Nurse Practitioners aren’t built in a day.

1. Nurse Practitioners aren’t built in a day. Anna Green Nurse Practitioner – ICU Liaison Nurse Practitioner Project Officer Western Health, Australia

2. Map of Australia Melbourne

3. Leadership core competencies Visionary Idea Energising Commitment Empowerment McLeod J. Leaders aren’t built in a day. Human Capital Issue 3.1: 24-27

4. ICU Liaison Nurse Role • Case-Manage patients post ICU discharge • Accept referrals for unstable patients • Rapid Response System - respond to clinical marker referrals

5. ICU Liaison hours worked • Two full time EFT • 7 day a week cover • 8am to 6pm • One day a week allocated to non clinical work • Research • Leadership • Education • Meetings/Committee • Working towards 24 hour service • Expanding service throughout the network

6. Leadership development Internal External 1996 1998 Self Leadership skills

7. Goal achievement Australia's First Critical Care NURSE PRACTITIONER 2004

8. Three Fundamental Problems Failure in planning Failure to Rescue Failure to communicate Failure to recognise deteriorating patient condition http://www.ihi.org

9. What is a Rapid Response System? ICU Liaison Team Medical Emergency Team Outreach Team MET & ICU Liaison Service

10. What are these warning signs? • Altered CNS • Fall in GCS of >2 points • Heart Rate >120 per minute • Systolic blood pressure <90mm Hg • Respiratory Rate >30 breaths per minute • Sa02 >90% on oxygen • Difficulty in breathing • UO <60mls for 2 hours • “Worried Staff” (Green & Williams 2006)

12. What difference Can a NP led Rapid Response Team Make? • Fast Track Patients to the ICU • Decreased cardiac arrest calls • Increased medical emergency calls • Improved survival for medical emergencies • +/- reduction in readmissions (Ball et al., 2003; Pittard, 2003) • +/- reduction in ICU patient mortality (Ball et al., 2003; Garcea et al., 2004; Priestly et al., 2004) • +/- decrease ICU LofS (Green & Williams, 2006)

13. Survey Responses Clear Guidelines Prompt Support ‘Back-up’ (Green & Williams, 2006)

14. Survey Response Disagreement with parameters Overstepping boundaries Increased workload for ICU MO Poor response from MO when called Further education (Green & Williams, 2006)

15. What extended practices do I need • Referral to ICU consultants • Ordering of diagnostic tests • Ordering of radiological tests • Limited prescribing rights • Admission / Discharge

16. ICU Liaison – extensions to practice Limited Prescribing Counselling Clinical Practice Initiate Diagnostics Admit / Discharge Management Policy Research Direct referral to Medical Specialists Education Conference

17. Reflecting on my achievements • Pioneered the ICU Liaison Role • Implemented Nurse-led Rapid Response Team • Australia’s 1st Critical Care NP • Published 5 Papers • National / International Guest Speaker • Founding Member of the Victorian NP Group

18. Future Endeavour's Expansion Succession Planning Victorian NP Group Australian Network

19. Concluding remarks: leadership tips for the Nurse Practitioner • Reenergize via successful results • Leave your comfort zone • Do not avoid conflict • Benefit the organisation • Recognise when change needs to occur and acting upon it