Particulars of Office

Human Resources Department, St. John’s Hospital Advanced Nurse Practitioner- Emergency Care

ADVANCED NURSE PRACTIONER – EMERGENCY CARE

JOB DESCRIPTION

Reporting Relationships:

Professionally accountable to Director of Nursing Clinically Accountable to Consultant in Emergency Medicine

Key Aims of the Post

 To contribute to the continuous improvement of the quality of care experienced by the patients in the Local Emergency Department (ED).  To share caseload management with the Emergency Department Doctors within the ED.  To assess, diagnose, treat and discharge a caseload of minor injury patients as identified in the scope of practice in a safe and co-ordinated way  To improve patient outcomes through health promotion, education and risk reduction  To improve the flow of patients through the ED by offering a seamless service  To provide quality of care across the HSE West region in conjunction with other Local Emergency Centre’s within the region.  To evaluate the quality of the service being provided through ongoing clinical audit and research  To participate in the continuing professional development and education of nurses, student nurses (undergraduate and postgraduate), support services and allied professionals.

Core Concepts of Advanced Nursing Practice

The key responsibilities in this job description are outlined from the core concepts of the Advanced Nurse Practitioner (ANP) role. The ANP will exercise higher levels of judgement, discretion and decision making in the clinical area above that expected of the Staff Nurse or Shift Leader in the Emergency Dept. / Emergency Centres. The four core concepts of advanced nursing practice are:

1. Autonomy 2. Expert practice 3. Professional and clinical leadership 4. Research

Clinical Practice: Autonomy & Expert Practice

The role of the ANP (Emergency Care) involves greater responsibility, accountability and autonomy than that expected of the staff nurse or Clinical Nurse Specialist. The ANP will utilise their advanced level of decision making skills and knowledge to assess, diagnose, manage and discharge patients five years of age and older, with minor injuries/conditions, who fall within the agreed scope of practice

April 2012 Human Resources Department, St. John’s Hospital Advanced Nurse Practitioner- Emergency Care

Minor injuries and illnesses, are classified in St. Johns Hospital according to the Manchester Triage Scale.

The caseload, traditionally managed by the emergency department medical staff, can be shared effectively with the ANP within an agreed scope of practice. The ANP will practice independently, yet collaboratively, utilising decision making skills from a nursing perspective unless the specific problem progresses outside the agreed scope of practice, then the ED Doctor’s review will be sought. The list below illustrates the most common categories of minor acuity managed by an ANP (Emergency Care).

• Upper and lower limb injuries • Acute traumatic and chronic wounds • Minor facial injuries • Ear and nasal trauma / conditions • Dental trauma / conditions • Local infections and abscess • Minor burns and scalds • Bites and stings

Referral pathway to and from the ANP service

Referral to the ANP: The ANP will accept referred patients who fall within the agreed scope of practice.

Referral from the ANP: The ANP will use his/her professional judgement, supported by collaboratively agreed clinical pathways to refer patients to other healthcare agencies, to outpatient clinics and to other treatment centres. If the management of the patient moves beyond the ANP’s scope of practice, the patient is referred to the doctors within the Emergency Department.

Scope of Practice

 Caseload management of minor injury and conditions that fall within a collaboratively agreed scope of practice  Recognises limits to own practice, consults and refers appropriately to achieve best health outcomes.  Accurately documents the assessment of patients’ health status, diagnosis and clinical decisions made.  Identifies situations of clinical risk and takes appropriate actions to ensure a safe environment for patient care.  Leads/participates in case review and debriefing activities as required.  Evaluates care and leads practice developments through research and audit of practice.

Expansion of Practice

 The ANP will commit to practice developments in emergency nursing beyond the current scope of practice.

 Expansion of the range of activities will be undertaken following exploration of service needs, patient demand, consultation with management and resource allocation.  The ANP will keep abreast of all practice developments. The care philosophy and clinical protocols that reflect such developments will be amended or expanded upon as necessary.

