Nurse Led Clinics and Services
News and updates from today’s Nurse Clinics 2016 event chaired by Dr Richard Hatchett Author ‘Nurse Led Clinic: Practice Issues’ looking at developing advanced nursing practice and setting up and running nurse led clinics and services.
Dr Hatchett opened the conference with a look at the current value of nurse led clinics, he said nurse led clinics are developed to meet the needs of patients and fill the gaps in the patient journey. Dr Hatchett went on to outline the background and evidence for the effectiveness of nurse led clinics.
Nursing revalidation and Advanced Practice: An update from the Nursing Midwifery Council
Sara Kovach-Clark Revalidation Transition Lead Nursing and Midwifery Council
Sara gave a detailed update on revalidation requirements and how to make your revalidation application. Sara said; "revalidation is about and your scope of practice regardless of what you do. You need to evidence your particular area. Everyone should be able to meet the requirements although how will be in different ways." She went on to clarify issues and queries around reflection and confirmation. Regarding confrmation she said; "you and the confirmer both need to prepare, you need to show you've done your practice hours, your CPD, your reflective discussion and you've met the revalidation requirements, the confirmer is assessing whether you meet the requirements for revalidation not whether you are fit to practice." When submitting your application there is no need to submit your evidence although this may be randomly requested for verification, it doesn't mean there are any concerns about you, and your revaliadation will not lapse whilst verification is ongoing.
Creating the culture for nurse led services
Dr Theresa Shaw Chief Executive Foundation of Nursing Studies https://www.fons.org/
Theresa said; "Nurses are able to really reach out and understand what people need. Nurses are able to be more flexible in their work and responsive...nurses create spaces where services could be delived in a more efficient way....business plans are so important to present new ways of working, people want to know what will make a difference....You really need to think about whether the workplace is ready to think about working in different ways...working collectively is so important....if the workplace culture (how things are done) is not strong and supportive you will struggle to achieve what you want to do."
Pre-Event Abstract: Creating the culture for nurse-led services
Nurse-led services offer the opportunity to strengthen and enhance the experience of care across health and social care. Despite the enthusiasm and best intentions of people delivering services the opportunity for change are lessoned by the complex contexts in which health and social care take place. Over a number of years, FoNS has supported nurses and nurse-led teams to lead improvement and change in practice; in most cases the beginning point for such work has been exploring the nature of the workplace culture and considering approaches to facilitating and leading change. This presentation will give an opportunity for participants to consider their own workplace cultures and how they can lead ongoing service development.
Overview of presentation
• Brief introduction to FoNS’ work with nurse-led teams, helping them to develop practice to improve patient care
• Developing the role of nurse led services across health and social care
• Understanding workplace culture and the impact it has on developing services and practice
• Identifying how leadership and skilled facilitation can enable the implementation of nurse led services and care delivery.
Beginners Guide: Setting up and Running Nurse Led Clinics
A step by step introduction to setting up and running a successful nurse clinic in practice
Alison Pottle Cardiology Nurse Consultant Royal Brompton and Harefield NHS Foundation Trust
Alison gave tips for setting up a new clinic saying; “generate ideas, it may be something new no one has thought of”
“planning is essential” “it’s not where you are today, it’s about where you are going to be. You have to look at all aspects, from referrals to administration”
“learn from others mistakes, there’s no point in persevering with something if someone can say to you, look we’ve done that and it’s really not going to work”
This presentation will cover both the theory and practice of running effective nurse led clinics. It will start with looking at why nurse-led clinics have developed and what the aims of these clinics are. The importance of establishing the need for the clinic and also looking at what can go wrong together with the aspect of competency of the staff who will run the clinic will be discussed.
The talk will then move on to practical issues which need to be considered when running nurse-led clinics including the importance of policies, procedures and guidelines. The vital need to plan everything that is done will be discussed. Aspects of referral to the nurse-led clinic will also be included.
The presentation will also focus on the need for evaluation of the clinic to enable areas for improvement and development to be identified.
The second part of the presentation will focus on my experience of running 3 different nurse-led clinics – a Rapid Access Chest Pain Clinic, a follow-up clinic for patients post PCI and a pre-admission clinic for PCI patients. Although these clinics are all based in the cardiology speciality, the problems, processes and issues raised would be applicable to any nurse-led clinic.
Hatchett R. Nurse Led Clinics: Practice Issues. 2003. Routledge, London
National Service Framework for Coronary Heart Disease. 2000. Department of Health. London.
The NHS Plan. Department of Health 2000
Setting up a nurse led clinic for children with acute lymphoblastic leukaemia during maintenance therapy
Sally Spencer Leukaemia Advanced Nurse Practitioner Birmingham Children’s Hospital NHS Foundation Trust
Sally said; “It was all very clear in my head but I needed to be sure and prove it would work”
“we are in an old Victorian building so clinic space is at a premium and I had to be flexible”
Pre-Event Abstract: Developing a Nurse-led clinic for Children with Acute Lymphoblastic Leukaemia during maintenance therapy
Historically children on maintenance therapy attend clinic once a month for review and administration of bolus vincristine (VCR). The child is reviewed by the Consultant, Leukaemia Advanced Nurse Practitioner (ANP) or a Specialist Registrar. A clinic nurse then inserts a cannula and administers the vincristine which is checked by a second nurse. Both of these steps can incur a long period of waiting for the patient and family during a busy treatment clinic.
