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Assistant Practitioners (AP’s) Our story….. Kate Howard Deputy Director of Nursing, AHP’s and Quality. Background. What does NHFT do: 4,500 staff 1800 health professionals 800 Bands 2 – 4 clinical staff
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Assistant Practitioners (AP’s)Our story…..Kate HowardDeputy Director of Nursing, AHP’s and Quality
Background • What does NHFT do: • 4,500 staff • 1800 health professionals • 800 Bands 2 – 4 clinical staff • Multi functional sites across the county delivering the following services under 3 pathways: child, adult and specialist
Background Specialist Adult and Children ICT District Nursing Community Beds Palliative care in-patient and Community Frail and older persons hub Rehabilitation Child mental health in- patient and community Children’s community Service Looked After Children • Mental Health in-patient and • community • Learning disability in-patient and • community • Forensic in-patient and • community • Crisis (MH) • Early intervention in psychosis…. • Prison health • Rehabilitation
Background • Current Assistant Practitioner Workforce: • 3 x community hca’s (qualified in 2013); one now accepted • onto pre registration • 3 x hcas’s (1 x Mental Health, 1 x support worker: schools, 1 • x community nurse) just about to qualify • 5 x hca’s (1 x mental health, 1 x community, 2 x Learning • disability, 1 x specialist services) commenced in 2014
Challenges… • This AP process was not without its challenges (or chaos) • the key ones for NHFT : • Staff buy in • Concern that band 5’s will be at risk • Accountability • Safety • Role and responsibility • Training support – difference in ability • Band 4 job availability
Role and Responsibility Issues Outcome - A robust job description based on RCN guidance and examples from other Trusts - Clear identification of what a band 3, 4 and 5 does, what skills are needed (what is the difference) - Educating those supporting/ employing band 4’s around accountability, skill maintenance and accountability • -What does a band 4 do? • -Competence in the • community work force (band • 3’s currently doing a hugh • amount of independent, • advanced work) • -Who’s responsible for the practice? (linked to accountability)
Staff Buy In Issue Outcome - Education, discussion and regular bullet in’s - Looking at developing the workforce via transformation and consultation - Job descriptions which give distinct responsibilities to bands 4 and 5 • - Why do we need band 4’s • - What will they do? • - Are we going back to the • old enrolled nurse programme? • - We have no posts available • - Will they replace band 5’s?
How it works in practice… • John was a 62 year old ex warehouse man whom over • the past 30 years had a series of cardiac events. However • 18 months ago at his appointment with a specialist • ‘heart’ hospital they had told him in no uncertain terms that • his heart could fail at any time. Because of the way this was • communicated John was anxious, and suspicious of health • professionals. • However John went home and carried on! • At home as John deteriorated it was obvious • that he needed District Nurse support – he refused, until it • got to a point where his wife was really struggling!
How it works in practice…. • The District Nurse went to assess him, he was hostile and • refused to answer any questions.. John stated he didn’t want • female nurses coming to see him! • However John’s need was so great in terms of blood tests, • vaccinations, equipment ordering, skin assessment, pain • assessment etc that he required someone with the skills and • experiences to visit as he could no longer get to the GP’s!
How it works in practice… • Luckily, we had a male trainee assistant practitioner • associated with the District Nurse Team. • Visit 1: TAP visit discussed rugby, football, and the TV from • last night! Engagement meant that without knowing it the • TAP was able to observe; how dry was the mouth? how • breathless was John when talking/ resting? How tired was • John? Skin integrity on hands and visible skin…What was • the social/ environmental situation?
How it works in practice…. • Visit 2: Discuss England football results, favourite films.. • Able to steer conversation into an assessment of need – • TAP able to find out about equipment needs, ADL’s and • Undertake SSKIN. Bloods taken… • Visit 3: Join John in the garden for a glass of juice, comment on the • cricket John is listening to on the radio, talk about the garden (picking up • some tips as John is a keen gardener!) Raise the issue of equipment • delivery dates – reduce John’s distress, try to reassure him that the • equipment is there to help him and not because he is deteriorating and is • losing his independence (a key anxiety).. John feels able to raise an issue • around incontinence.. TAP able to undertake an incontinence assessment and • referral…
How it works in practice…. • I hope you see the picture – the male to male engagement is • paramount, but the skills the TAP was learning/ had • learnt maximised the visits whilst maintaining John’s comfort • around only having a male practitioner.. I think this is a real • success story and I know it was a positive patient • experience for John and his wife. • Name and key details have been changed to protect confidentiality
What next… • Integration of more band 4 posts within the services. • Promotion of this pathway to our AHP colleagues. • Continued support of our current Trainee AP’s – providing • them with an optimal education experience. • On going development of the bands 1 – 8 education • pathway. • Evaluating how this fits with the DH Trailblazer programmes.
