Benefits and Challenges of Advanced Practitioners

Benefits and Challenges of Advanced Practitioners

            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 effectively, (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 whenever they are under critical conditions. As such, this is achieved by first identifying the Urgent and non-urgent cases in the Emergency Department, as suitable and transferring to majors or results, therefore keeping the unit to full capacity. 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).

Virtually most emergency departments consider themselves as understaffed, particularly when regarding medical staffing. As such, this is true to some extent considering that it’s a sector whose workload is large and variable from time to time. However, this makes it difficult to adjust to such fluctuations (Mabrook & Dale, 2015). AP program was introduced to bridge the gap in consideration to flexibility factor associated with stakeholders of the program like ANPs and ACPs. This was not the only reason behind the launch of the program as there are many other benefits associated with the program like improved service delivery, provision of greater professional and clinical leadership as well as support for education and clinical skills.

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. Although waiting times are key indicators of patient satisfaction in ED (NHS England, 2018) evidence shows that physician and APs equally help in reducing the waiting time in an acute setting.

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 (Silvermann,2013), advanced nurse practitioners uses a hybrid style consultation comprising of nursing ideologies and holistic approaches. However, this is by expressing activities of daily life in consideration to social, emotional and psychological factors as well as clinical knowledge to optimize therapeutic approach and shared decision making (Barrat, 2016). APs working in EDs can use this skill by explaining in detail patients diagnosis, results and management thereby facilitating effective communication to realize desirable outcome on patient satisfaction (Silverman, 2013).

A study in Ireland by Begley et al. (2012) showed that advanced practitioners provide improved service delivery, with increasing autonomy and produces greater professional and clinical leadership if given proper support for education and clinical skills.

Autonomy in this case plays very critical roles in saving patient lives. Compared to some cases where consultations must be sought from experts in higher ranks, at this level no consultation is required. All what the nurses will need to do whenever they are presented with victims is only to commit themselves in helping them. The process of consultation has many disadvantages to the patients, and especially those under critical conditions and most of the times facilitates deaths which otherwise could be prevented (Begley et al. 2012). Nobody enjoys suffering, and this is a fact, therefore leaving a patient under pains in the ward for consultations makes them suffer extremely to some extents of giving up and eventually dying. Autonomy factor is therefore very important in advanced clinical practitioners as it will alleviate the suffering of patients (Begley et al. 2012).

However, for autonomy to be achieved in the emergency department much will need to be done, educating the ACPs being the first in line. Educating the ACPs would ensure that they have the necessary knowledge and expertise to handle patients, and this also would increase their confidence greatly (Singleton & Nail, 2014). Studies have shown that currently no common national accreditation being followed for the practitioners. There are different methods which can be used to train ACPs. One of the approaches, and which has been proved at the Leighton Hospital is the in-house training. To make it more effective, this training is supplemented, for instance, by having a one-day radiographic interpretation.

Advanced Practitioners have been ranked among the top providers of professional and clinical leadership. A study by Reed (2005) indicated that advanced practitioners were preferred by patients to doctors. Their closeness and availability to patients greatly shaped their perception to patients who had different healthy problems. Supported by several other studies, the training undergone by advanced practitioners was associated with such excellent services to patients.

Although the transition from nursing to Advanced practitioner is a complex and multidimensional process which is not easy and even the most positive experience could be stressful (Cusson & Viggins, 2002), increased support and knowledge and a smooth transition can provide safe patient care, career satisfaction and sense of wellbeing (Cusson & Strange,2008). In my trust, the concept of a new integrated urgent care centre and a new post of trainee advanced clinical practitioner brought in a lot of chaos and uncertainty. The role transition, lack of job descriptions and the inability to prescribe after completing the prescribing course brought in a lot of confusion of what we can’t and what we can do. Although there was the lack of senior leadership and recognition of trainee ACP, there has been a new move, and there are recognition and support for the trainee ACP, e.g., we have a clear job description and upon completion of Pgdip in Advanced clinical practitioner we are offered a band 8 A pay scales, as per the DOH.

