Transcript Advanced Practitioner Role in the CRF

Clinical Research Nursing
and Advanced Practice
Helen Pidd and Gail Holmes
Overview of presentation
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National Context
What is Advanced Practice?
Manchester Context – why and how
MSc in Advanced Practice Health and Social care – an
overview
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
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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
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
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Extended and specialised role
Clinical Research Facilities
Biomedical Research Centres
Birmingham
Manchester
Cambridge
Southampton
Newcastle
London
•McMichael Centre
•UCLH
•Somers GOSH
•Guy’s & St Thomas’
Hull York
Manchester Children’s
Sheffield
Sheffield Children’s
Birmingham Children’s
Oxford
Peninsula
Brighton
Surrey
Aberdeen
Dundee
Glasgow
Edinburgh
Newcastle
Manchester
Liverpool
Cambridge
Oxford
London
Aberdeen
Edinburgh
Glasgow
Inverness
Tayside Dundee
Belfast
Dublin
Galway
Cork
Cardiff
Inverness
Aberdeen
Dundee
•Great Ormond St
•Guy’s & St Thomas’
•Imperial
•Moorfields
• Royal Marsden
• UCL
Glasgow
Edinburgh
Newcastle
Belfast
Galway
York
Dublin
Manchester
Liverpool
Hull
Leeds
Sheffield
Biomedical Research Units
Nottingham
Experimental Cancer
Medicine Centres
Edinburgh
Glasgow
Belfast
Newcastle
Leeds
Manchester
Liverpool
Sheffield
Leicester
Cork
Birmingham
Birmingham
Cambridge
Oxford
London
•Barts
•ICR
•Imperial
•KCL
•UCL
Southampton
Leicester
Cambridge
Oxford
Cardiff
Bristol
Southampton
Peninsula
London
Surrey
Leeds
Liverpool
Sheffield
Nottingham
Leicester
Birmingham
Oxford
Bristol
London
•Royal Brompton
•Barts
Brighton
Southampton
NIHR ClinicalNIHR
Research
Networks
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
NIHR Comprehensive Research Network
Clinical Research Nurses
Newcastle
year n
2006 - 93
2007 - 120
2008 - 140
2009 - 180
100%
Increase over 3 years
Similar Picture Across the Country
AHP/STUDY COORDINATORS
NURSES
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Cambridge
Sheffield
Manchester
Norfolk & Norwich
Newcastle
Birmingham
Scotland
148
173
168
56
180
87 (Trust)
411
2012/13
10,000
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Cambridge
Sheffield
Manchester
Norfolk & Norwich
26
21
13
8
NUMBERS INCREASING
YEAR ON YEAR
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 – www.ukcrfnetwork.co.uk
• Trust:- Lead Nurse Appointments, Local Training
Opportunities
Academic
Clinical
Management
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.
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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)
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.
Advanced Practice in Manchester
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Modernising workforce
European working time
directive
Patient centred seamless
care
PARTNERSHIP 2004
Strategic Health Authority
13 Acute and
Mental health Trusts
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University of Bolton
(primary care)
University of Salford
(acute)
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
Application Process
• Rigorous process
• Trust and WTCRF
commitment to the role
• Detailed proposal form
submitted to SHA
• Decision to support
application sits with SHA
The Proposal
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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
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.
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
• 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
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.
University of Salford, MSc Advanced practice
(Health and Social Care Pathway)
Programme Overview
Semester 1
Year 1
Semester
2
Principles of Advanced Practice
(30)
Application of Life Sciences
(30)
Semester
3
Contextualising
Advanced
practice (30)
Portfolio
Individual
Learning
Pathway
Tripartite
Agreement
core and
bespoke skills
Year 2
Research
Methods
(30)
AP1: Practitioner competence
(30)
AP2: Clinical Reasoning (30)
Credits
90
Organisational
pathway
analysis
90
Portfolio of Evidence
Year 1
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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
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
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
Programme Support
Trust
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Mentor
Line Manager
Assessors
Supervisors
University
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Personal Tutor
Academic Supervisor
Programme lead
Student Life
Learning Facilitator
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