Demonstrating

competence in a

new role or skill Alison Pottle

Consultant Nurse in Cardiology Royal Brompton and Harefield NHS Foundation Trust

Harefield Hospital

Nursing Competence, Hallam Conference Centre, London. May 1, 2014

Content

Why do we need new roles/skills?

What new roles are there?

What is competence?

Keeping up to date

Examples from nurse-led services at

Harefield Hospital

Why do we need new roles?

Government backing - The NHS Plan (DOH 2000), Making a Difference (DOH 1999)

Changes in health care delivery

European working time directive

Changes in career expectations

We want them!!

Range of new roles

Consultant nurses

Specialist nurses

ANP

Nurse-led and nurse-run services

Surgical assistants

Prescribing

Who should take on these new

roles?

Competence

Training

Competence 1

What is competency?

- knowledge, skills, motives and personal

traits

Collins English Dictionary

‘the condition of being capable, ability’.

Competency

This considers the nurse’s levels of competence as a whole. It combines the skills, knowledge and attitudes, values and technical abilities that underpin safe and effective nursing practice and interventions

Advanced Nurse

Practitioners – an

RCN guide to

advanced nursing

practice, advanced

nurse practitioners

and programme

accreditation

ICN Nurse Practitioner/Advanced Practice Nursing network - A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice

Competence 2

Specific skills/ knowledge

History taking/consultation

Clinical examination

Diagnostic skills

Interpretation of tests/investigations

Prescribing

Why is competency important?

Patient safety

Professional accountability

Maintains standards

Measurable

Facilitates good practice

Training

Advanced practice

?MSc/BSc

Relevant courses

Knowledge base

Observation

Supervision

Evaluation

Performance review

Policies, guidelines and protocols

New areas of working for nurses

Nurses are familiar with working to

guidelines/protocols/procedures

Enables practice to be measured

Provides role clarity

Ensures standard of care

Demonstrating competence is familiar to

HCPs

Examples from my practice

Rapid Access Chest Pain Clinic

Post PCI follow-up clinic

PCI pre-admission clinic

LDL-apheresis service

Nurse-led discharge

Rapid Access Chest Pain Clinic

Medically led clinic already in operation

NSF for CHD published 2000

Consultant Nurse employed 2000

Was I competent to take on this role?

Number of patients seen in the

RACPC

0

50

100

150

200

250

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

No.

Year

Where are we today?

Twice weekly clinics

Established nurse-led service – GPs refer

directly to me

Hospital consultants refer to me

New members of staff have been trained

On-going audit programme in place

Post PCI follow-up clinic

New initiative

No similar clinics elsewhere

No national guidelines

Protocol written

Careful negotiation

Selling a new service and new ways of

working

Competence

Clinics started January 2001

No specific training available

Observation of medical clinics

Agreed pathway of care

Training in non-invasive testing

New staff employed

Expansion of nursing roles

Number of patients reviewed in

post PCI clinic

0

500

1000

1500

2000

2500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Clinic

Telephone

No.

Year

The post PCI follow-up clinics

today

3 follow-up clinics a week

3 telephone follow-up clinics a week

5 Clinical Nurse Specialists in post (3.20

WTE)

In house training programme

Active audit programme

Consultant Nurse no longer runs clinics

PCI pre admission clinic

Initial 3-month audit - January 2009

Number of patients seen;

2009 267

2010 356

2011 384

2012 441

2013 531

DVD produced 2011

Competence

Experience in post PCI clinic

MSc module in clinical examination

Observation of Consultant Nurse in clinic

Audit

LDL-apheresis service

Dialysis type treatment for patients with

raised cholesterol, uncontrolled by

standard treatment

Only 7 units in the UK

Treatment is carried out every 2 weeks

Service started with 1 patient in 2000

Nurse-led service

Competence

Unusual service!

Training from machine manufacturer and

the other units in the UK

Service initially run by Consultant Nurse

Employment of nurse specialists

In-house training

Competency based assessments

Development of national standards

The LDL-apheresis service today

Moved into new unit in December 2009

Now treat 24 patients with another 1 waiting to

start treatment

Team of 6 Clinical Nurse Specialists (2.39 WTE)

Largest unit in UK

CNS’s run unit with supervision from Consultant

Nurse

National website launched in April 2010

On-going research study

Nurse-led discharge 1

PCI patients

Commenced March 2010

10 years experience as Consultant Nurse

Need identified

Prescribing

Consultant support

Nurse-led discharge 2

60-80% of patients discharged the same day

Changes to medication made in 55-60% of patients

Complex patients discussed with medical staff

Year March

2010-April

2011

April 2011-

March 2012

2012 2013

No. of

patients

reviewed

1070 833 807 669

Changes to medication 2013

611 changes to

medication were

made in 374 patients

(55.9%)

Drug New

prescription

Dose

titrated

ACE inhibitor/ARB 32 101

Beta blocker 19 58

Statin 11 34

Change Simvastatin

to Atorvastatin

13

Nicotine replacement

therapy

55

GTN spray 7

Proton pump

inhibitor

28

Change Omeprazole

to Lansoprazole

19

Prescribe regular

medication

24

Prescribing competency

Theoretical assessment, OSCE, portfolio

Competency framework -single framework for all prescribers

3 domains;

The consultation

Prescribing effectively

Prescribing in context

9 competencies in total

Framework can be used as an appraisal tool

Conclusion

Exciting time for nursing

Numerous opportunities for role/skill

development

Must demonstrate competency

Need for on-going education and training

Good quality patient care is paramount

Thank you for your attention.