NAMP Nursing Section
1. National Acute Medicine Programme Nursing Leadership
Overview
The nursing body accounts for over 460wte / 500 nurses working across all acute medicine units in Ireland who participate in the provision of the acute medicine model of care. Supporting and advocating for the development of acute medicine nursing as a speciality in unscheduled emergency care in collaboration with hospital Directors of Nursing, front line nursing staff, nursing and midwifery planning and development units, and at national policy making level is the responsibility of the programme Director of Nursing.
A collaborative between the Office of the Nursing and Midwifery Services Director (ONMSD) and the NAMP resulted in the appointment of a Director of Nursing to the programme in 2011. This collaborative has enabled the NAMP to conduct practice based research to identify the skills and competencies required to practice at core, specialist and advanced levels ; to conduct a national educational needs assessment survey; to develop, design and contract out for delivery an accredited Nursing and Midwifery Board of Ireland Level 8 certificate in acute medicine nursing , and to develop and publish a guiding framework for development of Advanced Nurse Practitioners in Acute Medicine.
The Director of Nursing is a member of the ONMSD Leadership team which affords an opportunity to advocate on behalf of acute medicine patients and nurses at the highest levels senior nurse leadership and to share with front line nurses current policy and practice initiatives being undertaken by the ONMSD.
The Director of Nursing works closely either through individual, face to face meetings or consultation with Hospital Group Chief Directors of Nursing to communicate the NAMP programme body of work and developments, to seek endorsement of NAMP nursing programmes and outputs and to work collaboratively on proposed nursing workstreams.
The NAMP Director of Nursing also works collaboratively with nurse and clinical leads across the broad spectrum of National Integrated Care and National Clinical Care Programme along with health and social care leads to support integrated person centered care aligned with the HSE Values in Action and Chief Nurse / Director of Nursing Services HSE core values of compassion, care and commitment for nursing.
Current Committees / Working Group Membership:
- Chief Nurse Taskforce “Nurse Staffing and Skills mix Phase 11 Emergency Settings” Department of Health
- Chief Nurse “Developing a Draft Policy for Graduate, Specialist and Advanced Nursing and Midwifery Practice” Implementation Group Department of Health including demonstrator site Evaluation sub group
- Ex-officio advisory member on Reducing Admission Rates & Length of Stay for Older Persons >65 years into and within the AHS from Residential Units Older Persons Services: HSE & NMPD DML Collaboration
- Criteria Led Discharge Implementation oversight Group, HSE Integrated Patient Flow Clinical Programme
- Acute Floor Information System User Specifications Working Group and associated nursing and clinical coding sub groups
- Office of Nursing and Midwifery Services Director Leadership Team
- “Frailty Train the Trainer cross Clinical Care programme Advisory Group” led by the National Clinical Care programme Older Persons
Nursing Forums
a) Acute Medicine Nurse Interest Group
The Acute Medicine Nurse Interest Group (AMNIG) was established in 2012 to provide an opportunity for nurses to guide, shape and influence the multidisciplinary design and delivery of care to the acutely ill medical patient across the Irish health service, in particular within the Health Service Executive (HSE) funded acute hospital setting.
The group, composed of Clinical Nurse Managers 1,2 & 3, Assistant Directors and Directors of Nursing offers a collective informed view of nursing to the National Acute Medicine Programme (NAMP), Office of the Nursing and Midwifery Services Director (ONMSD) Clinical Design and Innovation, Health Service Executive (H.S.E.) and the Department of Health.
Acute medicine nurses seek to place the patient at the centre of all discussions around practice, service design, delivery processes and evaluation; and to continuously demonstrate nursing values of Care, Compassion and Commitment along with H.S.E. organisational values.
The aims of AMNIG are to:
- Support the NAMP in providing, accessible, safe, timely, co-ordinated appropriate care and decision making for acutely ill medical patients
- Act as an advisory group and specialist nursing resource to programme leads, service and programme directors and to policy makers
- To ensure availability of an appropriately educated and experienced workforce to meet patient needs
The group members meet on a quarterly basis. Membership is agreed following nomination of the member by the hospital Director of Nursing.
Terms of reference (updated December 2018) for this forum can be accessed here.
b) Candidate and Registered Nurse Practitioner (Acute Medicine) Forum
The Acute Medicine cANP / RANP forum was established in April 2018 with approval of the NAMP team leadership and the Office of the Nursing and Midwifery Services Director to support the implementation of the recommendations outlined in “Developing a Policy for Graduate, Specialist and Advanced Nursing & Midwifery Practice Consultation Paper” (Department of Health, March 2017). This draft policy document has contributed to the workforce planning agenda for the H.S.E. and Department of Health (DoH), and assisted in realising some of the specific workforce and nursing recommendations of the NAMP Model of Care Report (HSE 2010).
The forum was also born out of the NAMP desire to provide an enabling channel for candidate and registered ANPs, higher education institutes and the NAMP to collaborate along with the wider health service stakeholder group to build ANP services, capability and capacity, integrate care at service and multidisciplinary level and to continuously develop and expand nursing roles for the benefit of patients.
