1. The Challenges of Capturing the Impact of Advanced Practice Roles in Nursing Ann McDonnell, Kate Gerrish, Fiona Kennedy Faculty of Health and Wellbeing

2. Plan Background Why capture impact? What are the challenges? What would help?

3. Background Exploring new roles in practice (ENRiP) (Read et al 2001) Empowering frontline staff to deliver evidence based care: the contribution of nurses in APN roles (Gerrish et al 2007) 'Empowering nurse consultants to improve patient outcomes and the patient experience: the development of a toolkit for enhancing the quality of care' Ongoing study funded by Burdett Trust for Nursing

4. Why capture impact? Service development Benchmarking Current climate 'If we look at it from a cost effectiveness perspective, there are conflicting priorities.... who gives best value for money. With practice-based commissioning we need to look at this in more detail. GPs will want to know, ‘why do we have this person?’. There is a need for them to understand the role and also for some demonstration of effectiveness. We need some measures that show that they offer benefits and value.' Director of Nursing from Gerrish et al 2007

5. Challenges Diversity in terms of clinical speciality, scope, boundaries, ways of working Who are the stakeholders? Which areas of impact do they value the most?

6. Whose perspective needs to be captured? Impact on patients Impact on staff Impact on the organisation Impact at national level

7. What indicators should be used? Patients Staff Organisation National level

8. Dimensions of impact Direct Indirect Unintentional Immediate Intentional Delayed

9. What about lung cancer nurses? Where they felt an ‘impact ‘ had been made was up to and at the point of diagnosis in terms of providing advice, emotional support and information to patients at this difficult time. Patients valued both the emotional and practical support from the CNS at diagnosis, and support given to their families. Patients valued continuity and co-ordinated care, and the way the CNS facilitated care by which they could re-access the health care system. Patients valued the prompt and easy access to the nurse specialist provided in order to gain information, advice and support. This often provided over the telephone rather than face-to-face. They felt it was difficult to assess their clinical effectiveness, especially in terms of patient outcome, as there were few systems in place to audit this.

10. More challenges Do APNs have the skills to go it alone?

13. What would help? A framework A toolkit Watch this space! 'Empowering nurse consultants to improve patient outcomes and the patient experience: the development of a toolkit for enhancing the quality of care' Ongoing study funded by Burdett Trust for Nurisng

14. References

15. Any questions? a.mcdonnell@shu.ac.uk Faculty of Health and Wellbeing