1. A Guide to Enhance ANP Nursing Services across Emergency Care Networks (2013) Project Update National Emergency Medicine Programme Seminar 2016 Valerie Small RANP Emergency Department, St James’s Hospital, Dublin ANP Advisor – National Emergency Medicine Programme

2. Introduction –Context of ANP Role –Key Objectives of ANP Strategy –Current Status / Service Activity –Patient Caseload –Next Steps

3. Context Advanced Nurse Practitioner Role Established St James’s Hospital 1996 Commission on Nursing recommended career pathway 1998 Variable development over 10-15 years National Emergency Medicine Programme Strategy (2012)

4. ANP Strategy (June 2013) Key Objectives Provide guidance on optimum number and location of ANP’s required in EDs/LIUs Standardise role profile and scope of practice Standardise recruitment and education requirements Support continuous professional development needs of ANP’s Sustain established ANP services through career and succession planning support

5. At a Glance Capacity Capability Caseload In Development NO SERVICE DEVELOPED In Development

6. Capacity 25 nurses undertaking education 52 nurses required to be recruited to education/career pathway 12 3 78 Registered ANPs (150 Total) 33 Established ANP Services (39 Units) ANP Specific CPD Education Study Days (6) National ANP activity data set Nurse Prescribing Ionising Radiation in Children (2015) 27 (28) EDs 6 (11) LIUs Standardised ANP Job Descriptions Standardised ANP candidate grade code to support recruitment ANP Forum Established

7. Capability Role changing expanding and increasing in levels of complexity & responsibilityRole changing expanding and increasing in levels of complexity & responsibility –Medicinal & ionising radiation prescribing –X-Ray referral (children approved) –Strong collaborative working with MDT –Commitment to CPD & innovation in clinical practice

8. Service Activity 70,000+ patients managed by ANP’s in 2015 Average 14-16% of total new ED patient attendances Hours of Service mainly 8.00am-20.00hrs Triage Cat 4= 60% Triage Cat 3= 21% Triage Cat 2= 3% 90% pt seen within recommended Manchester Triage times Average time from consultation to discharge 52mins Average PET = 93mins

9. Caseload /Patient Profile

10. Musculoskeletal Injuries

11. Initial Fracture Management ED Fracture Reviews

12. Head & Facial Injuries

13. Max Fax/Dental Trauma

14. Skeletal and Soft Tissue Injuries

15. Reduction of Fracture / Dislocations

16. Management of Soft Tissue Infection

17. Complex Wound Management

18. Specific Hand Injuries

19. Expanding Scope of Practice Medical & Surgical conditions Non-cardiac chest pain ENT conditions Hip fracture

20. NEXT STEPS! Workforce planning/Service needs analysisWorkforce planning/Service needs analysis Recruit & Train 52 additional ED nurses to continue capacity buildingRecruit & Train 52 additional ED nurses to continue capacity building

21. SO FINALLY !! WHAT ABOUT THOSE MIN RS !!