1. Advanced Neonatal Nurse Practitioners (ANNPs) Neonatal Unit, Queen’s Park Hospital Joanne Gent,Andy Grady, Jack Best

2. 13 November 2004ANNPs2 Introduction History of ANNPs ANNP Training Entry requirements Course contents The role of the ANNP in Blackburn Clinical procedures SHO / ANNP timeshare! The team

3. 13 November 2004ANNPs3 History of ANNPs USA: Certification began in 1983 Reason: an expected shortfall in medical staff UK: First course approved in 1992 Southampton University - ENB A19 Reason: increase & maintain quality of care available to neonates

4. 13 November 2004ANNPs4 History of ANNPs in Blackburn 1997 – desire to provide holistic nursing care & retain experienced nurses in the clinical field – 1 nurse seconded 2001 – need to reduce no. of GP trainees – 1 nurse seconded 2003 – EWTD – 2 nurses seconded 2004 – establishing ANNP team – 1 nurse seconded, recruiting more

5. 13 November 2004ANNPs5 Course Entry Requirements Current registration with NMC ENB 997/8 or equivalent ENB 405 or equivalent Minimum 4 years neonatal experience Undertake 12 week pre-course biomedical science learning package Pass MCQ entrance exam & interviewMCQ entrance exam

6. 13 November 2004ANNPs6 ANNP Course 15wk intensive theory = 3yr pre-med (biochemistry, physiology, embryology, pathology, radiology, pharmacology) Exams – MCQs, short answers & essay @ 18, 23 and 37 weeks182337 Continuous clinical assessment & competency evaluations Viva voce @ 52 weeks ANNP certification (+6m for dissertation)

7. 13 November 2004ANNPs7 Role of ANNPs in Blackburn (1) NICU based practitioners Work alongside and support SHOs Attend high risk deliveries & emergencies on CDS and in theatre Ongoing medical management Attend postnatal wards for reviews and emergencies

8. 13 November 2004ANNPs8 Role ANNPs in Blackburn (2) SHO induction, support & guidance Link person between medical & nursing staff Promote evidence based medicine / best practice Teaching Guidelines & protocols Audit Research

9. 13 November 2004ANNPs9 Clinical Skills (1) Advanced resuscitation of newborn Examination of the newborn IV cannulation / venepuncture Arterial cannulation / stabs CBG sampling & interpretation Intubation Initiation & management of ventilation Surfactant administration

10. 13 November 2004ANNPs10 Clinical Skills (2) Insertion of UACs / UVCs Insertion of percutaneous central lines Lumbar punctures Supra-pubic bladder aspirations Insertion of chest drains / needle aspiration Ordering laboratory investigations & x-rays and interpretation of results

11. 13 November 2004ANNPs11 SHO / ANNP Timeshare Need for all to acquire & maintain skills Mon – Fri: 0830 – 1630 NICU SHO ‘in charge’, ANNP supports 401 bleep held by PN ward SHO Mon – Fri: 1630 – 2045 401 bleep held by ANNP Sat – Sun: 0830 – 2100 ANNP ‘in charge’ on NICU SHO goes to PN ward & holds 401 bleep

12. 13 November 2004ANNPs12 The Team…so far Joanne Gent RGN ANNP Andy Grady RGN, RM ANNP Jack Best RSCN ANNP

13. Any Questions?

14. 13 November 2004ANNPs14 Example Entrance Exam Questions True or false ? The metabolism of glucose (C 6 H 12 O 6 ) to CO 2 and H 2 O is an example of a catabolic reaction In double stranded DNA guanine and cytosine are complementary base pairs All vitamins are easily dissolved in water Sucrose can be hydrolysed into two glucose molecules A hexose monosaccharide has six carbon atoms

15. 13 November 2004ANNPs15 Example Wk18 Exam Questions True or false as before Explain the ionic basis for the generation of nerve action potentials and the mechanisms by which they are transmitted along unmyelinated and myelinated nerves Write short notes on ventilation perfusion matching A 6 hour old full term infant has been found to be cyanosed by the ward midwife. Briefly describe how physical examination might help in determining the cause

16. 13 November 2004ANNPs16 Example Wk23 Exam Questions True or false questions Outline the histology of the conducting airways. How does this differ from the histology of the alveolar sacs? Describe the control of cardiac output Using protein as an example differentiate between oral and renal solute load Write short notes on the causes of anaemia in the first month of life

17. 13 November 2004ANNPs17 Example Wk37 Exam Questions True or false questions A 28/40 baby is noted to have signs suggestive of a PDA at 1 wk of age. Describe the characteristic clinical features of the condition in such a baby and explain their pathophysiological basis. Give an account of the investigations which may be used and outline the strengths and weaknesses of the therapeutic options Describe the structure of the mononuclear phagocyte system and briefly explain its function