Post on 27-Jun-2015
description
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Two perspectives of NP in an ED setting:
medical and nursing
Grainne Lowe Adeline Wu
Nurse Practitioner Consultant
Emergency Department Emergency Department
Box Hill Hospital Box Hill Hospital
Where we started
• Submission to DHS 2003/04
– Challenge to existing processes
– Look at new ways
– Improving pt journey
– Improving KPI’s
– Decrease frustration
Identify needs
• Services
– Create equitable delivery for patient groups
• Workforce
– Build capacity
– Strengthen capability
– Gaps in delivery of services
Politics of change
• Change is political
– Tactics
– Negotiation
– Lobbying
– Compromise
Stakeholders • Key partners working together
– Day to day colleagues
• Medical
• Nursing
– Pharmacy
– Pathology
– Radiology
– In/out patient units
Drivers/Champions
• From the top down
– Executive level support
• Across channels
– Referral pathways
• Community access
– Pt knowledge
Eastern Health
• 4 NP positions in ED
– all Endorsed
• Other positions
– Stroke Management
– Mental Health x 5
– Renal
– Palliative
NP as resource
• NP is “...”
• Compliment existing services
• Growth of decision making capability
• Pt satisfaction with access
• Increase volume of timely consultations
Key components
• Role clarity
– Identity
– Scope of practice
– Extensions to practice
– How the role “fits”
Key components
• Professional
• Leadership
• Recognition
• Collaboration
• Integration
Support for NP
• EH NP group
– Sharing ideas
– Problem solving
– Reducing isolation
– Regular meeting with DON
• Strengthening structure
• Professional issues
Future
• EH Nursing Scope of Practice Committee
– Various group representation
– EH Chief Nurse as chair
– Submission of interest
Scope of Practice
• NP scope of practice
– Locally determined
– Practical
– Constructive
– Without undue restriction
– Taking account of extensions to practice
Scope of practice ED
• Initially governed by CPG’s
– To structure extended practice
– Guide development of role
– Multi-disciplinary sign off
• Problems
– Restrictive
– Review and resvision ???
Model of Care • Minor injury / minor illness model
• Fast track guidelines
– Exclusion criteria
– Structure of ED
• Autonomous Collaborative
• Based on need
Value add to ED
• Increase efficiency
• More timely treatment
• Lower acuity presentations
• Increase patient satisfaction
• Provide resource for other staff
– Nursing
– medical
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital,
Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health
Doctor’s Perspective
My first thoughts….
• “if they want to practise medicine, then
they should go to med school”
Other concerns
• missed diagnoses
• Unnecessary or inappropriate
pathology/radiology requests and
specialist referrals
Other concerns
• ongoing training of junior medical staff
– in particular interns
• Emergency Medicine is a compulsory term to
complete internship
• fear of employment of NPs will eventually
replace medical staff
Resulted in
• specialist units refusing referrals from
nurse practitioners
• ED staff confusing roles of NPs
• perceived competition for patients
Other problems
• extent of scope of practice
– what can you do?
• lack of NP coverage
• loss of skilled nurses to become NPs
Acceptance is a BIG hurdle
In reality
• training of junior medical staff OK
– NPs now teaching
– gaps in rostering still provide opportunities
• NPs will see what they are comfortable
with
Other Benefits
• more cohesive clinical team
– NPs stay longer than interns/RMOs
• frees medical staff to see other patients
– may increase flow through the emergency
department
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Key Performance Indicators
• 4 hour discharge KPIs
• waiting times
• patients who did not wait
• MORE DATA NEEDED
Key Performance Indicators
• pt satisfaction
• unscheduled representations
• adverse events
My Opinion
• NPs are safe
– they are clear who they will and won’t see
My Opinion • NPs have a role in the ED
– increased patient satisfaction
• but further study is needed if there any effects on
ED flow
– greater teamwork
– will not replace doctors
• doctors should not feel threatened
My Opinion
• Teething problems
– training
– initial difficulty in acceptance
• Better education amongst non-NP staff
about scope of practice
Future for Other Departments
• Currently- NPs/NPCs in
– neurology
– psychiatry
• Increasing role in health care
– more widespread acceptance
– doctor shortages
Adeline.Wu@easternhealth.org.au
Grainne.Lowe@easternhealth.org.au
Grainne.Lowe@monash.edu