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Clinical Research Nursing and Advanced Practice
Helen Pidd and Gail Holmes
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Overview of presentation
National Context What is Advanced Practice? Manchester Context – why and how MSc in Advanced Practice Health and Social care – an overview
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Where’s the starting point?
Benefits of the Job The conduct of research to international standards Travelling to investigator meetings and conferences nationally and internationally Eating at good restaurants to discuss the research project/s and to network No shift work Drawbacks of the Job Drowning in a sea of research jargon Frequently working in isolation Other nurses view the CRN as a data collector Short term contracts Sometimes have to arrange holidays around studies in progress
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Historically Worked in isolation from their professional colleagues
Convenient whilst raising a family, not having to work weekends and evenings Mere data collectors Short term contracts Lack of line management support Invisible to trust personnel systems Extended and specialised role
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Biomedical Research Centres
Birmingham Aberdeen Manchester Edinburgh Cambridge Glasgow Southampton Inverness Newcastle Tayside Dundee London Belfast McMichael Centre Dublin UCLH Galway Somers GOSH Cork Guy’s & St Thomas’ Cardiff Hull York Manchester Children’s Sheffield Sheffield Children’s Birmingham Children’s Oxford Peninsula Brighton Surrey Clinical Research Facilities Biomedical Research Centres Aberdeen Dundee Glasgow Edinburgh Newcastle Manchester Liverpool Cambridge Oxford London Great Ormond St Guy’s & St Thomas’ Imperial Moorfields Royal Marsden UCL Inverness Aberdeen Dundee Glasgow Edinburgh Newcastle Belfast Galway York Dublin Hull Manchester Leeds Liverpool Sheffield Biomedical Research Units Nottingham Leeds Liverpool Sheffield Nottingham Leicester Birmingham Oxford Bristol London Royal Brompton Barts Southampton Experimental Cancer Medicine Centres Cork Birmingham Leicester Edinburgh Glasgow Birmingham Belfast Cambridge Newcastle Oxford Leeds London Manchester Barts Liverpool ICR Sheffield Imperial Leicester KCL UCL Southampton Cambridge Oxford Cardiff Bristol London Surrey Southampton Peninsula Brighton
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NIHR Clinical Research Networks
NIHR Dementias & Neurodegenerative Diseases Research Network NIHR Diabetes Research Network NIHR Medicines for Children Research Network NIHR Mental Health Research Network NIHR National Cancer Research Network NIHR Primary Care Research Network NIHR Stroke Research Network NIHR Comprehensive Clinical Research Network
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NIHR Comprehensive Research Network
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Clinical Research Nurses
Newcastle year n 100% Increase over 3 years
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Similar Picture Across the Country
AHP/STUDY COORDINATORS Cambridge 26 Sheffield 21 Manchester 13 Norfolk & Norwich 8 NUMBERS INCREASING YEAR ON YEAR NURSES Cambridge 148 Sheffield 173 Manchester 168 Norfolk & Norwich 56 Newcastle 180 Birmingham 87 (Trust) Scotland 411 Large body of nurses being employed with little or no strategic thinking of how to develop group of individuals. However as critical mass emerges, solutions to concerns or problems are developing 2012/13 10,000
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Changes since 2001 National:- including Developing the Best Research Professionals (Finch) 2007, Competency document – version 2, Training – GCP, Informed Consent, new roles emerging Networks:- Induction Portfolios, local training, information sharing - UKCRF Network – Trust:- Lead Nurse Appointments, Local Training
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Opportunities Clinical Academic Management
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Advanced Practitioner
The definition used widely by the DOH outlines that an advanced practitioner is a clinically autonomous practitioner, defines the scope of practice of others and continuously develops clinical practice within a defined field. • Experienced non-medical registered professional who has developed his or her knowledge to a very high standard in a specific and often high level of practice. This high standard is such that not only is the individual the expert in the base domain:-but can also accept the full responsibilities for providing those services hitherto supplied by others, in defined circumstances. (J. Sargent 2003)
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Core Characteristics of Advanced Practice
Work across organisations and different agencies Provide advanced levels of practice, knowledge and skills Clinical focus - Clinically autonomous. Empowered to make high-level decisions. Be self directed, manage risk, have high levels of communication skills and be a member of a wider clinical/ service team. In many cases the person will have their own patient/client caseload with decision making responsibilities In many cases manage medications including assessment, review and prescribing. Undertake a physical examination and history taking, diagnosis and plan care and treatment.
