Dr Kathleen Mac Lellan

1
Medication Management by Nurses and Midwives
Developments in Irish Nursing and midwifery to
support Advancing Practice

• Dr Kathleen Mac Lellan
• Head of Professional Development, National
  Council for the Professional Development of
  Nursing and Midwifery

2
The Irish Nursing Midwifery context

• 1900s Regulated, Current Act Nurses Act (1985)
  
• Historically no framework has existed for
  advancing nursing
• midwifery roles
• 1980 Working Party on General Nursing
  recommended that
• specialist nurses be developed
• 1998 Commission on Nursing
• 1999 Nursing Policy Unit within DoHC
• 2000 Scope of Nursing and Midwifery Practice
  Framework
• 2001 Frameworks for CNS/CMS and ANP/AMP
• 2001 Review of Nurses and Midwives in the
  Prescribing and
• Administration of Medicinal Products
• Mid 1990s-2002 Movement of registration
  education to diploma
• and degree level
• Await Nurses Bill

3
The Irish Health Context

• Life expectancy has increased at birth however
  life expectancy in
• Europe has increased at a greater rate
• Major causes of mortality cancer, circulatory
  diseases, injuries
• and poisoning (mortality rates for IHD, cancer
  and injuries higher
• than EU average)
• As our population grows there will be an
  increase in cancer
• morbidity
• Lifestyle choices (Slan 1999, 2003) highlight ..
  diet, alcohol
• consumption, exercise, smoking
• Inequalities in health status poverty,
  education, access to
• health services and environmental factors

4

• Health Strategy
• (Quality Fairness 2001)
• Health service undergoing major reform programme

5
Nurses and Midwives

• Nurses and midwives front line care givers
  responsive to a changing health context
• 60,774 Nurses and Midwives registered to practice
• Approximately 36,089 working in the health
  services in mainly public sector organisation

6
Clinical Career Pathway

• Staff Nurse
• Direct entry
• General
• Psychiatry
• Mental Handicap
• Staff Midwife
• Post-registration programme
• Pilot direct entry programme
• Clinical Nurse/Midwife Specialist
• Advanced Nurse/Midwife Practitioner

• Bachelors degree
• Higher/postgraduate diploma
• Diploma
• Higher diploma or above
• Masters degree

7
Definition of the Scope of Nursing Practice
The range of roles, functions, responsibilities
and activities that a registered nurse/midwife
is educated, competent and has authority to
perform
An Bord Altranais 2000
8
Clinical Nurse/Midwife Specialist
9
CNS Core concepts

• Clinical Focus
• Patient Advocate
• Education Training
• Audit Research
• Consultant

10
CNS/CMS Statistics
11
ANPs/AMPs

• Approved posts
• 1 Rheumatology
• 1 Diabetes
• 1 Primary Care
• 1 Breast care
• 1 Cardiology
• 17 Emergency
• 3 Cardiothoracic
• 1 Sexual health
• 1 Emergency cardiology
• 2 Neonatology
• 1 Oncology

ANP Evaluation Sept. 2005
12
Core Concepts of ANP/AMP

• Autonomy in clinical practice
• Professional clinical leadership
• Expert practitioner
• Researcher

13
EXAMPLECardiovascular disease

• Single largest cause of death in Ireland
• Chest pain major clinical presentation
• Heart failure affects 1-2 of population
• 22 Irish hospitals have a specialised service
  for heart failure patients

14
Advancing roles cardiovascular disease

• Staff nurse roles First line assessment and
  initiation of treatments
• CNS (Stroke care) x 4
• CNS (Chest Pain) x 9
• CNS (Heart Failure) x 9
• CNS (CPR) x 12
• CNS (Cardiac Rehabilitation) x 25
• CNS (Cardiac Disease Management) x3
• CNS (Cardiology) x 9
• ANP (Emergency Cardiology)
• ANP (Cardiothoracic)
• ANP (Cardiology)

15
Post Need Scope

• interpretation ECGs,
• bloods, cannulation,
• aspirin

Chest pain
Staff nurse Emergency
Education patients family Nurse-led clinics.
Telephone helpline Early detection clinical
deterioration
Prevalence 1-2 population
CNS Heart failure
7.5 attendees emergency depart. have chest pain
ANP Emergency Cardiology
Assess, diagnose, manage chest pain patient Risk
assessment health promotion Aspirin, oxygen,
thrombolytics
16

• Changing demographics
• Reduction of waiting times
• Patient/client choice
• Continuity of care

Review of Nurses and Midwives in the Prescribing
and Administration of Medicinal Products National
Conference Monday, 17 October 2005 at 9.00am in
The Alexander Hotel, Dublin 2
17
Examples of Nurse/Midwife Led Services

• Continence
• Asylum seekers
• Travelers service
• Midwives clinics
• School services
• Deliberate self harm liaison nurse
• Respiratory nurse clinic
• Behaviour therapy for persons with Intellectual
  Disability

18
Developments in nursing midwifery - future

• Responsive to need, patient benefits
• New models of care
• Working as part of multi-disciplinary team
• Career path with associated education
• Retaining clinical expertise at patient/client
  services
• Need to expand current functioning in medicines
  management to support holistic, timely and
  efficient quality care