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This week marks the start of the first national advanced practice week. Across the country organisations will be celebrating the contribution that these individuals make to care that our patients receive.
Within Warrington and Halton, the development of Advanced practice workforces is a relatively new venture, but their benefits have massive repercussions across the whole organisation. Visible role modelling , clinical autonomy of care and the removal of glass ceilings from career structures allow all members of the MDT to aspire to higher level clinical positions, with the real opportunity to take responsibility and autonomy for patients within their care.
Over the last eighteen months, we have significantly invested in individuals and the development of this special role, not just within nursing but also within allied health. Since May last year, we have initiated three cohorts of trainees, a total of 28 trainees, located within all three hospital sites and each CBU. Most recently we have seen the introduction of the multi-professional Advanced practice strategy, welcoming our first Occupational therapist and Physiotherapist into the training program,. Our fourth cohort, is due to commence in January with an equal distribution of nurses and allied health professionals and we feel this shows that we have a real desire to develop individuals with a specialist interest in clinical care to achieve higher levels of autonomy for the those within their care.
We currently have more trainees ACP’s than most large university hospitals and our plans is to become a centre of excellence for advanced practice, with our own academy of specialist and advanced practice. However, this week is about the individuals within this program, to make us all aware of their special contribution and the difference they are making to the delivery of quality care by pushing the boundaries of clinical practice.
Consultant Nurse in Diabetes, Warrington
Lesley Mills has been working in the field of diabetes for more than 24 years as Consultant Nurse for WHH she leads a team of specialist nurses looking after patients within both primary and secondary care in 2 hospital sites and 3 CCG areas. As part of her specialist practice, she runs a number of complex clinics including sexual dysfunction and diabetes clinics. As swell running “in-reach” clinics for offender health in 2 local prisons.
Lesley has completed a post graduate diploma in health education and sexual health and completed an MPhil in medicine at Liverpool University, where she compared consultant led clinics with nurse led clinics for patients with high risk cardio- vascular problems. She has been involved in pregnancy and diabetes for about 20 years and runs a joint obstetric/maternity and diabetes clinic for women with pre-existing diabetes or those who develop it during pregnancy. She has lectured at national and international conferences for a number of years and has had many papers published both nationally and internationally. Lesley was awarded the honour of Queen’s Nurse in 2016 for her work in improving patient care in the community. She is also the longest serving member of the editorial board for the Diabetes & Primary Care journal.
As part of Advanced practice week today we would like to highlight the exceptional work of our Advanced neonatal nurse practitioners (ANNP). The team Laura Iley and trainee ANNP Marisa Owen, are based on our neonatal unit at Warrington.
This service complements the medical rota with expert neonatal care, knowledge and enhanced clinical skills the service has received exceptional praise from parents and neonatal / obstetric teams regionally, and are seen as a key example of how advanced practice supports patient care and service delivery.
The team care for mothers and babies from 27 weeks to 42 weeks gestation; and are responsible for attending all high risk deliveries, utilising their skills and experience to providing expert complex care for premature and sick babies, which may require intensive or transitional care. The team provide in house neonatal life support training to neonatal and midwifery staff and often lead during resuscitations and emergency procedures that may be required during or following complex deliveries.
Laura and Marisa, work as an integrated part of the neonatal unit, supporting both medical and nursing colleagues with their clinical expertise. They provide supervision on the post-natal ward and help to plan and evaluate high levels of care. They view education as essential to ensuring the integration of best practice across the whole team , and regularly partake in teaching sessions and clinical audits with nursing staff.
Laura and Marisa, are actively involved within the wider neonatal network, attending meetings to evaluate services and the evolving role of ANNP’s across the Cheshire and Mersey region.
Their role has received praise from parents who experience the trauma of early or complex deliveries with Laura and Marisa being actively involved I the providing psychological support for parents providing antenatal counselling for threatened pre-term labours as well as being involved in difficult conversations in end of life care.
Describing themselves as ‘The Green Team!’, WHH are exceptionally proud of the fantastic work that this dynamic team of ANNP ‘s achieve on a daily basis to help our neonatal teams the best standard of care for all
Over the last eighteen months the number of trainees within the trust has risen to 28. These trainees are spread over all three sites and demonstrating a clinical interest in a wide range of specialities. We’ve picked a few of the trainees to demonstrate the variety of role that we are developing and the impact that their training will make to our patients but also to the level of support available for all members of the WHH team.
Cohort 2: joined the program in September 2018,
Prior to starting as trainee ANP in Acute Care, Cally worked as part of the Acute Pain Team covering all three hospital sites. She describes the role of trainee ACP acute care as appealed to her because she wanted to work in a diverse role – retaining and expanding her clinical skills but also developing her leadership, management components and with strong roots in education.
Cally is developing her skills as an advanced practitioner roles as part of an evolving team with her colleague Louise to enhance out of hours care, together through the development of their advanced clinical skills they work as pro-active autonomous practitioners for our most vulnerable patients. My vision for the future is one of collaboration between disciplines; the Acute Care Team is uniquely placed as we cover all specialties of medicine and surgery. The Acute Care nurses form the Medical Emergency Team first responders alongside junior doctors – ANPs can offer a permanent expert service as our medical colleagues rotate annually.
Cally is about to embarking on her dissertation project, and will be looking at ward nurses’ perceptions of the Medical Emergency Teams. She plans to use this opportunity to consolidate and enhance working relationships between ICU, the MET team and ward based care here at Warrington Hospital, for the benefit of both patients and staff.
