1. The Impact of Specialist Nurses
Alison Leary PhD FRCN FQNI MBE
Professor of Healthcare & Workforce Modelling
@alisonleary1

2. What do I do?

3. Nursing work is often invisible

5. Why do we still need to look at impact of specialist nurses?
Showing up here
But not here

6. How decision makers see the work

7. Lets do an experiment!
I am an expert

8. Know your audience

9. Work as imagined Work as done
Task

10. What expert nursing can offer
A good return on investment
High quality-expertise that’s accessible and flexible for patients & families
Safe-consistent care delivered by a stable workforce
Expert & capable new product not a competent replacement

11. FALSE False assumptions
Nursing is a series of primarily physical tasks that occupy time
Nursing is the application of a task based skillset with little decision making
Nursing can be measured i.e. time and motion type of activity.
Service industry.
Caseload same as Workload
All work is completed in time allocated
FALSE

12. How do nurses keep patients safe?
Vigilance
Clinical acumen & reasoning, application of knowledge in context
Rescue
Mitigate rookie factor
Prevent Kerplunking!

13. Who are nurses?

14. The times we live in

15. The complexity of SNAP work
Proactive case managers/brokers/vigilance
Promote and enable self management
Key accessible professional across a journey
Technical expertise
Alleviate suffering/dealing with uncertainty
Perform rescue work to a high degree
Admission avoidance work/referral
High quality patient experience including resolving poor experience
Design and manage own services & work in collaboration with other colleagues
Improve clinical outcomes
Leadership (role model, set standards)

16. APRNs are good value
Increasing body of evidence in LTCs in terms of ROI (Parkinson's, Diabetes, MS, rheumatology, cancer, IBD, palliative care, heart failure, primary care).
Generate income, efficient, high quality services
Key to future efficiency is self management
Majority of research around contribution to quality-access to treatment
Unpaid overtime average £4-6k per year-£30m
Improves outcomes ie survival in cancer

17. What works well in self management?
Emphasising problem solving & developing care plans as a partnership between service users and professionals
Setting goals and following up on the extent to which these are achieved over time
Promoting healthy lifestyles and educating people about their conditions and how to self-manage
Motivating people to self-manage using targeted approaches and structured information and support
Helping people to monitor their symptoms and know when to take appropriate action
Helping people to manage the social, emotional and physical impacts of their conditions
Proactive follow up
Health Foundation 2011 17

18. Showing impact and workload IS possible

19. https://human-resources-health. biomedcentral. com/articles/10

20. Results-DISNs in London
Significant reduction in rates of readmission/bed days saved and 27% reduction in LOS.
Data such as NADIA was too episodic but local harms evaluations show harm reduction.
Participation in NaDIA Hospital Characteristics dipped in 2018 with over 20 sites failing to return a survey.
Datix appears to under report in this group across trusts showing comparatively low useage.

22. Results
Activity analysis-60-80% of DISN time was spent on rescue or crisis work rather that proactive prevention of insulin errors and deranged blood glucose levels.
This was suggested as potentially down to a lack of knowledge by staff.
Staff education was often “ad hoc” although DISNs had brokered more learning opportunities for staff, service demands of both the DISN and the ward based staff meant these opportunities were limited.
Patient education tended to be more structured.

23. Results
Survey responses (for example working practices, unpaid overtime, confidence levels, qualifications) did not differ significantly from the average (national) survey.
Confidence levels in complex work such as titration of insulin of patients on dialysis dipped over time for the new appointees. This is not unusual and often attributed to overcoming the Dunning-Kruger effect.

24. Although confidence in complex care decreased, confidence in assessment increased.

25. Evaluation
Ideally think about this before starting a new service or activity!
Evaluation should be part of the business/strategic plan
How do I know my service:
Meets needs?
Is cost effective?
Is safe?
Is good quality?
What is your USP? Why would someone commission your service?

26. Top tips Tell people about your work-stops false assumptions
Understand the burden of proof required
Don’t worry about attribution
Understand the wider context in which you work (strategic organisational, political, financial)

27. We say who we are, not what we do
Compassion Empathy
Virtues i.e. courage
Skill, knowledge, expertise, alleviation of suffering
Voiced
Silent
Psychological care

28. “I didn't do anything, I just sat and listened”
“If I do express my views, no one will listen to me anyway.”
“I’m Sam,
I’m one of the nurses”
“It was nothing”
“Its just basic care”
“nursing is common sense its not rocket science”
“the doctor wants you to......”
“I see most of the patients, but I can ask the doctor to see the ones that are more complicated”
“I'm Just a nurse”
“I’m not an expert on health care, so how can I voice my opinions?”

29. So what can we do? Capability Competence
Use expertise stories as well as virtue stories-the missing C’s!
Use affirmative language
Little things
Basic nursing
Common sense
Capability
Competence
We can start to measure the things that matter rather than collect data
Learn that its OK to be good at what we do-nurses voices save patients lives

30. The cost of being invisible

32. Thank you alisonleary@yahoo.com @alisonleary1
“If you think it's expensive to hire a professional to do the job, wait until you hire an amateur.” Red Adair
Thank you
@alisonleary1