Autonomy in Clinical Practice

Underpinning the role of an ANP (Emergenct Care) is the deliverance of timely, clinical, autonomous and holistic care to patients presenting to the department who fall within the realms of specified agreed treatment Policies, Protocols, Procedures and Guideline’s (PPPG’s). Autonomy in clinical practice relates to professional accountability, the power to make advanced clinical decisions, to act upon them, and to take responsibility for those actions. Autonomous decision making in emergency nursing by the ANP extends to the whole episode of care and involves the following job responsibilities:

 Selecting and managing a caseload of patients and working alongside the ED Doctors.  Selecting patients from triage who fall within an agreed caseload.  Independently conducting a health assessment of patients with undiagnosed minor injuries and conditions to reach a clinical decision/diagnosis.  Requesting the necessary laboratory and radiology investigations, specific to the presenting injury, either independently or in collaboration with the ED Doctors.  Providing treatment and prescribing medication within the local Collaborative Practice Agreement – Nurse Prescribing.  Using his/her professional judgement to either refer patients to other healthcare agencies, out-patient clinics, other treatment centres or to discharge them.  Independently coordinating effective discharge planning and/or referral processes to health care providers and support agencies.  Using their own autonomy to maintain a person and family centred approach to the care delivered by the ANP service.

Clinical Supervision

The ANP’s clinical practice will be evaluated by the clinical supervisor, consultant in Emergency Medicine, through retrospective chart reviews of patients seen by the ANP. At regional level, a system of peer review will be established with other ANP’s in Emergency nursing. Ongoing clinical support will be provided by the ED consultant and/or the ED Doctors.

Maintaining Competence

The competency of the ANP will be maintained by the following:

 Consistent daily caseload management of patients, both adult and children, who present with a variety of injuries.  Engaging in clinical supervision and preceptorship of nursing staff (undergraduate and post graduate) and other healthcare professionals in the ED.

 Availing of opportunities to maintain and develop clinical skills within the remit of emergency nursing and a defined scope of practice.  Rotating into the Mid Western Regional Hospital, Limerick as determined.  Utilising evidence from the literature for best practice in the assessment and management of their caseload.  Practice in accordance with legal,ethical and professional standards.  Maintaining a portfolio of evidence of his/her current level of education , to demonstrate his/her own professional development , including specialist and professional knowledge and development

Expert Nursing Practice

The ANP, as an expert nurse practitioner, will function in a variety of roles including clinical, consultative, clinical practice development, teacher, coach, manager and researcher. The role encompasses both direct and indirect practice.

Direct Practice

Person and family centred care: by advocating a quality of life ethos and health promotion, the ANP will look beyond the patient’s presenting injury/condition towards patient focused, holistic models of care, encouraging patient and family involvement. The focus will be on the effects of the injury/illness on the individual/family.

Indirect Practice

The ANP will act as a consultant and educator in all matters relating to minor injuries and conditions. This includes patients, their families and it extends to nurses, doctors, other healthcare professionals and policy makers. The practical, theoretical knowledge and critical thinking of the ANP will be seen as exemplary amongst peers and will be recognised and acknowledged as an authority in emergency nursing. The ANP will look at ways of improving practice through exploring practice issues with team members, development of practice protocols and research/audit initiatives.

Multidisciplinary Team Work

The overall objective of the ANP (Emergency Care) role is to enhance and improve the health outcomes for patients by complimenting the role of other healthcare professionals. The ANP role therefore involves working alongside other members of staff in the ED. Good communication and teamwork are necessary for the integration of the ANP within the multidisciplinary team, this is essential in order to provide an effective, efficient service for the patient regardless of the injury or condition. Appropriate referral ensures the best outcome for the patient and contributes to a patient - centred approach to care, improving service delivery. The ANP will facilitate multi-disciplinary practice through a collaborative approach to guideline development, on-going research and education.

