1. Nursing in Remote Island Settings
Elaine Peace
Director of Nursing, Midwifery and Allied Health Professions
NNS Orkney

2. Primary and Community Care in Orkney
Orkney Population 21,349 (2011 Census)
Orkney Mainland
2 Community Nursing Teams linked to 5 Orkney Mainland GP Practices
Integrated Care Team
17 inhabited isles without land access to Kirkwall
3,300 people on isles
10 Isles Practices
4 single handed GP Practices
6 single handed Nurse-led Practices
Community Responders

3. The Recruitment Challenge
Identify the vision – engage and involve
Advertise the job – think outside the box
Secondment opportunities
Army discussions
Flexible working patterns
Local enhancements
Recruitment opportunities prior to interviews
Community supported visits to island
Practitioners available to answer questions
Reality of island life
Clarity of Expectations
Regular supervision
Recognise isolation and support resilience
Professional development
Clinical support

4. Remote Reality Isles communities Community Engagement in Recruitment
Passionate
Strong sense of ownership
Resilient
Each community different
Different solutions to different challenges
Populations
Community Engagement in Recruitment
Communities created information packs for applicants
Community orchestrated visit to their island and hosted the applicants
Community representative on interview panel
Expectations – community solutions

5. Evolving Model of Care
6 smaller islands Advanced Nurse Practitioners 24/7
Visiting GP services from individually linked General Practices
Two week on/off rota
Travel and accommodation included
Training and development time
Recruited into an informal team of mutual support (INOC)
4 larger islands with single handed GPs,
Community nursing 24/7 – band 5/6
Community first responders
Videoconferencing - INOC
Isles practitioners linked by weekly VC meeting
Review of all admissions
SEAs and incident reviews
Professional and Administrative Issues

6. (N)INOC Training Programme
Core skills and competencies
Competency framework
Training needs assessment
Emergency, practice and community nursing skill set
Clinical examination skills
Prescribing
BASICS
Long term conditions, mental health and paediatrics
Palliative and end of life care
Local education and national VC programmes
Emergency Care Training
EMRS / Paediatric Retrieval Outreach Training
Regular scenario and fire drill training

7. Professional Development and Retention
Competency framework
CPD built into working time model
Local delivery through HEI providers eg:
ACES
ALERT
Non-medical prescribing
Clinical supervision
Shadowing
Challenges of backfill
Add Scenario training picture

8. Sustainability Challenge
Community Nursing Posts
Variability
Grades and competence
“2nd Class” perception
Difficult to recruit to
Lifestyle choice
Isles Generic Support Workers
New model
Unknown outcome
Test and try

9. How are we doing? Visionary Not necessary a lifestyle choice
Advertise the opportunities – professional development, secondments
Opportunities of flexible working
Involve the community
Manage expectations
Early contact with a practitioner
Recognise limitations of pool
Prepare for gaps
Opportunities to grow your own

10. The Future
Evolving process Integration and opportunities for new models of care Strong Clinical Leadership and supervision Create a Vision for nursing Creating a supportive, cohesive integrated system Robust training and development opportunities Anticipation and preparedness for ongoing change and challenges One size will not fit all......But that’s ok!