This is a positive move among the Lead consultants in ED to support us with Royal College of emergency medicine credentialing (RCEM). It is important that leadership is shared between clinical and managers (Kings Fund, 2015). Enhancement of clinical leadership and professional leadership can play an indispensable role in building the Emergency Department. To be able to perform and showcase both clinical and professional leadership should be supported in their role. Although, a smooth role transition and leadership quality along with confidence, patient management and an environment conducive to learn and a good working relationship will make APs an autonomous provider.

A study by MacLellan, Levett, and Higgins (2016), shows that poor transition, the impact of politics, hostility among staffs and lack of support were some of the reasons new APs were left abandoned and demoralized. During this transition to develop their autonomy and make a place they need to have the quality of negotiable skills, resilience, tenacity and resilience (MacLellan, Levett-Jones and Higgins, 2016) Increased support from physician and managers or practice manager champion to educate them on how to improve the ability for a smooth transition, leadership classes, attending teaching sessions, releasing time from work to attend clinical lectures.

During this transition to develop their autonomy and make a suitable place they need to have the quality of transferable skills, resilience, and tenacity (MacLellan, Levett-Jones, and Higgins, 2016).Accountability and autonomy are the different sides of the same coin. Nursing and midwifery council suggests that we are responsible for our actions and omissions (NMC, 2015).

Although the trust was placed into special measures in December 2013, effective leadership with open culture staff engagements and stakeholder advocacy was used as the drive to change and 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. Additional trust was also under CQC special measures, and financial restrain, it funded for the course of master’s degree Advanced clinical practitioner program to develop aspiring nursing staff and other allied health group for carrier development and a resource for advancing to the new workforce. However, the university caters to academic knowledge and skills they trust lacked support in enhancing clinical and emergency skills. As a trainee ACP initially there was a lack of interprofessional acceptance, with weak management and absence of effective leadership unable to adopt a planning strategy.

Regardless of the sound Department of Health’s position explanation (2010) on cutting-edge hone and important existing wellbeing instruction structure (Health Education of England multi proficient ACP system 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 ANPs as a specialist good example giving structure and support to staff. 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 specialist. Moreover, on account of the disintegrating tolerant, the AP is accessible for master counsel, accordingly conceivably enhancing understanding results. Dalton, (2013), states the APs are in a decent position to start treatment. The powerful and transformational administration is essential to the achievement of social insurance associations, as medical attendants lead groups to give quality care and convey benefit change (Govier & Nash, 2009).

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 AP showed clinical administration by being a good positive example in self-sufficient clinical, basic leadership and went about as an asset for different individuals from the group.

Because of the worldwide deficiency of specialists and the WTD administer in the UK there has been a move to rebuilding and reengineering of the clinical group (McDonnell et al ;2014). Martínez-González et al. (2014) call attention to that there are a few advantages that accompany executing propelled experts, for example, the positive effect they have on their associates. In their view, the creators attest that ACPs add to the current pool of information inside the wellbeing office by imparting their encounters to the colleagues. The Royal College of Nursing (RCN) recognizes clinical authority 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 partners being excessively fundamentally 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)

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).

Professional rivalry leads to resistance which results to feelings of discomfort in work place and eventually deterring delivery of quality service. This has been the case especially from the doctors when they realize that practitioners are receiving much reputation compared to them. This has created harsh working environments where cases of laboratories being locked from the access by the practitioners have been reported (Reed, 2005). To counter the problem, doctors have been advised to enrol in advanced education to equip their skills as well.

There is, therefore, the need for a multidisciplinary approach to the planning of advanced practitioner services. An accredited and standardized education programme is required to achieve multi-protection acceptance, and this must address existing role boundaries. (Griffin and Melby, 2006)

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