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

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Advanced Nursing PracticeDeveloping an Advanced
Nurse Practitioner role in mental health

• Gordon Lynch
• Advanced Nurse Practitioner
• Child Adolescent Mental Health
• HSE Kildare

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

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Advanced Nursing PracticeDeveloping an Advanced
Nurse Practitioner role in mental health

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

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Developing an Advanced Nurse Practitioner Post

• Professional Practice within Services.
• Baseline of CNS posts
• Desire to develop clinical Career pathways
• Leadership for Clinical Practice

• Awareness of expertise within nursing cohort
• Logical progression
• Service needs

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Benefits / Challenges for Service

• New Level of nurse practice
• Expanded scope of practice
• Increased autonomy
• Development of nurse expertise
• Better quality service for clients

• Commitment needed to develop post / post holder
• Risk management
• Ongoing supports / development for post
• Growing scope of post

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How to --

• Decide to develop post
• Research service needs
• Consult NCNM documents
• Consult with other areas who already have ANP
  none in Mental Health!

• Seek wider support- MDT Human Resources
  FinancialLegal
• Begin Site preparation
• Begin paperwork trail
• Drive process!

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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

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Director of Nursing - ? How was it for you

• Time consuming!
• Challenging
• Exciting
• Frustrating
• Never ending
• Rewarding
• Great sense of achievement

• Learn from colleagues
• Get paper work together
• Pursue HR / Finance
• Get important stakeholders on side quickly CD,
  Admin Manager, LHO etc.,
• Dont take no for an answer!

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Practical Steps 1

• Prepare Business Case show service need
• Develop Job Description / Person Specification
• Demonstrate benefits of post
• Get Form A completed and signed off properly
• Get position Number
• Get approval to have this as a completely new,
  fully funded post

• Develop scope of practice
• Identify spectrum of referrals
• Identify sources of referrals
• Clarify system for catagorising referrals
• Clarify what constitutes inappropriate referral
• Clarify range of ANPs own work / approach
• Get Scope of Practice signed off by Management
  Team HSE and Clinical Team

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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.,

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Practical Steps 3

• Meet with stakeholders
• Keep actively in touch with relevant personel
• Drive process
• Identify roadblocks remove or renegotiate
• Invest in education / training to improve
  portfolios

• Identify potential candidate(s)
• Work with them to develop ideas / prepare
  portfolio
• Provide practical supports / facilitate candidate
  in preparation
• Research and adopt framework for post

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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

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Advanced Nursing PracticeDeveloping an Advanced
Nurse Practitioner role in Mental Health

• Gordon Lynch
• Advanced Nurse Practitioner
• Child Adolescent Mental Health
• HSE Kildare

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Summary of presentation

• Personal background
• Service Description
• ANP Post Position
• Separate
• Related
• Mirror each other

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Personal Backgroundtraining

• Late to Nursing
• Psychiatric Nursing (St Lomans Hospital, Dublin)
• Counselling (Maynooth)
• Management
• Child Adolescent Analytic Psychotherapy (TCD)
• Solution Focussed Brief Therapy

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Personal Backgroundprofessional

• Residential Child Care
• Adult Mental Health. Training Staff
• CA Mental Health. Staff Nurse
• Assistant Co-ordinator Co-ordinator CA
  Residential Treatment
• a/ACNO (ADON) CA Psychiatry
• Return to Clinical
• SN CNS - ANP

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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

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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

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The Service
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The Service
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Range of Referrals

• Emotional, Behavioural, Psychological,
  Developmental Psychiatric Issues
• Significantly Impacting on Functioning

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The Problem

• Waiting list - One Year plus and growing
• Dissatisfied Clients
• High rate of non-attendance
• Dissatisfied Referral Agents
• Low Staff Morale

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The Proposal

• Proposal to MDT
• Utilising Advanced Nurse Practice
• Triage and Therapeutic Assessment
• Solution Focussed
• Client Centered
• Maximise Initial Contacts
• Accessible to Stakeholders

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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

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Agreed Plan (ref to other service, review,
discharge)
MDT Referral Meeting
Specialised Stream
Allocation to MDT Member (Can be ANP)
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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

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Number of Referrals and Waiting times
The likely waiting time for the 62 awaiting
appts at the end of 2003 was 51 weeks
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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

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IDENTIFICATION OF NEED

• Service Users
• Stakeholders / referral agents
• Service
• Organisation

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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

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The Post Job Description

• Job Title
• Specific, descriptive but not constricting
• Grade Hours
• Reporting Relationships
• Professional
• Clinical
• Location (Site, service HSE Region)
• Background
• Purpose

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The Post Job Description continued

• Clinical Practice
• Autonomy
• Expert Practice
• Professional Clinical Leadership
• Research
• Qualifications
• Experience
• Competencies
• Core
• Specific
• Terms of Service

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The Post Material support

• Accomodation
• Admin Support
• IT Communications
• Budget
• Literature
• Education
• Other

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Position Developing the Portfolio

• Candidate Requirements
• General - NCPDNM criteria
• Specific - Need to match the post

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NCPDMN criteria

• Registration
• Masters
• Post Registration Experience
• 7 years
• 5 years specialist
• Supervision
• Competence advanced level demonstrate -
  context
• Continuing Professional Development

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Competencies

• Core Concepts
• Autonomy in Clinical Practice
• Expert Practice
• Professional Clinical Leadership
• Research
• Specific
• Qualifications Training
• Experience
• Continuing professional development
• Professional activity

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Scope of Practice

• Context
• Protocols
• Evidence base
• Supporting references
• Clinical Presentations
• Referral pathways In
• Referral pathways Out
• Clinical Interventions
• Be Comprehensive

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Portfolio dont 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

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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