Advanced Nurse Practitioner ANP Role Development in Rheumatology

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Advanced Nurse Practitioner (ANP) Role
Development in Rheumatology

• Patricia Minnock
• Personal Account June 01- Oct 03

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Summary of Audit Trail

• 1998 - Eagerly awaited CoN Report
• 1998-2000 -Undertook Msc Nursing TCD
• 2001
• June - Received NCNM Framework from DoN,
  Presented copies to consultants (CR), CEO and HR
• August -Spoke with K Macellan (NCNM) ?Where to
  begin
• September -Presented framework to CR, agreed to
  proceed and shared meeting outconme with DoN
• 2002
• Jan - DoN sought advice from NCNM and stated
  intention to proceed with process

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Audit Trail of Process
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Support Groups

• Mentorship Group
• DoN, ADoN, Tutor (periodic meetings), Colleagues
• Medical Supervision
• Professor of Rheumatology (weekly discussion)
• Role Models
• 1. Site visit to SR Nurse Consultant in
  Rheumatology UK, Staffordshire (February 02)
• 2. SR invited lecturer _at_OLH 2-hour mentoring
  session 2003
• 3. Site visit to Sandra Delemare/Ann Cuffe SJH
• NCNM
• From Sept 02- Sept 03 regular exchange of
  documents and phone calls with NCNM

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Janurary 2002-July 2002

• Compiled document according to each heading
  sub-heading in framework
• Conducted site visits UK/SJH
• Submitted first draft August 2002

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Preparation of Job Description

• As per Appendix 1 in framework document
• Described current role as oppossed to vision for
  ANP role
• Background-specific details referenced from
  annual reports, strategic plans and meeting
  minutes in chronological order
• Geographic/demographic service details from
  annual reports, national reports, strategic
  documents

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Areas of clarification sought by NCNM

• Differentiate between role of S/N, CNS/ ANP
• Levels of decision making between 3 levels of
  career pathway
• Specifics of patient case load
• Mode of patient referral
• Vicarious liability
• Demonstrate link between service requirements
  and role developments
• Details of benefits to patient care

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Service need addressed by post

• The post holder's remit is clinical leadership
  and development of quality patient centred
  services
• Supported by table sequencing nursing service
  developments from 1992-2003
• Reference to relevant literature

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• 1. Need -Patients with chronic rheumatic
  diseases have many secondary health education
  needs. The health education component of the
  ANP's role is central to the provision of a high
  standard of nursing care
• Response ANP Patient Health Education And
  Clinical Support Sessions, which encourage
  empowerment of patients and families coping with
  a chronic disease (Appendix 1 RR 06, 07 P 81-85
  RR 11, 12 P. 92-122)
• 2. Need - Childhood and adolescent rheumatology
  services in Ireland are underdeveloped. Our
  Department of Rheumatology (SVUH and RR, OLH)
  provides the only adolescent rheumatology service
  in Ireland
• Response - Optimise Patient and Family Care in
  the Adolescent Rheumatology Service (Appendix 1
  RR 06, 07 P. 81-85)    

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• 3. Need The advent of new biologic therapies
  in rheumatology has put a new and increased
  demand on an already very busy service.
  Monitoring disease activity as it relates to the
  therapeutic self care demands of this cohort of
  patients with refractory disease requires an
  expert practitioner with expanded clinical
  judgement skills
• Response - ANP Review Clinics For Patients
  Prescribed Biologic Therapies. (Appendix 1 RR 08
  P. 86-88).
• 4. Need - Case management of patients with
  complex rheumatic conditions requires optimal and
  timely care. A complex case management clinic
  will reduce the number of elective admissions
  required by this specific cohort without
  compromising their management.
• Response - ANP Complex Case Management (Appendix
  1 RR 09 P. 88-91).

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• 5. Need - Patients with arthritis report
  pain as the health status dimension where
  improvement is most desired.
• Response - ANP Led Pain Management Service
  (Appendix 1 RR 10, 11, 12 P. 90-122 )
• 6. Need - To develop, lead and support
  professional and academic development for nurses
  working in rheumatology
• Response - ANP Leadership and Development of
  Post-Graduate Multidisciplinary Education in
  Rheumatology (Appendix 2 P. 140).

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•     7. Need - To facilitate clinical and
  professional development of nurses working in the
  speciality of rheumatology
• Response Provision of both formal and informal
  clinical mentorship, leadership and education  

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Service Need and Core Concepts

• Autonomy, expert practice, pioneering
• professional and clinical leadership, and
• research reflected within
• Protcols for practice and
• Policies for intervention for each identified
  service need

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Policy/Protocols for Clinical Activities

• Each specified clinical activity has a
  documented
• Policy statement on practice (clinical prctice)
• Process of referral (flow chart)
• Protocol for referral
• Protocol for ANP intervention from assessment to
  discharge (for each clinical episode) including
  need to document all activities.

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Review of Job Descriptions

• With the ADoN
• Staff Nurse
• CNS
• ANP

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Site Preparation

• Lots of areas of site preparation documentation
  intermingled with describing job from identified
  service need
• Service plans
• Guidelines for practice
• Service developments (Pt nos, new treatments,
  service commensurate with centre of excellence)

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• Identified healthcare need
• Laws rules regulation guidelines
• Vicarious liability
• Collaborative guideline development
• Determine patient benefits
• Consistent with service philosophy
• Project how change will meet service need
• Role definition within nursing framework
  responsibility,accountability, levels of
  authority
• Resource implications

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Projected Patient/Service Benefits
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Person Specification
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Competencies

• Participated indefining work role
• competencies of nurses and allied health
• professionals in rheumatology in UK

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Other Core Concepts

• Pioneering professional and clinical
  leadershipRole development
• Role expansion
• Inservice education
• Third level educationProfessional Organisations

• Researcher
• MSc publications (2)
• International poster presentations (2)
• Invited to join international research group (Pt
  perceptions)
• Scope of practice publication (joint injections)
  WIN
• Rheumatoid Arthritis (WIN)
• RCSI Role of CNS rheumatology

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My conceptual difficulties

• Didnt appreciate that elements of job
  description could be worked towards
• Unequal emphasis on core concepts of role ie
  clinical practice dominated discussions (akin to
  medical model)
• Lack of directive on time allocation to role
  maybe good or bad thing
• Job title during process (CNS) term nurse
  practitioner does not appear anywhere in
  professional documentation
• ? Title ANP exclusive to those accediated

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ANP 06 October 2003

• Time management challenging
• ? How much clinical time 30- 50
• Keen to lead development of other CNS and ANP
  posts in rheumatology
• Re-accreditation
• Huge paper work in process

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Thank You