Nursing in Remote Island Settings Elaine Peace Director of Nursing, Midwifery and Allied Health Professions NNS Orkney

Primary and Community Care in Orkney Orkney Population 21,349 (2011 Census) Orkney Mainland 2 Community Nursing Teams linked to 5 Orkney Mainland GP Practices Integrated Care Team 17 inhabited isles without land access to Kirkwall 3,300 people on isles 10 Isles Practices 4 single handed GP Practices 6 single handed Nurse-led Practices Community Responders

The Recruitment Challenge Identify the vision – engage and involve Advertise the job – think outside the box Secondment opportunities Army discussions Flexible working patterns Local enhancements Recruitment opportunities prior to interviews Community supported visits to island Practitioners available to answer questions Reality of island life Clarity of Expectations Regular supervision Recognise isolation and support resilience Professional development Clinical support

Remote Reality Isles communities Community Engagement in Recruitment Passionate Strong sense of ownership Resilient Each community different Different solutions to different challenges Populations 60 - 650 Community Engagement in Recruitment Communities created information packs for applicants Community orchestrated visit to their island and hosted the applicants Community representative on interview panel Expectations – community solutions

Evolving Model of Care 6 smaller islands Advanced Nurse Practitioners 24/7 Visiting GP services from individually linked General Practices Two week on/off rota Travel and accommodation included Training and development time Recruited into an informal team of mutual support (INOC) 4 larger islands with single handed GPs, Community nursing 24/7 – band 5/6 Community first responders Videoconferencing - INOC Isles practitioners linked by weekly VC meeting Review of all admissions SEAs and incident reviews Professional and Administrative Issues

(N)INOC Training Programme Core skills and competencies Competency framework Training needs assessment Emergency, practice and community nursing skill set Clinical examination skills Prescribing BASICS Long term conditions, mental health and paediatrics Palliative and end of life care Local education and national VC programmes Emergency Care Training EMRS / Paediatric Retrieval Outreach Training Regular scenario and fire drill training

Professional Development and Retention Competency framework CPD built into working time model Local delivery through HEI providers eg: ACES ALERT Non-medical prescribing Clinical supervision Shadowing Challenges of backfill Add Scenario training picture

Sustainability Challenge Community Nursing Posts Variability Grades and competence “2nd Class” perception Difficult to recruit to Lifestyle choice Isles Generic Support Workers New model Unknown outcome Test and try

How are we doing? Visionary Not necessary a lifestyle choice Advertise the opportunities – professional development, secondments Opportunities of flexible working Involve the community Manage expectations Early contact with a practitioner Recognise limitations of pool Prepare for gaps Opportunities to grow your own

The Future Evolving process Integration and opportunities for new models of care Strong Clinical Leadership and supervision Create a Vision for nursing Creating a supportive, cohesive integrated system Robust training and development opportunities Anticipation and preparedness for ongoing change and challenges One size will not fit all......But that’s ok!