patient satisfaction in ED

patient satisfaction in ED

The ANP role is seen as having the professional knowledge, behaviours and also the skills of high level, and the ability to practice health care safely and efficiently, (Council for Healthcare Regulatory Excellence, 2009). Adopting these key qualities accompanied by expert skills as well as knowledge, ANPs are in a position to assist in the reduction of patients waiting time in ED. Additionally, Nieminen et al. (2011) noted that the AP’s are well sanctioned with expert skills and knowledge which they utilize to perform highly skilled and complex decision making in a familiar and unfamiliar situation using their expert clinical knowledge and expertise. AP’s in ED can recognize, initiate the investigation, prescribe, refer to specialty and liaise with the appropriate multi-disciplinary by recognizing and prioritizing the urgent and non-urgent cases. As such, this could be achieved by first identifying the Urgent and non-urgent cases from the triage in UCC, initiating relevant treatment and investigation and appropriate transferring to other units such as majors or resuscitation area, therefore keeping the unit to full capacity.

Although waiting times are key indicators of patient satisfaction in ED (NHS England, 2018). Li et al, (2013) Argue AP’s equally help in reducing the waiting time in an acute setting.  Arguably, the most important benefit of ANPs is its ability in improving the quality of services at the Emergency Department (McDevitt and Melby 2015) by increasing positive patient outcome satisfaction and safety (McDonnell et al 2014). However according to (Seale et al, 2005) emphasizes that patient satisfaction level by the AP’s are much higher compared to the doctors, the key factor being the effective communication they exhibit. According to Comiske et al (2014), while doctors opt to take a problem-based approach or likely a traditional medical approach of history taking (Silvermann,2013), advanced nurse practitioners use a hybrid style consultation comprising of nursing ideologies and holistic approaches. However, this is by discussing activities of daily living in consideration to social, emotional and psychological factors as well as using clinical knowledge to optimize therapeutic approach and shared decision making (Barrat, 2016). APs working in EDs can use this valuable skill by explaining in detail patient’s diagnosis, results and management thereby facilitating effective communication for a desirable outcome on patient satisfaction (Silverman, 2013).  There is no doubt that AP’s improves care quality through improved communication, patient satisfaction, holistic approach and reducing ED waiting time (Acton Shapiro .2009). However, limited studies and researches in this area further highlight a significant need for further work and research to be carried out to evaluate the APs sustainability, role integration, patient satisfaction within the heath care (Jennings al.,2015).

Another way of increasing quality is to enhance the new ACP workforce by increasing their autonomy. A study by Begley et al. (2012) showed that advanced practitioner provides improved service delivery, with increase autonomy producing greater professional and clinical leadership, if given proper support for education and clinical skills. According to Scar (2010) autonomy is the ability to make a decision and the freedom to act in a professional knowledge base. Although accountability and autonomy are the different sides of the same coin, accountability is a subject which is more prioritised compared to the latter in a clinical area.The Nursing and Midwifery Council in its code of conduct mentions that we are accountable for our actions and omissions(NMC,2015). Autonomy is the centre of advanced practice as it empowers the practitioner (Petersen et al., 2015).

In my trust, the concept of a new integrated urgent care centre and a new role of trainee advanced clinical practitioner brought in a lot of chaos and uncertainty. Although the transition to the Advanced practitioner is a complex and multidimensional process which is not easy and even the most positive experience could be stressful (Cusson and Viggins, 2002), increased support and knowledge and a smooth transition can provide safe patient care, career satisfaction and sense of wellbeing (Barnes,2014). Royal College of Nursing (RCN) recognizes clinical leadership as one of the necessities keys for guaranteeing and maintaining quality care through the supervisory part of a pioneer and the production of a viable working environment culture. However, APs can feel professionally disengaged because of colleagues being excessively fundamental due to newness to the extent of training and clinical aptitudes that the APs can convey to the group. Consequently, this may prompt a threatening workplace (Fitzpatrick and Gripshover, 2016). The new role transition, lack of job descriptions, poor acceptance from the medical colleague and the inability to prescribe after completing the prescribing course brought in a lot of confusion about the clarity and context of the trainee ACP role. ACP initially through negotiations and making oneself visible  to the seniors leaders and management, recently have initiated a move for  support and recognition , e.g.,  a clear job description , an assigned consultant  mentor ,fortnight clinical lectures and pay rise to Band 8A upon completion of Pgdip in Advanced clinical practitioner , as per the DOH(2010) despite lack of senior leadership and recognition of trainee. Undoubtedly, there is a positive move among the Lead consultants in ED as well to support new trainee APs with Royal College of Emergency Medicine Credentialing, RCEM pathway to enhance both knowledge and skills required in ED. Appropriate mentorship, clinical supervision, increased knowledge will improve support for new AP’s (Moran and Nairn, 2017), which could affect career satisfaction and retention, as well as a result in the sense of achievement and well-being (Branes,2014). There can be a significant barrier during the transition to develop autonomy if the quality of negotiable skills, resilience, tenacity, and resilience are not developed    (MacLellan, Levett-Jones, and Higgins, 2016)