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Advanced Practice in Manchester
Modernising workforce European working time directive Patient centred seamless care PARTNERSHIP 2004 Strategic Health Authority 13 Acute and Mental health Trusts University of Bolton (primary care) University of Salford (acute)
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Advanced Practice in Manchester
Greater Manchester SHA initiative – Delivering the Workforce Advanced and Assistant Practitioners Need identified by Trust, application to GMSHE Trainee roles commissioned and funded through GMSHA Supported by an education programme
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Application Process Rigorous process
Trust and WTCRF commitment to the role Detailed proposal form submitted to SHA Decision to support application sits with SHA
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The Proposal Executive sign off Role description
Reason for developing role Needs analysis Skills and competencies Facilitation of WBL Identification of mentor/assessor/line manager Safety, effectiveness. governance Funding arrangements and sustainability Organisational track record
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The Role - Overview To develop advanced knowledge and skills in the identified theme areas and assist both new and established investigators to efficiently carry out their studies and enable them to achieve study targets by providing continuity of service. In partnership with the Clinical team manager provide clinical leadership to the team of nurses, focusing on enhanced practice development To develop nurse led research and support the development of clinical academic roles.
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The Role - Expectations
Lead on participant care for the duration of a study, including assessment for inclusion in a study, medical history taking, medical examinations, management of drug infusions, prescribing and reviewing and refining participant care throughout the study Provide medical cover for identified cardiovascular and paediatric studies Undertake informed consent for Clinical Trials of Investigational Medicinal Products
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Demonstrate enhanced clinical skills including arterial bloods, biopsies, management of central lines, minor surgical procedures, ultrasound in the vascular system, management of anaphylaxis, pulse wave analysis, analysis and decisions relating to test results Lead on the development of nurse led research and enhanced clinical practice Provide advice and guidance to PI’s on study efficacy and safety Participate in the development and testing of new devices and approaches to health care for patient benefit
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MSc - Programme 2 years (part time) 45 weeks per year (3 semesters).
2 learning days per week. Thursdays taught day. Thursdays and some Fridays sem 1 and 2 Attendance at University greatly reduced year 2. - WBL Second day student choice for clinical/work based needs. 90 days per year clinical application.
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University of Salford, MSc Advanced practice
(Health and Social Care Pathway) Programme Overview Semester 1 Semester 2 Semester 3 Credits Year 1 Principles of Advanced Practice (30) Application of Life Sciences (30) Contextualising Advanced practice (30) 90 Portfolio Individual Learning Pathway Tripartite Agreement core and bespoke skills Organisational pathway analysis Year 2 Research Methods (30) AP1: Practitioner competence (30) AP2: Clinical Reasoning (30)
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Portfolio of Evidence Year 1
Job description Individual Learning Pathway Clinical Skills Learning Agreement Bespoke Skills identified and agreed Objective and subjective evidence for sub elements of the Elements of Advanced Practice Achievement of skills at level 2 on Taxonomy of Achievement Organisational pathway analysis 360 degree feedback
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Portfolio of Evidence Year 2
Cases (formative and summative) Triangulated evidence for many sub-element of Elements of Advanced Practice Completed skills log (core and bespoke) at level 2 and 3 40 case assessments Completion of Individual Learning Pathway 180 credits at level M
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Programme Support Mentors Stay with student for 2 years
Understand programme and learning requirements Advocate in Trust on behalf of student Assessors Objective judgement on performance throughout 2 years May delegate some work to supervisors of appropriate standing
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Programme Support Trust Mentor Line Manager Assessors Supervisors
University Personal Tutor Academic Supervisor Programme lead Student Life Learning Facilitator
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Where are we now Successful SHA application – 2 posts
Successfully recruited through internal secondment – band 7 in training, 8a once qualified Steering group in place 2 trainees commenced Sept 2011
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