November 2016 Nursing clinics. Essential characteristics nurse clinics and services

Nursing clinics 2016: Eighth Annual Conference
Essential characteristics of nurse led clinics
Linda Nazarko
MSc, PgDip, PgCert, BSc(Hons), RN, NIP, OBE, FRCN
Nurse Consultant West London Mental Health Trust
London 9th
November 2016
,

Learning objectives
To be aware of how :
 Nurse led clinics fit within the framework of advanced
nursing practice
 To determine the characteristics of nurse led clinics
 Understand and promote the value of nurse led
services
Relevance to NMC (2015) Code
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-
publications/nmc-code.pdf
Prioritise people ,Practise effectively, Preserve safety, Promote
professionalism and trust

Defining advanced nursing practice
“A registered nurse who has command of an
expert knowledge base and clinical
competence, is able to make complex clinical
decisions using expert clinical judgement, is
an essential member of an interdependent
health care team and whose role is
determined by the context in which s/he
practices”
NMC 2007

Components of advanced
practice

Core competencies advanced practice
 Practicing autonomously
 Making decisions and being accountable
 Admitting and discharging patients
 Ability to take a clinical history
 Ability to physically examine patient
 Ability to determine diagnosis
 Ability to determine when onward referral is
required
 Ability to prescribe

Do you need to be an expert to run a clinic?

The continuum of advanced nursing practice
 No one is born an expert
 We have to develop and nurture expert
practitioners
 Nurse clinics can be a safe place for nurses
to develop

Scope of practice
 The nurse’s scope of practice must be related to his or
her competencies.
 There is room within the clinic for expert nurses and
nurses who are developing expertise.
 Level of support and supervision is related to level of
expertise.

Generic clinical competencies
 Practicing autonomously
 Making decisions and being accountable
 Admitting and discharging patients
 Ability to take a clinical history
 Ability to physically examine patient
 Ability to determine diagnosis
 Ability to determine when onward referral is required
 Ability to prescribe

Specific clinical competencies
 Competencies specific to your service
 Competencies related to where your service
is delivered
 Competencies specific to the client group

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Definition of a nurse-led clinic
 In a nurse-led clinic the nurse has his or her own patient
case load. The service often involves an increase in the
autonomy of the nursing role. The nurse-led clinic
requires the patient to fit into a rigid time slot, often
through an appointment system.
 There is the ability to admit and discharge patients from
the clinic, or to refer on to other more appropriate
healthcare colleagues, based on the nurses’ own
assessment.

15
Rationale for nurse led services
 Increased efficiency and effectiveness
 Increased patient access
 An educative role
 Psychological support
 Monitoring the patient's condition
 Empowerment of the patient

Types nurse led clinics and services
 Generic e.g. frailty clinics, falls clinics, intermediate care,
long term conditions in primary care
 Specific e.g. diabetes, chronic heart failure
 Follow up e.g. post operative, prostatectomy
 Diagnostic e.g. endoscopy

Essential criteria
 Admission/entry criteria
 Exclusion criteria
 Referral forms/protocols
 Escalation criteria
 Referral to other services
 Pathways, how often to see patient
 Follow up
 Discharge
 KPIs and reporting

Effectiveness and acceptability
 “Cost cutting”
 “Practicing
medicine without
a license”
 “Depriving people
of proper medical
care”

Evidence
 In heart failure people receiving nurse led care “experienced
fewer hospital admissions for any cause and an increase in
survival and number of participants reaching target dose within
a shorter time period” (Driscol et al, 2015)
 In diabetes patients receiving nurse led care demonstrated
better outcomes and costs were reduced (Cook-Johnson et al
2012).
 In monitoring people with prostatic cancer nurse led was
acceptable to patients and good coutcomes were demonstated
(Wade et al, 2015)
 In caring for people with hypertension nurse led care led to
improved outcomes and reduced costs (Sanders & Guse,
2016).

The value of advanced nursing practice
 Holistic, innovative, evidence based
 Cost effective, increased review of medication
 Patient and family centred
 Integrated

References
 Cook-Johnson R et al (2012). The effectiveness of nurse-led care in general practice on clinical outcomes
in adults with type 2 diabetes. JBI Best Practice 16(1) 2012
 http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=9255
 Driscoll A, Currey J, Tonkin A, Krum H (2015). Nurse-led titration of angiotensin converting enzyme
inhibitors, beta-adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure
with reduced ejection fraction. Cochrane Database Syst Rev. 2015 Dec 21;(12):CD009889. doi:
10.1002/14651858.CD009889.pub2.
 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009889.pub2/abstract
 Sanders J, Guse CE (2016). Reaching Urban Poor Hypertensive Patients: A Novel Model of Chronic
Disease Care Versus a Traditional Fee-for-Service Approach. J Prim Care Community Health. 2016 Aug 9.
pii: 2150131916662465. [Epub ahead of print]
 Julia Wade, Peter N Holding, Susan Bonnington, Leila Rooshenas, J Athene Lane, C Elizabeth Salter,
Kate Tilling, Mark J Speakman, Simon F Brewster, Simon Evans, David E Neal, Freddie C Hamdy, Jenny L
Donovan , for the ProtecT Study Group (2015). Urology - Research: Establishing nurse-led active
surveillance for men with localised prostate cancer: development and formative evaluation of a model of
care in the ProtecT trial. BMJ Open 5:9:
 http://bmjopen.bmj.com/content/5/9/e008953.full

Advanced nursing practice
 Contributes to
developing nursing
 Enables us to nurse
with the hands, the
heart and the head
 Enriches the lives of
those we care for
and our lives

Thank you for listening
Any questions?
Download on
https://uk.linkedin.com/in/linda-nazarko-1952a746

November 2016 Nursing clinics. Essential characteristics nurse clinics and services

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