Regardless of the sound Department of Health’s position statement explanation (2010) on AP’s generating practice innovations remodelling solutions and an important and valuable member of the team (Health Education of England multi professional ACP framework (2017), there kept on being a misconception on instructive, aptitudes preparing, level of independence, work title and pay scale. The position stretches out past clinical aptitudes to consolidate initiative, educating, and a good example for help and exhortation. DeBourgh (2001) depicts the APs as a role model good giving structure and support to staff. For example, the position is a significant asset to the nursing staff, for instance; being able to endorse, the patient would not be deferred by waiting for a doctor for prescribing or initiating treatment and investigation planning. Moreover, on account of the disintegrating tolerant, the AP’s is accessible for master counsel, accordingly conceivably enhancing understanding results.For example, venous blood gas and ECG  are performed by health care assistance in UCC which neds to be interpreted and acted upon professionally and competently.AP’s can a play a pivot role in this area by working within the scope of practice using their clinical knowledge and can display leadership enables and safer patient care. The AP would be more associated with how the division functions, confirm by the permanency of the post, a well-known asset, a combination of solution and nursing. Begley et al, (2012), set up clear proof that the APs can exhibit positive clinical leadership by being a role model by autonomous decision making and showcasing as a valuable resource to the team. A higher level of motivation, satisfaction, and performance is seen in those who entwine the principles of good leadership which is integral to improving patient care. (Govier and Nash, 2009).

Where The Mid Staffordshire  NHS Foundation Trust (2013) had to be scrutinized with enquiry due to lack of leadership been one of the prime cause of its downfall, my trust displayed a major shift in positive leadership when it witnessed special measures in December 2013 by Quality Care Commission.Effective leadership with open cultures, staff engagements, and stakeholder advocacy was used as the drive to change to bring about such a massive change. In March 2015, a further inspection revealed encouraging signs, and the trust came out of special measures in March 2017. Despite being under special measures and financial constrain there was a positive initiative for strategic workforce planning and integrating of emergency department and general practitioner services(NHS England, 2014; NHS England, 2017).Although a report by West Yorkshire and the Harrogate District during a four week period in 2016 about the reason for people attending UCC  showed, only 37.1 % needed medical attention. Although the waiting time was more, patients had a higher satisfaction level. Interestingly 45.5% had been send by their GP practice. It is quite imminent that to ease the pressure of ED; there have to be proper services in the primary sector which are integrated into the acute settings. APs can be a lever in tackling these issue by liaising with GP services and forming an action plan .Telemonitoring is another innovative effort in unnecessary admission to the hospital.The study by Birmingham East and North Primary trust (Urgent Care project ) showed two trials where telemonitoring reduced unplanned hospital admissions.

Despite many benefits which were linked to the ACPs, challenges were inevitable. The perceived challenges of implementing an ACP program as identified by Tye et al (2016) included opposition from other professional groups, staffing difficulties, protocol limitations, medicolegal concerns, and funding. The service is seen to be taking a successful trend in the emergency department which eventually will make the whole department fully dependent on it, even to the extent that providing clinical service in the absence of ACPs will become a difficulty (Tye et al 2016).

Conclusion

It is important for health facilities to offer quality and reliable healthcare for patients. One way that a hospital can achieve this mission is by implementing APs within the ED. The health facilities can meet the increasing demand for quality health care. For instance, I contribute actively to the delivery of quality services within the ED by offering my knowledge and expertise on the daily operation of the department. Other benefits of implementing APs are such as; enhanced capacity-building of other healthcare professionals who work closely with the former.

Also, this is evident from my endeavours in sharing my skills and knowledge with other personnel with the department. As an AP, I am often driven by passion and mission of providing specialised and quality care for patients.  Also, the implementation of AP’s is added benefit to the workforce, rather than treating them as members who fill gaps of the medical rota, they are a valuable autonomous practitioner able to deliver high-quality care and skillfull decision-making capacity.  Additionally, the presence of advanced practitioners in the Accident and emergency department increases the pace at which the health care services are delivered. Given my presence as a trainee ACP within the ED, we are a source of resource for junior doctors both in nursing as well as medical scenarios

Some of the challenges that hinder the implementation of advanced practitioners include overlapping of roles with other personnel within the department. Also, there is no consistency in the healthcare industry in as far as job titles of the practitioners is concerned. The inconsistency is confusing both the public and the health institutions who intend to high the practitioners. There is further need for the trust to design local framework to have a clarity among professionals and the public. Lastly, health facilities do not have the framework for implementing the practitioners. It is notable that the challenges of implementing the practitioner’s cuts across other departments within the hospital. Some of the ways addressing these challenges include; ensuring that the duties of every personnel are defined to avoid duplication or overlapping of roles. Also, the management can implement favourable policies to ensure hospitals hire adequate personnel. Lastly, adjustment of local institutional frameworks to accommodate the duties of advanced practitioners within the hospital.

Notably, such alternatives are beneficial as they may help in reducing the time that patients use to wait for services at the ED. Also, hiring volunteers is critical in relieving work-related pressure from health care personnel, by sharing their roles within the ED.  Conclusively, one may argue that the implementation of ACPs within the ED is crucial given the numerous benefits that come with the process such as; enhanced service delivery and reduction of patients’ waiting time. Also, I would recommend for systematic reform of the health system that entails the integration of ACPs based on my personal experience and literature analysis of their importance in improving the quality of health care delivered at the ED. Overall, one would support the implementation of ACPs within the ED owing to the benefits that are associated with it such as improvement of the quality of healthcare delivery at the Emergency Department. There is a need for a multidisciplinary approach to the planning of advanced practitioner services. To achieve multiprotection acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries.