the role of the advanced practice nurse and nurse consultant

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Bringing excellence to life

The role of theAdvanced PracticeNurse and NurseConsultant

Nathaniel AultConsultant HIV NurseBarts and the London


The Role of Advanced Practice inHIV Care

Consultant Nurse Advanced Nurse Practitioner Nurse Practitioner Clinical Nurse Specialists Etc….

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The Whys andWherefores

Why has advanced practicecome about? (Drivers)

What is it? (Definition) How do we know we are

capable? (Competence) Who is doing it? (Examples) Where is it going? (Future

issues)


The Why:The Drivers for Change

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Drivers

Making a Difference (1999) NHS Plan (2000) Ara Darzi and Polyclinics

Government White Paper: OurHealth Our Say – advocatinggreater community based care

Community Matrons


Drivers

Long term conditions BHIVA HIV Service Standards BHIVA Treatment Standards HIV Care Pathways Finances HIV Nursing

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The view of the Royal collegeof Physicians:

“HIV clinic nurses are also keymembers of the clinical team.They develop specialised skills inassessing the wide range ofclinical and other problems thatpatients experience, and may betrained to assist with orundertake a wide range of medicalprocedures”


The What:A definition of Advanced Practice

RCN (2008) An RCN Guide to the advanced

nurse practitioner, competenciesand programme accreditation

“Senior Nurses working in HIV whohave a defined cohort of patients forwhom they manage an aspect ofclinical care. Care should includeprofessionally autonomous decisionmaking based upon the interpretationof data gathered from a systematicassessment, and associatedinvestigations and results, within awider supervised clinical team”

(HIV Nurses in Advanced PracticeGroup)

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The How:Exploring Competence

Wilson I et al (2005) “Quality of HIVCare Provided by Nurse Practitioners,Physician Assistants, and Physicians”Annals of Internal Medicine 143 (10)729–736

Hekkink C et al (2005) “HIV NursingConsultants: patients’ preferences andexperiences about quality of care”Journal of Clinical Nursing 14 (3) 327-333


Horrocks S et al (2002)“Systematic Review of whethernurse practitioners working inPrimary Care can provideequivalent care to doctors”.British Medical Journal 324, 6April 02, p819-823

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Published Competencies

National HIV Nurses AssociationCompetencies

June 07

Level 4 competencies: this level ofpractice reflects the role of expertpractitioners working in advancedpractice roles such as nurseconsultant, senior clinicalpractitioner or senior nursemanager.


The Who:Examples of Advanced Practice

Kirkpatrick, E et al (2006) ‘HIVService Redesign: an audit ofthe contribution that SpecialistNurses make to managingpatients with non-complex healthand social care needs’ HIVMedicine 7, supp 1, 18 (P31)

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Community CNS / Matron Community based clinics (stable

patient, lipid, avoiding admission)

District General Hospital AcuteCNS’s Stable patients, Triage and

treatment minor ailments, Lipidclinics etc


The Where:Future Issues in Advanced Practice.Possibilities..

Primary or Secondarybased care?

Community BasedOne-stop-shop care?

Prescribing 1st LineTherapy?

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And challenges…

The Essence ofnursing!


Acknowledgements:

Sheila MorrisDiane Reid

the role of the advanced practice nurse and nurse consultant

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