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The challenge of advancing nursing roles

Judith Graham Advanced Nurse Consultant at Rotherham, Doncaster and South Humber NHS Foundation Trust spoke at Nurse Clinics 2015 today on:

● managing the advancement of nursing roles  
● ensuring nursing roles are supported with policy, procedure and competency frameworks
● stratifying advanced nursing skills and developing supervision 
● the development of nurse led services in specialist mental health care

Abstract of Judith’s presentation

Nurse-Led Clinic Services have been established in our NHS Trust for just over 5 years. A practice development project was undertaken to produce a framework that enables a clear definition between the clinical roles and responsibilities of different levels of nurses. 

This delineation went beyond focusing upon job descriptions, specifically targeting specialist Advanced Nursing skills, for example: prescribing, physical health assessment, specialist diagnostic assessment, and the nurse’s role concerning application of the Mental Health Act. This has paved the way for the development of enhanced nurse-led clinic services.

•    The development of a clear role delineation chart concerning Band 5 - Band 8c (RCN, 2014) Mental Health Nurses. 
•    The development of structured advice and guidelines for non-nursing supervisors.
•    The development of enhanced nurse-led clinic services targeting interventions, supporting the Payment by Results (DoH, 2013) initiative.

This specialist community initiative has been successful, resulting in complete eradication of traditional medical out-patient clinics, replaced by nurse-led clinics, providing holistic assessment, physical health monitoring and medication management. Patient feedback is positive, specifically regarding faster clinic response time and lengthened appointment duration. 

The role of Advanced Nurses is not necessarily to replace traditional medical roles, but to enhance team provision. This introduced a further nursing change to local mental health culture, meaning that Multi-Disciplinary Team meetings are now led by the most appropriate professional, which may be a doctor or an Advanced Nurse, often in equal numbers. Feedback from patients, carers, and other members of the MDT has been predominantly positive, however there are still cultural challenges regarding attitudes and organisational structures to fully realise this initiative.  

A further result concerns the production of the role delineation framework. For nursing staff, the framework aids clarification of roles and responsibilities, providing role security, boundaries, and giving a clear career development framework. For medical staff, who under the new system provide or receive supervision from these nurses, this has helped develop a valuable insight into the unique roles, duties, and responsibility of each nursing post.

The full PowerPoint presentation is available for download at the end of this page.

Judith is a qualified mental health nurse who has worked in the NHS between both inpatient and community mental health setting for over 10 years. Post-registration, she has completed a BSc in Acute and Forensic Mental Health, an MSc in Cognitive Behavioural Psychotherapy, an MSc in Advanced Nursing Practice, and she is in the final stages of completing her Doctorate qualification. Judith’s current clinical role includes the provision of specialist assessment and treatment for adults and older adults who have a range of mental health problems and learning disabilities, and also people with substance misuse problems. She is a qualified Independent Prescriber, specialist assessor for people with Autistic Spectrum Conditions, and has recently been awarded the title of Queen's Nurse. 

Judith has been published in several scholarly heath journals, and has presented at national and international conferences on mental health issues, specifically regarding Personality Disorder, complex trauma, prescribing ethics, and systems leadership. As well as direct clinical care, her current role includes research and development of new service initiatives, particularly related to service and organisational change and its effect on service users, carers, and professionals. Judith is involved in regional forums including Autism Partnership Boards, and has also contributed to National Policy Change via contribution at NICE stakeholder events and within her role as an elected board member of the NHS Confederation Mental Health Network Board.  Judith is passionate about service user and professional education, clinical teaching and supervision is also a core part of her work, and she has lectured at several universities on various mental health topics.

Future events of interest:

Nursing Revalidation for Specialist Practice and Advanced Roles
Wednesday 2 December 2015 
ICO Conference Centre, London

Advancing IV Therapy
Thursday 3 December 2015 
ICO Conference Centre, London

Nurse Prescribing
Thursday 3 December 2015 
Manchester Conference Centre, Manchester

Nursing Metrics for Quality: Measuring quality in nursing and monitoring progress against the 6Cs
Monday 7 December 2015 
Hallam Conference Centre, London

Managing and Reducing Bank and Agency Staff in Nursing
Tuesday 19 January 2016 
Hallam Conference Centre, London

Nurse Prescribing for Wound Care
Tuesday 19 January 2016 
ICO Conference Centre, London

Nursing Appraisal and Revalidation & implementing the New NMC Code of Practice
Wednesday 20 January 2016 
ICO Conference Centre, London

Nursing Revalidation Preparing for Going Live
Tuesday 2 February 2016 
Thestudio Conference Centre, Birmingham

Nurse Prescribing for Pain
Wednesday 3 February 2016 
Thestudio Conference Centre, Birmingham

Demonstrating and Expanding Nursing Competence
Friday 11 March 2016 
Hallam Conference Centre, London


Download: Judith Graham full presentation

19 November 2015


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