1. Illuminating the Path: Becoming a Respiratory Nurse Practitioner
John Serginson NP Respiratory
Caboolture Hospital
RN BN MCN MNPS GD Nur Sc (crit care).
Rhona MacDonald NP Respiratory
Lung Health Unit Ipswich P&CHS
RGN, MNPS. 1

2. Outline Reflections on our different journeys from CNC to NP.
Themes, observations & lessons
A few of us talked about this topic last year & how the journey to being an NP brings hard earned lessons but the path is largely invisible to those who haven’t walked it and so that may put off potential candidates.

3. 2008 Planning model of care , DON $ 2010  Appointed to NP role
1990 – CCU / ICU RN/CNC/ Edu
MCN. QH NP scholarships
Scholarship 
QUT
Planning model of care , DON $
2010 
Appointed to NP role
Resp NP project Caboolture H
Practice Scope approved.
2009 UQ MNPS. DON Exec Dir →$
2000 TPCH Thoracic CNC
Dynamic practice, clinical leadership, professional efficacy.
Critical success factors
Vision: unmet needs: Pts & health service. “NP shaped hole”
Supportive mentors: find & develop
Supportive executive: $ & professional
Clinical & professional credibility

4. Potholes NP in role: Clinical training Academic study
support, funding, scope, access, autonomy, integration & outcomes.
Potholes
Limited referrals
Confidence > competence
Clinicians don’t share vision
Lenient mentor
NP Candidature
Recurrent funding
Model development
Clinical training
Shared clear vision
Service shaping
Academic study
Limited autonomy: NP works as CNC
No NP role
Physicians write & control model
Exec doesn’t $ support vision
Unable to complete clinical training
Role developed to meet physicians’ needs:
Scope limited by physicians’ (NP does what they did as a CNC).
Conceptual model for service developed separate to Executive / DON.
Model based around skill set / interest of candidate vs service needs .
↓ NPC expertise in clinical leadership to recruit executive support, strategically develop and implement the model.
Unclear need, model, skills or knowledge
No clinical support
Study without candidature.
Pre NP candidature

5. Evolution of Clinical Reasoning
CNC
Strategies developed with pts , Communicate → specialists in team to discuss findings / suggest changes.
Focused on resp. issues, symptom impacts & support needs.
Diagnosis & Mx plan clear →
Assess, educate, support, behaviour
Patients are undifferentiated.
→ Assess (Hx, PE, tests) → Diagnose / clarify Dx NP
Resp. focus & other issues found:
address or refer each.
Develop MX plan.
Communicate →physicians / GPs outside team: evidence to support recommendations.
Follow your process, keep open mind, consider DDx but avoid early fixation.
Tests: when to & when not to, risk vs benefit, cost verses utility, false positive & false negatives & confounders.

7. Primary & Community Health Service (Ipswich)
Employed as a CNC within Lung Health Service
Completed NP course in June 2010
Employed as NP from February 2011
How to add value to our existing service?
How to change from CNC to NP?
How are the staff in our service going to respond?

8. Service looked at: ED presentations with asthma N= 605 in 12 months
No formal follow up for patients who presented
Some presenting to ED several times
Strain on ED & the hospital
Ipswich general has 341 beds (soon to be 431)
Significant numbers in rural locations (could benefit from home visits but too far to travel).

9. Resp NP Patients Rapid access asthma clinic Rural clinics
Smoking cessation clinics
Patients referred from no formal diagnosis (request & interpret investigations).
Patients referred from physician teams for action plans
Commencing appropriate medications
Problem solving with lung health team

10. Rapid access Asthma clinic:
Weekly clinic: 14 patients per week.
referrals from ED, GP or wards
also phone or write to all ED visits in month.
SB nurse practitioner
Investigations ordered (spiro, CXR, bloods as needed)
Medications ordered or adjusted
Action plans completed
IF NP can gain control (NP patient only)
If issues: S/B specialist for further investigations & follow up

11. Rural clinic 3 rural hospitals in district 1 clinic / month at each
Generally more severe patients
Referrals from main hospital, GP, rural hosp.
May not have definite diagnosis (patients need work up)
Clinic done with exercise physiologist: modified exercise programs can be done up.

12. Value Add by NP within service

13. How to change CNC to NP 2-3 yrs of hard work Think holistically
Work autonomously
Take your team with you
Good communication with all

14. Hurdles & stress PBS versus LAM (QH List of approved medicines)
No provider number for state (Qld Health) funded NPs
Unable to refer out from Qld Health
Poor understanding of the NP role

15. End of day stress relief.

16. Does your service need one of us?