Nursing clinics 2016: Eighth Annual Conference

Essential characteristics of nurse led clinics

Linda NazarkoMSc, PgDip, PgCert, BSc(Hons), RN, NIP, OBE, FRCN

Nurse Consultant West London Mental Health Trust

London 9th November 2016,

Learning objectives To be aware of how : Nurse led clinics fit within the framework of advanced

nursing practice To determine the characteristics of nurse led clinics Understand and promote the value of nurse led

services

Relevance to NMC (2015) Codehttps://www.nmc.org.uk/globalassets/sitedocuments/nmc-

publications/nmc-code.pdf

Prioritise people ,Practise effectively, Preserve safety, Promote professionalism and trust

Defining advanced nursing practice

“A registered nurse who has command of an expert knowledge base and clinical competence, is able to make complex clinical decisions using expert clinical judgement, is an essential member of an interdependent health care team and whose role is determined by the context in which s/he practices”

NMC 2007

Components of advanced practice

Core competencies advanced practice

Practicing autonomously Making decisions and being accountable Admitting and discharging patients Ability to take a clinical history Ability to physically examine patient Ability to determine diagnosis Ability to determine when onward referral is

required Ability to prescribe

Do you need to be an expert to run a clinic?

The continuum of advanced nursing practice

No one is born an expert We have to develop and nurture expert

practitioners Nurse clinics can be a safe place for nurses

to develop

Scope of practice

The nurse’s scope of practice must be related to his or her competencies.

There is room within the clinic for expert nurses and nurses who are developing expertise.

Level of support and supervision is related to level of expertise.

Generic clinical competencies

Practicing autonomously Making decisions and being accountable Admitting and discharging patients Ability to take a clinical history Ability to physically examine patient Ability to determine diagnosis Ability to determine when onward referral is required Ability to prescribe

Specific clinical competencies

Competencies specific to your service Competencies related to where your service

is delivered Competencies specific to the client group

Combining theory and practice

Education and training

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Definition of a nurse-led clinic In a nurse-led clinic the nurse has his or her own patient

case load. The service often involves an increase in the autonomy of the nursing role. The nurse-led clinic requires the patient to fit into a rigid time slot, often through an appointment system.

There is the ability to admit and discharge patients from the clinic, or to refer on to other more appropriate healthcare colleagues, based on the nurses’ own assessment.

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Rationale for nurse led services

Increased efficiency and effectiveness Increased patient access An educative role Psychological support Monitoring the patient's condition Empowerment of the patient

Types nurse led clinics and services

Generic e.g. frailty clinics, falls clinics, intermediate care, long term conditions in primary care

Specific e.g. diabetes, chronic heart failure Follow up e.g. post operative, prostatectomy Diagnostic e.g. endoscopy

Essential criteria Admission/entry criteria Exclusion criteria Referral forms/protocols Escalation criteria Referral to other services Pathways, how often to see patient Follow up Discharge KPIs and reporting

Effectiveness and acceptability

“Cost cutting” “Practicing

medicine without a license”

“Depriving people of proper medical care”

Evidence In heart failure people receiving nurse led care “experienced

fewer hospital admissions for any cause and an increase in survival and number of participants reaching target dose within a shorter time period” (Driscol et al, 2015)

In diabetes patients receiving nurse led care demonstrated better outcomes and costs were reduced (Cook-Johnson et al 2012).

In monitoring people with prostatic cancer nurse led was acceptable to patients and good coutcomes were demonstated (Wade et al, 2015)

In caring for people with hypertension nurse led care led to improved outcomes and reduced costs (Sanders & Guse, 2016).

The value of advanced nursing practice

Holistic, innovative, evidence based Cost effective, increased review of medication Patient and family centred Integrated

References Cook-Johnson R et al (2012). The effectiveness of nurse-led care in general practice on clinical outcomes

in adults with type 2 diabetes. JBI Best Practice 16(1) 2012 http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=9255

Driscoll A, Currey J, Tonkin A, Krum H (2015). Nurse-led titration of angiotensin converting enzyme inhibitors, beta-adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure with reduced ejection fraction. Cochrane Database Syst Rev. 2015 Dec 21;(12):CD009889. doi: 10.1002/14651858.CD009889.pub2.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009889.pub2/abstract

Sanders J, Guse CE (2016). Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic Disease Care Versus a Traditional Fee-for-Service Approach. J Prim Care Community Health. 2016 Aug 9. pii: 2150131916662465. [Epub ahead of print]

Julia Wade, Peter N Holding, Susan Bonnington, Leila Rooshenas, J Athene Lane, C Elizabeth Salter, Kate Tilling, Mark J Speakman, Simon F Brewster, Simon Evans, David E Neal, Freddie C Hamdy, Jenny L Donovan , for the ProtecT Study Group (2015). Urology - Research: Establishing nurse-led active surveillance for men with localised prostate cancer: development and formative evaluation of a model of care in the ProtecT trial. BMJ Open 5:9:

http://bmjopen.bmj.com/content/5/9/e008953.full

Advanced nursing practice Contributes to

developing nursing Enables us to nurse

with the hands, the heart and the head

Enriches the lives of those we care for and our lives

Thank you for listening

Any questions?Download on

https://uk.linkedin.com/in/linda-nazarko-1952a746