The NAMP considers the forum as a source for obtaining expert nursing advice on programme developments impacting on the quality and outcome of patient care, e.g. clinical and service pathways, ambulatory care, multidisciplinary team development, research and leadership,
Support for RANPs is pivotal to the ongoing development and expansion of the role.
The overall aims of the cANP/RANP Acute Medicine Forum is to:
- Support implementation of the Department of Health Draft Policy on Advanced Nurse practice as it pertains to Unscheduled Care, and in particular to the area of acute medicine advanced nurse practice
- Clarify the cANPs / RANPs scope of practice and explore opportunities for expanding the scope of the role and professional capability across ambulatory, inpatient care, unscheduled care settings and other settings
- Support the development of integrated service delivery underpinned by interdisciplinary and multidisciplinary working.
- Ensure that the patient is at the heart of service delivery with the nurse cANP /RANP enabling patient choice, providing a full episode of care in a variety of location’s and supporting the patient journey in health and illness
The forum meets quarterly. Terms of reference (updated December 2018) for this forum can be accessed here.
2. Supporting Nurse Development and Education
Developmental Framework for supporting Nursing Skills and Competencies
Level 8 Certificate in Acute Medicine Nursing
Commencing in 2016 in collaboration with the ONMSD a National nursing (acute medicine) Education and Training Needs Assessment Survey was undertaken and analyses of results conducted in order to inform the development of a Level 8 (NMBI accredited) Certificate / Foundation Programme Acute Medicine Nursing.
This 12 week blended learning programme, funded by the ONMSD is provided through a collaborative of the Institutes of Technology Departments of Nursing Studies at Dundalk, Athlone, Letterkenny, Galway-Mayo (Castlebar), Tralee and Waterford.
Open to all nurses working in acute medicine units and medical short stay wards its focus is to:
-provide one nationally standardised accredited clinical education programme which is geographically accessible and which minimises ‘time out’ from service delivery
-provide nurses with the core skills and competencies to deliver evidence based patient centered care to patients attending for unscheduled emergency medical care
-complete the development of a structured clinical career development pathway which is stand alone or can be built upon progressing to postgraduate and MSc Advanced practice
118 nurses have undertaken the first three programmes to the end of 2018. The programme will continue until 2020.
For further course content and application details visit websites of the colleges listed above or contact Mr Richard Walsh
3. Advanced Practice Nursing (Acute Medicine)
The Report of the Acute Medicine Programme (HSE, 2010) initiated the establishment of Acute Medical Units (AMU), Acute Medical Assessment Units (AMAU), Medical Assessment Units (MAU) and Acute Medical Short Stay Wards (AMSSU) within defined hospital models 1, 2, 3, 4, to stream acutely unwell medical patients away from Emergency Department’s (ED) to more appropriate settings with a focus on assessment to discharge rather than admit to assess. The report seeks to develop acute medical services leading to improved quality of care and efficiency through provision of ambulatory care pathways, hospital avoidance measures and earlier discharge from in-patient beds.
The Report advocated for the development of nursing to meet patients’ needs and to manage, integrate and co-ordinate care. It envisioned the addition of Registered Advanced Nurse Practitioners (RANPs) with senior clinical decision making capability as members of the acute medicine multidisciplinary team. This was further reiterated by the HSE in 2017 with the publication of the “Acute Floor Model of Care” (a model of integrated acute unscheduled care emergency services ).
RANPs in Acute Medicine Multidisciplinary Team
The Office of the Nursing and Midwifery Services Director (ONMSD) Plan 2016-2018 (HSE 2016) sets out the actions the Office will take to strategically lead, support and develop the nursing and midwifery workforce to deliver safe high quality person centred care to support the HSE objectives.
To this end a collaborative approach was taken by the NAMP and the Director of the ONMSD of an Expert Advisory Group, chaired by the Director of Nursing NAMP in 2016 to assist services in defining future RANP Acute Medicine services in their area which would support integration across settings, hospital diversion, earlier discharge, improved quality and patient experience. These RANP services are envisaged to be adaptive and responsive to changes in patient profiles and needs along emerging patient clinical pathways and models of care.
Enablers to developing and expanding RANP Acute Medicine services now and into the future include the Report of the Acute Medicine Programme (HSE, 2010) including a blueprint for the development of the ‘acute floor’; the Acute Floor Model of Care (a model of integrated acute unscheduled care emergency services ) (HSE Oct 2017); the Draft Policy paper “Developing a Policy for Graduate, Specialist and Advanced Nursing & Midwifery Practice (Office of the Chief Nurse, DoH, March 2017), and the establishment of Advanced Practice ‘demonstrator sites’ in 2017; Sláintecare (DoH, May 2017), and Sláintecare Implementation Plan (DoH, 2018).
The concept and emergence of integrated models of care opens up new avenues and areas for consideration when developing RANP Acute Medicine services and in defining scopes of practice from assessment through to investigation, intervention and discharge, to meet identified needs.
The output of the Expert Advisory Group - "A Guiding Clinical Guidance Framework for Development of Registered Advanced Nurse Practitioners – Acute medicine" provides an evidence based guiding framework and conceptual model for sites developing RANP Acute Medicine services and an accompanying suite of resources developed through literature review, consultation with services and policy makers and placed within the context of national policy statements and legislative requirements, to aid candidate ANPs and service sites.