Advanced Nurse Practitioner ANP Role Development in Rheumatology

1. Advanced Nurse Practitioner (ANP) Role Development in Rheumatology Patricia Minnock Personal Account June 01- Oct 03

2. 2 Summary of Audit Trail 1998 - Eagerly awaited CoN Report 1998-2000 -Undertook Msc Nursing TCD 2001 June - Received NCNM Framework from DoN, Presented copies to consultants (CR), CEO and HR August -Spoke with K Macellan (NCNM) ?Where to begin September -Presented framework to CR, agreed to proceed and shared meeting outconme with DoN 2002 Jan - DoN sought advice from NCNM and stated intention to proceed with process

3. 3 Audit Trail of Process

4. 4 Support Groups Mentorship Group DoN, ADoN, Tutor (periodic meetings), Colleagues Medical Supervision Professor of Rheumatology (weekly discussion) Role Models 1. Site visit to SR Nurse Consultant in Rheumatology UK, Staffordshire (February 02) 2. SR invited lecturer @OLH 2-hour mentoring session 2003 3. Site visit to Sandra Delemare/Ann Cuffe SJH NCNM From Sept 02- Sept 03 regular exchange of documents and phone calls with NCNM 

5. 5 Janurary 2002-July 2002 Compiled document according to each heading sub-heading in framework Conducted site visits UK/SJH Submitted first draft August 2002

6. 6 Preparation of Job Description As per Appendix 1 in framework document Described current role as oppossed to vision for ANP role Background-specific details referenced from annual reports, strategic plans and meeting minutes in chronological order Geographic/demographic service details from annual reports, national reports, strategic documents

7. 7 Areas of clarification sought by NCNM Differentiate between role of S/N, CNS/ ANP Levels of decision making between 3 levels of career pathway Specifics of patient case load Mode of patient referral Vicarious liability Demonstrate link between service requirements and role developments Details of benefits to patient care

8. 8 Service need addressed by post  The post holder's remit is clinical leadership and development of quality patient centred services Supported by table sequencing nursing service developments from 1992-2003 Reference to relevant literature

9. 9 1. Need: -Patients with chronic rheumatic diseases have many secondary health education needs. The health education component of the ANP's role is central to the provision of a high standard of nursing care Response: ANP Patient Health Education And Clinical Support Sessions, which encourage empowerment of patients and families coping with a chronic disease (Appendix 1 RR 06, 07; P 81-85: RR 11, 12; P. 92-122) 2. Need: - Childhood and adolescent rheumatology services in Ireland are underdeveloped. Our Department of Rheumatology (SVUH and RR, OLH) provides the only adolescent rheumatology service in Ireland Response: - Optimise Patient and Family Care in the Adolescent Rheumatology Service (Appendix 1 RR 06, 07; P. 81-85)    

10. 10 3. Need: The advent of new biologic therapies in rheumatology has put a new and increased demand on an already very busy service. Monitoring disease activity as it relates to the therapeutic self care demands of this cohort of patients with refractory disease requires an expert practitioner with expanded clinical judgement skills Response: - ANP Review Clinics For Patients Prescribed Biologic Therapies. (Appendix 1 RR 08; P. 86-88). 4. Need: - Case management of patients with complex rheumatic conditions requires optimal and timely care. A complex case management clinic will reduce the number of elective admissions required by this specific cohort without compromising their management. Response: - ANP Complex Case Management (Appendix 1 RR 09; P. 88-91).

11. 11 5. Need: - Patients with arthritis report pain as the health status dimension where improvement is most desired. Response: - ANP Led Pain Management Service (Appendix 1 RR 10, 11, 12; P. 90-122 ) 6. Need: - To develop, lead and support professional and academic development for nurses working in rheumatology Response: - ANP Leadership and Development of Post-Graduate Multidisciplinary Education in Rheumatology (Appendix 2; P. 140).

12. 12     7. Need: - To facilitate clinical and professional development of nurses working in the speciality of rheumatology  Response: Provision of both formal and informal clinical mentorship, leadership and education  

13. 13 Service Need and Core Concepts Autonomy, expert practice, pioneering professional and clinical leadership, and research reflected within Protcols for practice and Policies for intervention for each identified service need

14. 14 Policy/Protocols for Clinical Activities Each specified clinical activity has a documented: Policy statement on practice (clinical prctice) Process of referral (flow chart) Protocol for referral Protocol for ANP intervention from assessment to discharge (for each clinical episode) including need to document all activities.

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17. 17 Review of Job Descriptions With the ADoN Staff Nurse CNS ANP

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19. 19 Site Preparation Lots of areas of site preparation documentation intermingled with describing job from identified service need  Service plans Guidelines for practice Service developments (Pt nos, new treatments, service commensurate with centre of excellence)

20. 20 Identified healthcare need Laws rules regulation guidelines… Vicarious liability Collaborative guideline development Determine patient benefits Consistent with service philosophy Project how change will meet service need Role definition within nursing framework responsibility,accountability, levels of authority Resource implications

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22. 22 Projected Patient/Service Benefits

23. 23 Person Specification

24. 24 Competencies Participated indefining work role competencies of nurses and allied health professionals in rheumatology in UK

25. 25 Other Core Concepts Pioneering professional and clinical leadershipRole development Role expansion Inservice education Third level educationProfessional Organisations Researcher MSc publications (2) International poster presentations (2) Invited to join international research group (Pt perceptions) Scope of practice publication (joint injections) WIN Rheumatoid Arthritis (WIN) RCSI Role of CNS rheumatology

26. 26 My conceptual difficulties Didn’t appreciate that elements of job description could be worked towards Unequal emphasis on core concepts of role ie clinical practice dominated discussions (akin to medical model) Lack of directive on time allocation to role = maybe good or bad thing Job title during process (CNS)= term nurse practitioner does not appear anywhere in professional documentation ? Title ANP exclusive to those accediated

27. 27 ANP 06 October 2003 Time management challenging ? How much clinical time 30%- 50% Keen to lead development of other CNS and ANP posts in rheumatology Re-accreditation Huge paper work in process

28. Thank You