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

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

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 Historical Review

Registered Nurse Clinical Nurse Specialist (Government of Ireland 1998) Advanced Nurse Practitioner Clinical Career Pathway

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 Influences

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

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

Advanced Practice Clinical Education Management Public Health MSc Nursing Programme UCD

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

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

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

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 Current Status - UCD

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

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) Current Irish Status

“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) Advanced Nurse Practitioner (ANP)

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 ANP Involves

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

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

MAY 2001

Registered nurse Masters Degree or higher 7 years post registration 5 years in speciality area Supervised practice Demonstrate competencies Evidence of professional development ( Criteria for ANP

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

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 Site Preparation- Organisational

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 Site Preparation Approval

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

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 Part 2 Process for Accreditation

Definitions Core concepts Responsibilities Framework Scope of practice Literature Role Development

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 Setting Your Own Agenda

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

Contribution to Cancer Nursing

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