Professional and Clinical Leadership

The ANP will demonstrate professional and clinical leadership in the following ways:

 Act as a nursing resource, providing professional leadership, strategic direction, expert advice and support to the clinical team in the ED.  Advance the boundaries of professional practice with reference to the values and principles that underpin and guide nursing practice as described in the “Scope of Practice for Nursing and Midwifery”.  Share a vision of clinical practice developments with key stakeholders by communicating with, valuing and enabling their contribution to care.  Strive to improve primary care links with GP’s, Public Health nursing, Home Care supervisors, Community Intervention Teams in collaboration with the Admissions, Discharge and Transfer (ADT) Coordinator. All relevant personnel will receive written information regarding the patient’s treatment and follow-up arrangements made.  Identify areas of nursing in emergency care that require development and demonstrate a commitment to such development.  Involvement in clinical supervision and act as preceptor to nursing staff (undergraduate and post graduate) and other healthcare professionals in the clinical area.  Act as a change agent to lead, implement and assimilate new developments into clinical practice aimed at maximising patient outcome and meeting clinical need.  Involvement in ongoing clinical audit and research  Lead education initiatives and undertake teaching in the clinical area, the classroom and the wider community through conferences, seminars and workshops, thus advocating advanced nursing practice in the ED.  Contribute to annual service reports and service plans in the interest of high quality patient care  Articulate and rationalise the concept of advanced nursing practice in the ED to colleagues , other healthcare professionals as well as members of the public  Maintain and promote multi-agency , inter-professional relationships and networks , thereby advancing the current systems of care

Research

The ANP has a professional responsibility to give the highest standard of care to patients. The ANP will achieve excellence through improving the standard and quality of nursing care in the following ways:

 Initiating and coordinating research into aspects of emergency nursing care.  Reviewing protocols and clinical guidelines frequently with reference to best evidence available.  Evaluating the ANP service through audit and utilisation of research to further develop and advance the role , promoting evidence based practice and improving clinical effectiveness therefore further enhancing the quality of the service patients receive  Actively initiating , undertaking and contributing to research projects to change and lead new practice within the ED and identify researchable patient problems for clinical review  Ensuring that clinical decision making will be founded upon evidence based practice from peer reviewed journals , online electronic databases and medical/nursing library access

 Fostering inquiry, critical thinking and research skill acquisition amongst the nursing workforce to advance nursing practice and person centred holistic care in the ED.

In addition to the foregoing, the ANP will:

 Act at all times in a professional manner befitting the role in accordance with the rules and regulations laid down by An Bord Altranais.  Ensure that patient confidentiality is observed at all times  Endeavour to protect the interest of the public, staff and self  Adhere to and have knowledge of the following legislation in relation to Nurse and Midwifery Prescribing: Irish Medicines Board (Miscellaneous Provisions) Act 2006 (Commencement Order 2007, the Misuse of Drugs (Amendment) Regulations 2007, the Medicinal Products Prescription and Supply (Amendment) Regulations 2007.  Ensure a safe environment in accordance with Health and Safety at Work Acts 1989 to 2005.  Adhere to hospital policy in relation to safe work practices, e.g. high risk patients, sharps disposal, Infection Control, Non-Smoking, decontamination policies and standards  Keep accurate and up to date records; maintain the confidentiality and safety of these records, in accordance with Data Protection Acts 1988 and 2003 and any future amendments  Adhere to the right of persons to access information in accordance with the Freedom of Information Acts 1997 and 2003 and any future amendments  Adhere to and have knowledge of the United Nations Convention on the Rights of Children 1996, The Child Care Act 1991 and Children First, DoHC 1999 and any future amendments  Be flexible within the service in response to client and service needs.

 The ANP is responsible for his/her own professional development and maintenance of a portfolio of evidence of on-going professional development

The job description may be subject to review and amendment in accordance with local/national policy. The ANP may be required to perform such other duties as may be assigned from time to time by the Director of Nursing

April 2012