life

Learning Facilitator
29
Where are we now

• Successful SHA application 2 posts
• Successfully recruited through internal
  secondment band 7 in training, 8a once
  qualified
• Steering group in place
• 2 trainees commenced Sept 2011

30
(No Transcript)