A proposal – to create a nurse led model for the emergency management of minor injury and minor illness pathways, via the A&E Department.

The programme is structured around a series of work based learning modules which are completed prior to devising a research outline and producing the thesis. The research question I had intended to address as set out in my original applications still stands; but the focus of the work based project has been on a specific aspect of ‘person centred care,’ which is the development of the Emergency Nurse Practitioner (ENP) role in the A&E Department to support effective, safe and sustainable minor injury and illness services.

I have chosen the development and implementation of an enhanced ENP model in A&E as the basis of doctoral study and as a means of research skills acquisition because there is considerable scope to:

  1. Develop a sustainable model minor injury and illness management, which could also be applied to other remote and rural healthcare teams across Scotland;
  2. Explore different models for emergency care pathways and ENP roles and in doing so, create new theoretical and practical knowledge which can be applied locally (e.g. as part of developing a service model for Shetland) and more widely as an output of literature reviews and reporting to colleagues across Scotland;
  3. Explore training needs and competencies across the ENP team, design appropriate learning packages and strategies for skill development and maintenance. There is scope for undertaking the development of appropriate learning packages with partners e.g. High Education Institutes, regional planning groups, other health boards and sharing this approach more widely through RRHEAL.

 

This project if successfully implemented will represent quite a considerable shift in organisational culture and the acceptance of enhanced nursing roles in the hospital setting, in Shetland. The changes will also mean that patient experience should be improved across a number of measurable areas i.e. reduced duplication (handover of care from ENPs to junior doctors), reduced waiting times, consistency of care and knowledge of the ENPs (in relation to treatments, medications and local services) and improved patient safety (through the clinical supervision model).

This project is particularly challenging because of the context of delivering emergency care in a remote and rural setting. The factors which make the transition to a new model a challenge include the fact that we have:

  1. Small nursing teams;
  2. Consultant delivered services with small teams of junior doctors in support roles and few Specialty Doctors;
  3. No dedicated A&E Consultant – clinical pathways are shared across medical, surgical and critical care teams;
  4. All clinicians are essentially generalists who are often managing specialist care e.g. mental health and child health pathways with decision making input from mainland services;
  5. Rural District General Hospital status – this means we can provide many services locally but rely on NHS partners in tertiary centres to provide shared pathways.

In light of these unique challenges, I have focussed equal attention on the practical and technical aspects of developing the model along with understanding motivation, behaviours, culture and positively influencing stakeholders from frontline staff to senior clinicians and managers.

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