Presentation on theme: "Nurse Practitioners aren’t built in a day."— Presentation transcript:
1 Nurse Practitioners aren’t built in a day. Anna GreenNurse Practitioner – ICU LiaisonNurse Practitioner Project OfficerWestern Health, Australia
2 Map of Australia Melbourne If you are planning on coming to Australia then your visit would not be complete without a stay in Melbourne.We pride ourselves on our sporting venues which includes the formula 1 Grand Prix, the Melbounre Cup HorseRace, and our own brand of football known as Aust. Fooltball League.Melbourne is also renown for its arts and culture centres and not to mention exquisite dining venues.Melbourne
3 Leadership core competencies VisionaryIdeaCommitmentEnergisingWhen researching up on leadership skills The common theme was these core leadership competencies were repeated again and again and can be best summarized by Jodie McLeod in her article in Human Capital Issue as:creating a vision around where you need to goEnergising people to ensure that they’re empowered to come on board with you and follow youBuilding commitment to the vision…Given what I have said about leadership how does this differ to what I do normally.EmpowermentMcLeod J. Leaders aren’t built in a day. Human Capital Issue 3.1: 24-27
4 ICU Liaison Nurse Role Case-Manage patients post ICU discharge Accept referrals for unstable patientsRapid Response System - respond to clinical marker referralsInitially established to only case manage pts post ICU dischargeWithin 3 months of commencing in this role we started receiving referrals from nursing and allied health staff for other patients on the wards who were clinically deteriorating.It wasn’t long after this that referrals from medical staff started to occur and has continued to increase each year of operation. It is not uncommon to be asked by the ICU medical staff or ward medical staff to review clinically unstable patients on the ward, to assess if ICU admission is required.Whilst we receive a large proportion of referrals for unstable patients in the ward there are still others who are admitted to ICU from the ward where we have had no involvement with and have shown significant signs of clinical instability for several hours and in some cases days.It was these patients we were not referred to us that led us to come up with the clinical marker referral system. This system is based on the MET. The MET in some hospitals in Australia, has replaced the traditional resuscitation team and respond to emergency calls for all pts showing signs of pre-determine vital sign abnormality. Our clinical markers that are based on the MET criteria have been modified following a 3 month review of all unplanned admissions unto ICU to identify earlier signs of deterioration than pre arrest criteria.
5 ICU Liaison hours worked Two full time EFT7 day a week cover8am to 6pmOne day a week allocated to non clinical workResearchLeadershipEducationMeetings/CommitteeWorking towards 24 hour serviceExpanding service throughout the network
6 Leadership development InternalExternal19961998Obtaining an office and equipmentChanges to the reporting structure of the roleMeeting organisational demands that were separate to individual demandsComplex care courseProcess improvement teamPolicy and procedure manualRewarded with leadership development courseExtending hours to full timeSelfLeadership skills
7 Goal achievement Australia's First Critical Care NURSE PRACTITIONER 2004My application to the NBV was back in May 2002 and it was 2 1/2 years later that I was finally endorsed. Waiting that length of time was frustrating however, it was more important to get the process right. All of us who have gone through the endorsement process in Victoria have an immense sense of achievement and are very proud of the commitment of not only ourselves but also the NBV and the DHS Victoria.So in essence my training in becoming a NP whilst working in an advanced practice role took 6 years which does not take in account 10 years previously of working in my specialty area of critical care.
8 Three Fundamental Problems Failure in planningFailure toRescueFailure to communicateIn the 100,000 Lives Campaign they report on three main systemic issues contributing to the problem of failure to rescue.The first is failure in planning which includes assessments, treatments and goalsThe second is failure to communicate including patient to staff, staff to staff, and staff to physician etc)The last is a failure to recognise the deteriorating patientAnd all of these contribute to fail to rescueHence the rapid proliferation of MET, Outreach Teams and the ICU Liaison Teams.Failure to recognisedeteriorating patient condition
9 What is a Rapid Response System? Medical EmergencyTeamOutreachTeamICU Liaison TeamA rapid response system (RRS) involves the utilisation of a variety of hospital resources, for the detection and treatment of patients in crisis, to prevent deterioration, morbidity or death.MET – Liverpool Hospital 1990ICU Liaison – Western Hospital 1996Outreach Team – UK Late 1990’s early 2000MET & Liaison –The aim of implementing a RRS is to reduce the number of unexpected in-patient deaths.MET & ICU Liaison Service
10 What are these warning signs? Altered CNSFall in GCS of >2 pointsHeart Rate >120 per minuteSystolic blood pressure <90mm HgRespiratory Rate >30 breaths per minuteSa02 >90% on oxygenDifficulty in breathingUO <60mls for 2 hours“Worried Staff”(Green & Williams 2006)These criteria are the MET criteria for Liverpool HospitalThese reportable ranges vary depending on the individual hospital.In the UK the criteria used are based on Franklins article that identified warning signs 6hrs of arrest.Differences includeLowering the upper range of heart rate to 125Lowering the upper range of respiratory rate to 30 breaths/minute
11 Changes to criteria ranges New criteriaOmitted criteria
12 What difference Can a NP led Rapid Response Team Make? Fast Track Patients to the ICUDecreased cardiac arrest callsIncreased medical emergency callsImproved 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)
14 Survey Response Disagreement with parameters Overstepping boundaries Increased workload for ICU MOPoor response from MO when calledFurther education(Green & Williams, 2006)
15 What extended practices do I need Referral to ICU consultantsOrdering of diagnostic testsOrdering of radiological testsLimited prescribing rightsAdmission / Discharge
16 ICU Liaison – extensions to practice LimitedPrescribingCounsellingClinicalPracticeInitiateDiagnosticsAdmit /DischargeManagementPolicyResearchDirect referral toMedicalSpecialistsEducationConference
17 Reflecting on my achievements Pioneered the ICU Liaison RoleImplemented Nurse-led Rapid Response TeamAustralia’s 1st Critical Care NPPublished 5 PapersNational / International Guest SpeakerFounding Member of the Victorian NP Group
18 Future Endeavour's Expansion Succession Planning Victorian NP Group Australian Network
19 Concluding remarks: leadership tips for the Nurse Practitioner Reenergize via successful resultsLeave your comfort zoneDo not avoid conflictBenefit the organisationRecognise when change needs to occur and acting upon it
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