Nurse Practitioners aren’t built in a day.

Anna GreenNurse Practitioner – ICU Liaison

Nurse Practitioner Project Officer

Western Health, Australia

Map of Australia

Melbourne

Leadership core competencies

VisionaryIdea

Commitment Energising

Empowerment McLeod J. Leaders aren’t built in a day. Human Capital Issue 3.1: 24-27

ICU Liaison Nurse Role

Case-Manage patients post ICU discharge

Accept referrals for unstable patients

Rapid Response System - respond to clinical marker referrals

ICU Liaison hours worked

Two full time EFT 7 day a week cover 8am to 6pm One day a week allocated to non clinical work

Research Leadership Education Meetings/Committee

Working towards 24 hour service Expanding service throughout the network

Leadership development

Internal

Leadership skills

Self

External

1996 1998

Goal achievement

2004Australia's

First Critical CareNURSE PRACTITIONER

Three Fundamental Problems

Failure to Rescue

Failure in planning

Failure to communicate

Failure to recognise deteriorating patient condition

http://www.ihi.org

What is a Rapid Response System?

Medical Emergency Team

Outreach Team

MET & ICU Liaison Service

ICU Liaison Team

What are these warning signs?

Altered CNS Fall in GCS of >2 points Heart Rate >120 per minute Systolic blood pressure <90mm Hg Respiratory Rate >30 breaths per minute Sa02 >90% on oxygen Difficulty in breathing UO <60mls for 2 hours

“Worried Staff”(Green & Williams 2006)

What difference Can a NP led Rapid Response Team Make?

Fast Track Patients to the ICU Decreased cardiac arrest calls Increased medical emergency calls Improved survival for medical emergencies

+/- reduction in readmissions (Ball et al., 2003; Pittard, 2003)

+/- reduction in ICU patient mortality (Ball et al., 2003; Garcea et al.,

2004; Priestly et al., 2004)

+/- decrease ICU LofS

(Green & Williams, 2006)

Survey Responses

Clear Guidelines

‘Back-up’Support

Prompt

(Green & Williams, 2006)

Survey Response

Disagreement with

parameters

Poor response from MO

when called

Overstepping boundaries

Increased workload for

ICU MO

Further education

(Green & Williams, 2006)

What extended practices do I need

Referral to ICU consultants Ordering of diagnostic tests Ordering of radiological tests Limited prescribing rights Admission / Discharge

ICU Liaison – extensions to practice

ClinicalPractice

ResearchEducation

Con

fere

ncePolicy

Management

Counselling

LimitedPrescribing

Direct referral to Medical

Specialists

Admit / Discharge

InitiateDiagnostics

Reflecting on my achievements

Pioneered the ICU Liaison Role Implemented Nurse-led Rapid Response Team Australia’s 1st Critical Care NP Published 5 Papers National / International Guest Speaker Founding Member of the Victorian NP Group

Future Endeavour's

Expansion

Succession Planning

Victorian NP Group

Australian Network

Concluding remarks: leadership tips for the Nurse Practitioner

Reenergize via successful results Leave your comfort zone Do not avoid conflict Benefit the organisation Recognise when change needs to occur and

acting upon it