Eileen Furlong

1. Eileen Furlong School of Nursing & Midwifery University College Dublin The Emerging Role of the Advanced Nurse Practitioner 16th October 2004

2. Objectives • To provide background information • To outline the development of an educational framework for advanced nursing practice • To present the framework process • To consider the role of the advanced nurse practitioner in cancer care

3. Historical Review • Development of specialist and advanced practice roles • Increase in knowledge and educational reforms • Technological advances • Service need / public need / economic forces • Desire by nursing to develop its full potential in service provision

5. Clinical Career Pathway Advanced NursePractitioner Registered Nurse Clinical Nurse Specialist (Government of Ireland 1998)

6. Influences • Department of Health and Children • An Bord Altranais • National Council for the Professional Development of Nursing and Midwifery • Nursing and Midwifery Planning and Development Units • Reports

7. European Working Directive on Medical Manpower Hanley & Brennan Medication Management Cancer Nursing Cancer Strategy Quality and Fairness

8. How I Became Involved • Interest • Persistence !! • Curriculum work (2000 onwards) • London City University (March 2001) • Summer in Penn (2001) • Started programme (Sept 2001)

9. MSc Nursing Programme UCD • Advanced Practice • Clinical • Education • Management • Public Health

10. Core Modules on Masters Degree: Theory & Practice Advanced Research Leadership & Management CQI MSc Nursing (Advanced Practice)

11. Advanced Practice Modules: Pathology Physiology Physical Assessment Pharmacology Case Management Clinical Practicum MSc Nursing (Advanced Practice)

12. Speciality Areas Adult / Paediatric • Oncology / haematology • Critical care • Palliative care • Primary care / community nursing • Emergency / diabetes / renal nursing • Dermatology /Gastro–intestinal nursing • Stroke care

13. Current Status - UCD • 4 graduates • 3 due to finish next month • 16 on programme currently • No one yet accredited from UCD programme • UCG commenced programme in Jan 2002

14. Current Irish Status • 14 accredited • Emergency • Sexual Health • Rheumatology Map of ireland to go here

15. Current Irish Status • Refers to nursing practice that focuses on the client and situations which enhance positive outcomes for the client, family and community (Hamric et al. 2000) • Advanced nursing practice is carried out by autonomous, experienced practitioners who are competent and responsible for their own practice (NCNM 2001)

16. Advanced Nurse Practitioner (ANP) • “ANP’s promote wellness, offer healthcare interventions and advocate healthy lifestyle choices for patient / clients, families and carers in a wide variety of settings in collaboration with other healthcare professionals according to an agreed scope of practice guidelines” (NCNM 2001)

17. ANP Involves • Specialisation, expansion and advancement • Higher skill and knowledge to allow for the adoption of independent and autonomous roles • Clinical practice that focuses on direct clinical care…emphasis is on experiental development of competencies, underpinned by theoretical knowledge

18. Core Concepts Expert practitioners Pioneering professional & clinical leadership ANP Autonomy in clinical practice Researcher (NCNM 2002)

19. Differentiation(Commission on Nursing 1998) Advanced Nurse Practitioner: Clinical Nurse Specialist: • Higher level that CNS • MSc – theoretical & clinical modules • Extensive experience & advanced expertise • Works independently in collaborative role • Conducts research • Beyond level of initial qualification • (H.Dip/Post Graduate Dip) • Experience & expertise • Work with interdisciplinary team • Research utilisation • Teaching/advisory

20. MAY 2001

21. Criteria for ANP • Registered nurse • Masters Degree or higher • 7 years post registration • 5 years in speciality area • Supervised practice • Demonstrate competencies • Evidence of professional development (www.ncnm.ie)

22. ANP Establishment Process Part 1. Organisational Application Approval of Site Preparation and Job Description Part 2. Individual Application Accreditation of ANP

23. Site Preparation- Organisational • Identify healthcare need to be addressed • Understand laws, rules, regulations and guidelines governing nursing practice • Accept the legal principle of vicarious liability • Ensure good practice guidelines are developed collaboratively • Determine the patient / client benefit from ANP service

24. Site PreparationApproval • Service to be consistent with organisational philosophy • Project how change will help to meet the service plan • Consider optimal location of service • Consider integration into MDT • Define role content • Identify resource implications

25. Job Description Approval • Job title • Grade • Reporting relationship • Location • Background to post • Specific factors • Purpose of post

26. Part 2 Process for Accreditation • Application form • A professional portfolio demonstrating extensive experience, knowledge and skills in the context of practice in which the accreditation is sought in line with National Council criteria • Accreditation valid for 5 years • Non-transferable

27. Role Development • Definitions • Core concepts • Responsibilities • Framework • Scope of practice • Literature

28. Setting Your Own Agenda • ANP role – grounded in nursing theory ensuring holistic practice • Role development must occur in the context of service need and be established within the framework of the service plan

29. Challenges Ahead • AA process • Role development in cancer nursing • Competencies • Outcomes research (quality and cost) • Accessibility of programme • Evaluate educational framework

30. Contribution to Cancer Nursing

31. Email eileen.furlong@ucd.ie Webwww.ucd.ie/nursing Webwww.ncnm.ie