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Bringing excellence to life
The role of theAdvanced PracticeNurse and NurseConsultant
Nathaniel AultConsultant HIV NurseBarts and the London
Bringing excellence to life
The Role of Advanced Practice inHIV Care
Consultant Nurse Advanced Nurse Practitioner Nurse Practitioner Clinical Nurse Specialists Etc….
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Bringing excellence to life
The Whys andWherefores
Why has advanced practicecome about? (Drivers)
What is it? (Definition) How do we know we are
capable? (Competence) Who is doing it? (Examples) Where is it going? (Future
issues)
Bringing excellence to life
The Why:The Drivers for Change
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Bringing excellence to life
Drivers
Making a Difference (1999) NHS Plan (2000) Ara Darzi and Polyclinics
Government White Paper: OurHealth Our Say – advocatinggreater community based care
Community Matrons
Bringing excellence to life
Drivers
Long term conditions BHIVA HIV Service Standards BHIVA Treatment Standards HIV Care Pathways Finances HIV Nursing
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Bringing excellence to life
The view of the Royal collegeof Physicians:
“HIV clinic nurses are also keymembers of the clinical team.They develop specialised skills inassessing the wide range ofclinical and other problems thatpatients experience, and may betrained to assist with orundertake a wide range of medicalprocedures”
Bringing excellence to life
The What:A definition of Advanced Practice
RCN (2008) An RCN Guide to the advanced
nurse practitioner, competenciesand programme accreditation
“Senior Nurses working in HIV whohave a defined cohort of patients forwhom they manage an aspect ofclinical care. Care should includeprofessionally autonomous decisionmaking based upon the interpretationof data gathered from a systematicassessment, and associatedinvestigations and results, within awider supervised clinical team”
(HIV Nurses in Advanced PracticeGroup)
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Bringing excellence to life
The How:Exploring Competence
Wilson I et al (2005) “Quality of HIVCare Provided by Nurse Practitioners,Physician Assistants, and Physicians”Annals of Internal Medicine 143 (10)729–736
Hekkink C et al (2005) “HIV NursingConsultants: patients’ preferences andexperiences about quality of care”Journal of Clinical Nursing 14 (3) 327-333
Bringing excellence to life
Horrocks S et al (2002)“Systematic Review of whethernurse practitioners working inPrimary Care can provideequivalent care to doctors”.British Medical Journal 324, 6April 02, p819-823
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Bringing excellence to life
Published Competencies
National HIV Nurses AssociationCompetencies
June 07
Level 4 competencies: this level ofpractice reflects the role of expertpractitioners working in advancedpractice roles such as nurseconsultant, senior clinicalpractitioner or senior nursemanager.
Bringing excellence to life
The Who:Examples of Advanced Practice
Kirkpatrick, E et al (2006) ‘HIVService Redesign: an audit ofthe contribution that SpecialistNurses make to managingpatients with non-complex healthand social care needs’ HIVMedicine 7, supp 1, 18 (P31)
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Bringing excellence to life
Community CNS / Matron Community based clinics (stable
patient, lipid, avoiding admission)
District General Hospital AcuteCNS’s Stable patients, Triage and
treatment minor ailments, Lipidclinics etc
Bringing excellence to life
The Where:Future Issues in Advanced Practice.Possibilities..
Primary or Secondarybased care?
Community BasedOne-stop-shop care?
Prescribing 1st LineTherapy?