1. The Role of the APNP in Children’s services. Jo Ellis September 2012

2. Advanced practice Advanced practice is a 'level of practice' rather than a role or title Underpinned by: autonomous practice, critical thinking, high levels of decision-making and problem- solving, values-based care and improving practice (NES, 2007) Advanced practice is shown across four key themes Advanced clinical/professional practice Facilitating learning Leadership/management Research

3. Children are different Paediatric services are very specialist and require members of staff who have skills and knowledge which are very different to those needed to provide care for adults. Hospital Episode Statistics (HES) show that admissions into hospital for children are going up year after year.

4. What is an APNP??… o A nurse specialist in the care of children from birth through adolescence. o Possesses in-depth knowledge and experience of paediatric health care with regard to: i. the assessment, diagnosis and management (including prescribing) of a wide variety of paediatric illnesses/conditions ii. the spectrum of wider issues that impact the health and well-being of the child and family unit - safeguarding, health promotion, growth/development

5. Excellent and accessible services for children. (Change for Children- Every Child Matters (2004), which is underpinned by the Children’s Act (2004), from good to great 2009, Healthy Horizons 2008) The kennedy report 2010, Health care service standards in caring for neonates, children and young people. The National Service Framework for Children,Young People And Maternity Services (DH, 2004c),the Welsh Assembly Government (2004) and theScottish Government (Scottish Executive, 2007) Improved patient choice (NHS Improvement plan (June 2004), Creating a Patient Led NHS, Our health Our care Our say 2004, Our NHS our future) Extended opportunities for nurse education and practice. (modernising workforce plan DOH 2004, prescribing policies) Cost effectiveness (from good to great 2009) EWTD Collaboration vs competition.

6. Collaboration Rather than professional roles or boundaries, it should be the child or young person’s needs which are paramount in the way services are developed Employed by paediatrics - Work across 2 directorates (A&E and Paediatrics).

7. LEADERSHIP MANAGEMENT STRATEGY How it works in practice ADVANCED CLINICAL PRACTICE EDUCATION RESEARCH SKILL MIX CHILDREN’S NURSES RGNs APNP (1) 0.5 Vacant +1 trainee MEDICINE (A/E) MEDICINE (Paediatrics) Co-located Children’s A/E and Children’s Assessment Unit (CAU) CAU referrals from GPs, WIC, OOH, A/E, M/W A&E – undifferentiated – local practice

8. The service… Jo Ellis (paeds 37.5 hrs) & currently unfilled 18 hour post (A&E) Cover times and areas of most need Masters level advanced practice qualification Independent practitioner Independent and supplementary prescriber APLS trained SUPERNUMERARY.

10. A&E Attendances Average Daily Attendances Average Daily Admissions Apr-1245.44.3 May-1248.63.9 Jun-1244.04.3 Jul-1243.64.1 Aug-1238.74.5

11. The Clinical Role Assess undifferentiated conditions presenting to the children’s emergency department (A&E and APAW) Order diagnostic tests including x-rays, scans, bloods etc. Advanced clinical skills (Canulation, LP) Diagnose, treat, prescribe, discharge / refer. Offer explanation, support and anticipatory guidance. Lead on emergency situations Support for junior medical and nursing staff Registrar bleep Work closely with other HCP HOLISTIC approach – the value added piece!!

12. Facilitating learning Teaching/ education / resource Informal. Formal Canulation, Blood culture collection, PLS, Grand round. Training in house staff and other agencies (nurse practitioners/apnp..) Sharing knowledge & guidelines LJMU

13. Leadership/management Guidelines / Procedures Policy implementation. Mentoring? KSF reviews Refer to senior doctors/ consultants Supervision by consultants.

14. Research Audit – Asthma Collaboration on systematic review –acute abdominal pain in children. Bronchiolitis regional research

15. What the role offers Consistency Evidence based best practice. Support for medical and nursing staff The best possible patient journey….

16. Colleagues accept/ appreciate role really well Great support from medical colleagues Freedom to create role opportunities Rewarding Uncertainty accessing training opportunities Competing commitments/ Lack of time NMC role definition re advanced practice

17. Future opportunities Competencies for advanced practice. More Non clinical time Advanced Clinical skills Collaboration with primary care – shared pathways – reducing admissions – improving patients journey. Rotas??

18. Any Questions??