2. Cora O Connor M.Sc, RNP, RANP. Chairperson Irish Association of Advanced Nurse and Midwife Practitioners IAANMP

3. Background Advanced Nurse Practitioners: the Irish Experience. 1996 Valerie Small St James’ Hospital 1998 Commission on Nursing ( A Blue Print For The Future) 2000 National Council for the Professional Development of Nursing and Midwifery in Ireland 2000 Mater Hospital 1 ANP candidate, 2013 4RANPs/1 ANP candidate 2001 Valerie Small First ANP (emergency) 2013 Nationally (100 RANPs in various specialities)

5. Context Emergency Department Mater Hospital 48,000 Patients Annually 20% present with a minor injury/illness Challenges ANP Service Within the Department (5,000 pts) Innovation Funding Health Service Executative Location

6. The Journey 1st Meeting Jan 2010 Participants (16 attendees) IT/telephones/housekeeping/pharmacy/security/lab x-ray/transportation/stores/clinical indemnity/data protection Pilot study for 6 months

7. Pros Designated Location for the Care of Patients Presenting with Minor Injuries Recognition of the Benefits of ANP Service Alleviating the Numbers Presenting to the Main ED Ensures Appropriate Use of the Emergency Department Off Site Direct Access to the Mater Hospital

8. Cons Logistics of New Initiative Time consuming Minor Stakeholders with large Input to Consultation Process Working Outside of the Emergency Department Team Loss of Contact Between ANPs Provision of Care Across to Sites Without Increase in Staff. Available to a Wider Catchment Area No Access to Other Hospitals in Patients Catchment Area

9. Logistics Communication/Education Public (Information Leaflets) Staff Members of ED Team and Allied Disciplines and Specialities Hospital (telephone. Internet) Merging of Information and Transfer of Information Between Two Separate Systems (Private and Public)

10. Challenges ED Attitude Self Triage (information sheet) Emergency Procedures Client Group Isolation Work Ethos (8am to 6pm) Education of Public and GPs to Prevent Unsuitable Presentations

11. Success Patient Satisfaction Patients Seen Since Opening Appropriate location for Treatment of Specific Cohort of Patients GP/ANP Collaboration GP Training Scheme Value for Money

12. Case Presentation 38 year old male self referral- thumb injury Using I phone the night before and felt a pop to the thumb as he was scrolling the thumb across the screen Noticed loss of extension to the distal phalanx of the thumb and wrist swelling History of a punching injury x 3/52 previous Past history/meds/allergies Assessment Impression /Differential Diagnosis Plan Outcome /Diagnosis Treatment/Follow up care.

13. Present Day Numbers Increasing Information Spreading by Word of Mouth RANPS/RNPS Evaluate the Role of the RANP/RNP in the Prescription of Antibiotics Evaluation of the Service

14. The Future The role of the Registered Advanced Nurse Practitioner in a Minor Injuries Clinic Evolution of the Role and Scope of Practice to Facilitate and Increase the Service to the Public