Trainee Advanced Nurse Practitioner
Place of work
Theatres, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust
Rising waiting times, changes to surgical training and the introduction of European Working Time Directive have generated huge logistical challenges in the East Lancashire General Surgical Services to achieve government targets (Kings Fund, 2016). Locally, a preliminary audit demonstrated the referral pathways for low risks minor surgery is micromanaged in order to maintain the achievement of 18 week targets (NHS Trust, 2015).
An Advanced Practitioner who has the advanced clinical skills set and is trained to deliver minor surgery service can play a vital role in providing minor surgery service. Evidence suggests their contribution can reduce waiting times and maintain surgical services (Kingsnorth, 2006). Costs can be reduced and the surgical training of junior doctors supported (King’s Fund, 2016).
The aim of this project is to implement an Advanced Nurse led minor surgical pathway with the aim of increasing efficiency and productivity to reduce delays in achieving 18-week patient journey.
- Kotter’s change theory (2007) was used to develop strategies to support the project implementation.
- Involvement and engagement with key stakeholders after identifying bottlenecks in service delivery using a process map exercise.
- Devised a business plan based on demand capacity analysis and financial appraisal.
- Development of an ANP training pack, competencies and clinical governance framework based on Royal College of Surgeons SCP Curriculum Guidance.
- Concurrent list alongside consultants to ensure proximal supervision (observe 20cases /shadowing 4 sessions).
- Devised an inclusion and exclusion criteria for patient selection to offer safe effective harm free care.
Using the PDSA cycle, formative evaluation was attained at regular intervals. Re- audits were performed to assess the number of cases completed / sessions used, complication rates and waiting list / times. Results were analysed to measure the impact of service provision on 18 week waiting rule using the Donabedian (Structure, Process and Outcome) Conceptual model (Donabedian, 1966). Patient satisfaction was measured using Friends and Family test.
The ANP would provide integrated care for patients while working in partnership with consultants will free up surgical workforce to treat more complex patients in a timely manner. Alongside this, the project aimed to improve the utilisation of capacity within theatres by increasing day case activities, revenue and reduce waiting times.
Three key learning points
1. Interconnect your vision and involve all staff in the implementation of the initiative early in your change process.
2. Applying theoretical frameworks in change management can enable effective and sustainable project management.
3. Keep patients informed of new developments and try to find out if they find your plans acceptable. Be prepared to be flexible for patients who prefer to see a surgeon.