Eileen Furlong

16th October 2004

School of Nursing & Midwifery

University College Dublin

The Emerging Role of the Advanced Nurse Practitioner

Objectives

• To provide background information

• To outline the development of an educational framework for advanced nursing practice

• To present the framework process

• To consider the role of the advanced nurse practitioner in cancer care

• Development of specialist and advanced practice roles

• Increase in knowledge and educational reforms

• Technological advances

• Service need / public need / economic forces

• Desire by nursing to develop its full potential in service provision

Historical Review

Registered Nurse

Clinical Nurse Specialist

(Government of Ireland 1998)

Advanced NursePractitioner

Clinical Career Pathway

• Department of Health and Children

• An Bord Altranais

• National Council for the Professional Development of Nursing and Midwifery

• Nursing and Midwifery Planning and Development Units

• Reports

Influences

Cancer Nursing

Hanley & Brennan

European Working Directive on

Medical Manpower

Cancer Strategy

Quality and Fairness

Medication Management

• Interest

• Persistence !!

• Curriculum work (2000 onwards)

• London City University (March 2001)

• Summer in Penn (2001)

• Started programme (Sept 2001)

How I Became Involved

• Advanced Practice

• Clinical

• Education

• Management

• Public Health

MSc Nursing Programme UCD

Core Modules on Masters Degree:

• Theory & Practice

• Advanced Research

• Leadership & Management

• CQI

MSc Nursing (Advanced Practice)

Advanced Practice Modules:

• Pathology

• Physiology

• Physical Assessment

• Pharmacology

• Case Management

• Clinical Practicum

MSc Nursing (Advanced Practice)

• Oncology / haematology

• Critical care

• Palliative care

• Primary care / community nursing

• Emergency / diabetes / renal nursing

• Dermatology /Gastro–intestinal nursing

• Stroke care

Speciality Areas Adult / Paediatric

• 4 graduates

• 3 due to finish next month

• 16 on programme currently

• No one yet accredited from UCD programme

• UCG commenced programme in Jan 2002

Current Status - UCD

• 14 accredited

• Emergency

• Sexual Health

• Rheumatology

Current Irish Status

Map of ireland to go here

• Refers to nursing practice that focuses on the client and situations which enhance positive outcomes for the client, family and community (Hamric et al. 2000)

• Advanced nursing practice is carried out by autonomous, experienced practitioners who are competent and responsible for their own practice (NCNM 2001)

Current Irish Status

• “ANP’s promote wellness, offer healthcare interventions and advocate healthy lifestyle choices for patient / clients, families and carers in a wide variety of settings in collaboration with other healthcare professionals according to an agreed scope of practice guidelines”

(NCNM 2001)

Advanced Nurse Practitioner (ANP)

• Specialisation, expansion and advancement

• Higher skill and knowledge to allow for the adoption of independent and autonomous roles

• Clinical practice that focuses on direct clinical care…emphasis is on experiental development of competencies, underpinned by theoretical knowledge

ANP Involves

ANPPioneering

professional & clinical leadership

Res

earc

her

Autonomy in clinical practice

Exp

ert

prac

titio

ners

Core Concepts

(NCNM 2002)

Differentiation(Commission on Nursing 1998)

• Beyond level of initial qualification

• (H.Dip/Post Graduate Dip)

• Experience & expertise• Work with

interdisciplinary team• Research utilisation• Teaching/advisory

Clinical Nurse Specialist:

• Higher level that CNS

• MSc – theoretical & clinical modules

• Extensive experience & advanced expertise

• Works independently in collaborative role

• Conducts research

Advanced Nurse Practitioner:

MAY 2001

• Registered nurse

• Masters Degree or higher

• 7 years post registration

• 5 years in speciality area

• Supervised practice

• Demonstrate competencies

• Evidence of professional development

(www.ncnm.ie)

Criteria for ANP

Part 1. Organisational Application

Approval of Site Preparation and Job Description

Part 2. Individual Application

Accreditation of ANP

ANP Establishment Process

• Identify healthcare need to be addressed

• Understand laws, rules, regulations and guidelines governing nursing practice

• Accept the legal principle of vicarious liability

• Ensure good practice guidelines are developed collaboratively

• Determine the patient / client benefit from ANP service

Site Preparation- Organisational

• Service to be consistent with organisational philosophy

• Project how change will help to meet the service plan

• Consider optimal location of service• Consider integration into MDT • Define role content • Identify resource implications

Site PreparationApproval

• Job title

• Grade

• Reporting relationship

• Location

• Background to post

• Specific factors

• Purpose of post

Job Description Approval

• Application form

• A professional portfolio demonstrating extensive experience, knowledge and skills in the context of practice in which the accreditation is sought in line with National Council criteria

• Accreditation valid for 5 years

• Non-transferable

Part 2 Process for Accreditation

• Definitions

• Core concepts

• Responsibilities

• Framework

• Scope of practice

• Literature

Role Development

• ANP role – grounded in nursing theory ensuring holistic practice

• Role development must occur in the context of service need and be established within the framework of the service plan

Setting Your Own Agenda

• AA process • Role development in cancer nursing• Competencies• Outcomes research (quality and

cost)• Accessibility of programme• Evaluate educational framework

Challenges Ahead

Contribution to Cancer Nursing

Email eileen.furlong@ucd.ie

Web www.ucd.ie/nursing

Web www.ncnm.ie