Caring the Gloucester Way using the right person for the job

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Caring the Gloucester Way using the right
person for the job

• Karen Easton
• Consultant Nurse in Gynaecology
• Gloucestershire Royal Hospital NHS Trust

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(No Transcript)
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Who did what - history

• Doctors
• Lead Healthcare
• Dr to Dr Referral
• Responsible for decision making
  diagnosis
• Admission Discharge
• Clinical diagnostic skills

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Who did what - history

• Nurses
• Hierarchy
• Nursing tasks care to all patients within
  their unit
• Limited decision-making
• Consultant / medical
• staff led admission
  discharge, in primary secondary care

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Who does what now 1

• Doctors
• Oversee care and lead complex care delegate
  care to advanced nurses
• Dr to Nurse referral including GPs
• Involve nurses much more in decision making and
  manage advanced nurses workload on a day to day
  basis
• Clinical diagnostic skills
• Admission discharge

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Who does what now 2

• Nurses
• Less hierarchy more autonomy. Advanced nurses
  give holistic nursing medical care to a
  designated group or groups of patients
• Referral is - Nurse/ midwife to Nurse, GP to
  nurse, Consultant to nurse nurse to Consultant
• Advanced Clinical diagnostic skills teach
  junior medics
• Lead care
• Admission Discharge

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and why?

• Care is more responsive to patient need and more
  flexible
• Less reliant on Consultants who may have other
  duties
• More continuity of care (registrars have year
  long placements only)
• Good use of a valuable resource
• Patient choice
• Develop expert practice which is a good support
  to GPs and hospital staff.
• Better liaison between primary secondary care

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One Size?
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Getting There - Changing the Culture and
Professional Tribes

• Mapping of current working practices and
  comparing it to evidence
• Stakeholder meetings to map out changes and where
  the team wants to go with care planning
• Use other peoples experience to smooth your own
  path
• Try before you buy pilot everything!

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Changing the Culture and Professional Tribes 1

• Training of personnel to undertake new roles
  dont forget succession planning!
• Support the multi-professional team in the change

• MSc in Advancing Practice

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Changing the Culture and Professional Tribes 2

• Use good communication systems and keep all
  tribes informed of what is happening and what
  is expected of them at each stage
• Tell fellow staff in other units what you are
  doing, why and how it will affect them
• Write policies and guidelines for practice which
  pertain to all groups and are ratified by the
  local legal department and board.

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Solutions to Challenges in Practice

• Employ your driver first youll get nowhere
  without one!

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Solutions 1

• Fit the tribe to the job not the job to the tribe
• Involve the patients they can be your best ally

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Solutions 2

• Development of Unit Guidance and development of
  Nurse Prescribing
• Use recognised and tried tested training
  courses

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Solutions 3

• Invest in your people they are your most
  valuable resource they will repay you tenfold
• Dont forget the administrative support must be
  multi-disciplinary too

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Share Good Practice

• Show it works by talking about it
• It encourages others and saves re-inventing the
  wheel

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Summary

• Plan well
• Implement with staff and patient involvement
  (ownership)
• Invest in the people
• Share practice
• Plan for the future

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Good luck the cheese is out there!
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Thank you for listening

• Suggested Reading
• Easton K Burns N (2001). Crossing the
  professional boundaries. (Experience of 2
  advanced nurse practitioners in sharing the
  duties of an obstetric and gynaecology senior
  house officer). Nursing-Times. 2001. 12 Apr.
  97(15). p42-3.
• Easton K, Read MD, Woodman NM (2003). Influence
  of early discharge after hysterectomy. Patient
  outcomes and GP workloads. Journal of Obstetrics
  and Gynaecology. May. Vol. 23. No. 3. PP 271-275
• Easton K, Griffin A, Read MD, Woodman N (2004).
  Can an advanced nurse practitioner take on the
  role of senior house officer within a specialised
  area of practice an evaluation. Journal of
  Obstetrics Gynaecology. Volume 24, Number 6 /
  September 2004. pp 667 - 674