Creating and implementing a model of care for an acute care Advanced Nurse Practitioner within Colorectal Surgery Imogen Fecher Lower GI ANP

ANP: Drivers for Change EWTD (DOH 2009) Reduction in numbers junior doctors Reduced surgical training opportunities Increased patient acuity Shortening lengths of stay Increasing pressures on nursing staff

Background First NP’s graduated 1992 Role developed within primary care 2002 first RCN guidance on NP role 2008 RCN Advanced Nurse Practitioner competency document 2011 ANP’s throughout primary, secondary and tertiary settings

ANP Definition “ A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master's degree is recommended for entry level” (International Council of Nurses 2001)

SGH Colorectal Team Cons SPR FY1 SHO FY1 SHO FY1 ANP CSN LEAD GI CNS Cons

Junior Doctors Survey Results April 2010 FY1’s working hr weeks SHO’s finish late 4 out of 5 days 1-2 ward rounds a week carried out by SHO and FY1 alone None of juniors able to attend all teaching available SHO’s only able to attend treatment centre theatre once a month

Expanded practice roles identified by junior doctors as potentially beneficial Prescribing Discharge facilitatation Unwell patient assessment X-ray ordering ABG;s Colonoscopy requesting

Advance Practice Qualification MSc Level Examination and History Taking Non Medical Prescribing Advanced Communication Skills Venepuncture and Cannulation Male Catheterisation Advanced Life Support Interpretation of ECG’s Training Qualification’s and training required for ANP to undertake expanded practice

Expanded Scope of Practice Prescribing intravenous fluids where required for pre and post operative patients Writing discharge summaries and TTO’s Assessment and management/escalation of patients who have activated the “Modified Early Warning System” (MEWS). Requesting chest and abdominal x-rays. Requesting colo and flexi sigmoidoscopies as directed by a consultant. Taking of Arterial Blood Gasses

April – December 2010 SMART Objectives Time table Extended Practice documents Governance Training Assessment Competence

Repeat doctor survey FY1’s working hour weeks SHO late finish 3 out of 5 100% senior cover onward rounds Juniors able to attend most of teaching available SHO’s attending treatment centre theatre up to three times a month ANP role found to benefit team

Challenges Junior doctor change over Division expectations Line management

Future Challenges Audit to monitor expanded practice, junior doctors working hours, patient satisfaction. Introduction of ANP’s into other surgical specialities at SGH 24 hour ANP service

Conclusion An ANP can provide a range of extended roles previously provided by the junior medical team The addition of an ANP to colorectal surgery benefits patient’s, doctors and nurses Further work is needed to audit: –Clinical impact of the expanded practice –Patient satisfaction

References Department of Health (2009) The European Working Time Directive - UK notification of Derogation for doctors in training. International Council of Nurses (2001) Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife Prescribers. Royal College of Nursing (2008) Advanced Nurse Practitioners: An RCN guide to the Advanced Practitioner Role Competencies and programme accreditation. RCN Advanced Nurse Practitioner Forum