A nurse-led clinic has been set up to improve the patient pathway and to ease the congestion in consultant-led clinics. Children eligible for the clinic are receiving 100% doses of VCR and dexamethasone. Those patients with significant toxicity or who are not receiving 100% doses remain in the consultant-led clinic.
Following initial written consultant referral, children are booked into a 30 minute appointment every 4 weeks. The child is reviewed by the ANP and the VCR given immediately after the consultation, with the ANP acting as the second checker to the cannulating nurse.
Challenges faced when developing this clinic included securing finance for increase in working hours, securing clinic space, education of families to adhere to appointment times and training of clinic nurses.
During the clinic’s first 10 weeks there were 51 patient attendances. Families were offered the opportunity to complete the hospital friends and family survey and data was collected to ascertain the length of time each patient spent in clinic. This was also collected from patients attending the consultant-led clinics to enable data comparison
The data collected shows that the nurse-led clinic provides a more time efficient service without compromising patient and family satisfaction. The average time spent in the nurse-led clinic is 50 minutes compared to 2 hours and 20 minutes in the consultant-led clinic and patients are seen on average within 10 minutes of their appointment time compared to 50 minutes in the consultant clinics.100% of parents who completed the hospital friends and family survey said that they are extremely likely to recommend the service to others.
Future work includes further data collection to show the impact of the nurse-led clinic on relieving consultant clinics, considering the patient pathway for children on maintenance who are not having VCR and dexamethasone and reviewing the management of children attending clinic for review of non-urgent medical problems.
Nurse Prescribing: A national update on nurse prescribing within a nurse led clinic or service
Deborah Robertson Consultant Editor, The Journal of Nurse Prescribing, and Senior Lecturer & Programme Leader Non-medical Prescribing, University of Chester
Pre-Event Abstract Non-Medical Prescribing in Nurse Led Clinics
The scope of the presentation is
• Nurse prescribing and autonomous practice: where are we at
• Evidence to support nurse prescribing
• Top tips for safe and effective nurse prescribing practice
Nurse Led clinics and services are growing and Non-Medical Prescribing has added to this growth by allowing nurses to complete episodes of care by writing prescriptions where necessary for the patients and clients in their care. Prescribing is a responsibility that should not be taken lightly and nurses should understand that there are accountable for their actions as prescribers. This presentation will outline the background to NMP, what prescribing has done for nurse led care and give some tips to remember for safe practice.
Further information can be obtained from:
• DH Website- http://www.dh.gov.uk/en/index.htm
• NPC/NICE site- http://www.nice.org.uk/mpc/
• Nurse Prescribing Journal - http://www.nurseprescribing.com/
• Professional Regulatory Body Websites
Legal Issues and Risk Management
Roz Hooper Head of Legal (Regulatory) Royal College of Nursing
The session will provide an outline of the law around accountability and risk management and will provide a summary of typical issues that give rise to negligence and misconduct actions. Principles around consent to treatment will be explored. There will be an opportunity to apply this learning to the challenges that might arise in Nurse Clinics, where there is more autonomous working. There will be a consideration of some recent case examples where nurse action has been the subject of clinical negligence claims, and the lessons that can be learned.
The future of advanced nursing practice
Gill Coverdale Professional Lead for Education The Royal College of Nursing
Gill spoke about the future of advanced level practice defining it as; "advanced practice is a level of practice, rather than a type of practice. Advanced Nurse Practitioners are educated at masters level in advanced practice and have been assessed as competent in practice using their expert knowledge and skills. They have the freedom and authority to act, making autonomous decisions in the assessment, diagnosis and treatment of patients." The RCN is trying to assure consistency of training through an accreditation programme; quality assuring CPD, training, study days, they would like all education provision accredited to ensure the same standard and level of practice as there's currently a huge variation. RCN Credentialing of Advanced Level Practice designed to 'influence the standard of nursing through RCN accreditation/credentialing' is currently being tested.
Pre-Event Abstract:CLOSING ADDRESS: The future of advanced nursing practice.
Gill will discuss the future direction of specialist and advanced nursing and about the recognition for high level clinical expertise within nursing.
Future nursing events:
Advancing IV Therapy
Improving Out of Hours Care in Hospitals: Hospital at Night
Implementing the New National Framework for Nursing Midwifery and Care staff
Eliminating Heel Pressure Ulcers
Nurse Prescribing for Pain
Masterclass: Nurse Led Discharge
Cancer Survivorship Summit: Improving outcomes for people living with and beyond cancer
Safe Staffing Summit: A Practical Guide to Safe and Effective Nursing Staffing Levels and Skill Mix
Effective Nurse Prescribing in End of Life Care
Nurse Prescribing in Cardiology
In-depth legal masterclass: Informed Consent After Lanarkshire
9 November 2016