Sian Edwards, has worked in women’s health for the majority of her career, and has developed a specialist interest in gynaecology, she has strived to develop a range of skills that she feels has helped her to care for patients with a greater and more compassionate service. Throughout her career, she has focussed upon developing as a specialist practitioner in Gynaecology, completing a surgical practitioner’s degree in 2002, followed by further modules in modules in family planning and counselling. She achieved the role of specialist practitioner in 2012, within maternity services at Warrington.
As part of this role she has gained experience in a variety of clinical settings, but felt that she developed an affinity towards acute and early pregnancy care. Sian began to feel that due to service demands, access to emergency (gynaecology services) could often become prolonged due to limitations in suitably trained staffing and physical resources, envisioning that this role could be perfectly suited to that of an Advanced practitioner. With the support of her clinical supervisor Vicky Sephton and Tracy Cooper, Sian joined the ACP program and has tailored her training to help develop and stream access into gynaecology services with the vision of developing this service into an ACP lead service.
The project that has recently completed its pilot period and has demonstrated a significant improvement in how women within Warrington are able to access early pregnancy services. The development of this innovative nurse led service is a prime example of how advanced practice roles are beginning to blur and support roles predominantly associated with medicine, and enabling Warrington and Halton to be at the forefront of innovative project development programs such as these.
Accident and Emergency
Alex and Sarah are both existing band 6 nurses in the Emergency department. Over the next two years they will build upon the knowledge and skills that they learned as ED nurses to developing a range of clinical skills that enable them to see all categories of patients, both adult and paediatric.. This challenging training schedule has meant that they have a rigorous program to follow with objectives and physical skills identified to enable them to work as part of the tier 1 rota upon completion of their training.
Following completion of their training, Alex and Sarah will join an existing ACP team currently work alongside their medical colleagues, working autonomously, to make independent clinical decisions relating to the management of complex and non-complex patient presentations. Whilst the ED ACP role offers Alex and Sarah to the chance to develop a specialist skill set, they are also encourage to participate in training and education for the rest of the ED team a process that is seen as essential to allow further generations of nurses to aspire to similar training role
Cohort 2 : Left to right: Cally Littler (night prac team),Sian Edwards (gynae assessment), Sarah (ED Ale Mceneny (ED) Luoise Miekle (night Prac team)
Louise Tucker Consultant Midwife
Louise, has been qualified as a midwife for 18 years, working in both hospital and community settings, she became the first Consultant Midwife at Warrington in 2015.
Louise describes her role as being to promote normality within the unit, and to drive service initiatives which support women to achieve positive birth experiences. She is passionate about maternity services and ensuring that the women that choose to have their babies at Warrington receive the best care possible.
As part of her role, Louise has responsibility for the clinical leadership of the midwifery services within WHH as well as contributing to the direction of maternity care in the UK at both regional and national forums. She describes her role as being multifaceted, combining clinical practice, education and research, a role that helps to developing and improving the services that WHH can offer whilst ensuring that every woman and their families can be supported to achieve their best birth possible.
Louise maintains her clinical skills by regularly working within the birth setting as well as running clinics in the hospital and community. She describes having a particular interest in promoting choice and personalised care plans, running specialist clinics for women who have had previous caesarean sections, women who may have had a previous traumatic experience or a fear of childbirth (tocophobia), or women who may request care that may involve a little more complex care planning.
Louise identifies that she is incredibly proud to be a Consultant Midwife particularly within the award winning maternity service of WHH. A service that she describes as constantly striving to provide a safe, high quality care for women and babies in Warrington and surrounding areas.
Nurse Consultant (Emergency Medicine)
Qualifying as an RGN in May 1995. Nick initially, wanting to become a Sick Children’s nurse however, following a placement in Accident and Emergency he developed a love of emergency medicine.
During the initial part of his career nick, developed strong ties with Greater Manchester Fire and Rescue, becoming a senior trauma instructor for the brigades ‘trauma tech’ fire crews. In 1996, he was on scene at the Arndale city Centre bombing, an experienced that helped him to develop a regional pre hospital care / training programme that linked all the emergency departments of each hospital within Greater Manchester.
He has retained his interest in prehospital and trauma care, completing his aeromedical certification and becoming an instructor in prehospital trauma, paediatrics and pre hospital obstetric emergencies. Maintaining an interest in education and professional development, he became the practice educator for Emergency care at Pennine Acute hospitals and in 2005 was seconded onto the first MSc Advanced practice program at Salford University which he completed in 2007. Following completion of his training he helped develop and introduced a nurse led AP model for Urgent care centres.
Nick became lead ACP (ED) in 2013, working as part of the ED Registrar rota. He developed skills in ultrasound trauma abdomens and insertion of long lines /chest drains. In addition, he continued to champion ACP and helped to establish ACP roles as part of the medical rota within a wide range of clinical specialities allowing Pennine Acute.
In 2017, he moved to WHH as NC in Emergency Medicine and strategic lead for advanced practice. Over the last eighteen months, he has led in the development of streaming in ED, the development of Urgent treatment centres and assisted in the design of Warrington’s first Multi professional core competency framework. He is working towards completion of his professional doctorate with a specialist interest in how individuals transit between clinical roles. Nick continues to maintain his pre-hospital skills and is part of the UK national medical response team (UK-Med), as well as maintaining an advisory / training role with UNHCR within which role he has taught in Sweden, Norway, Qatar, Saudi, Malaysia, Zambia, Switzerland, Romania and Latvia.