Normally awareness weeks in this trust would involve banners and cakes, this year however, as we are all very aware, things are a little different.

But we do still want to raise awareness of the exciting role that is Advanced Practice, so we will do so from a distance, definitely a social distance.

If you want to join in on the week on social media, share using hashtags #AdvPracWeek20 and @uhp_nhs.

To help celebrate, a range of staff in Advanced Practice roles have given their experiences and thoughts about what this role means to them.

Tasha Kendall and Kim Pauling, Advanced Paediatric Nurse Practitioners (APNPs).

We both started within Paediatrics as the other APNPs were leaving, and therefore it was down to the two of us to pave the way for how APNPs could work within the department in the long term. We now have a trainee in post and we are hoping to recruit more to expand our team and to meet the demand on our services. Between us we cover: the Children’s Assessment Unit, Woodcock Ward, Wildgoose Ward, Paediatric Outpatients and hold the crash bleeps.

We work autonomously and alongside the paediatric medical team, whilst supporting the nursing team too. Our job within paediatrics is extremely varied, one day we could be teaching on medical inductions or departmental nurse training days, or creating patient information leaflets. On another we could be clinical and doing our prolonged jaundice and faltering growth clinics, seeing patients on CAU or helping in ED resus. We love the opportunities our role has and continues to present to us, and as a team we are passionate about driving quality improvement and change for our colleagues and the children that we see. It is a real privilege doing this job, and helping the children and their families in doing so.

Anna Jones, Advanced Clinical Practitioner (ACP) Lead for Acute Medication.

The role of the advanced clinical practitioner in acute medicine began when I qualified six years ago and now we have five others currently in post, with some of those qualifying very soon.

We cover the Medical Assessment Unit (MAU), the Acute Assessment Unit (AAU) and the Acute Frailty Unit (AFU) working alongside the medical team. We work independently alongside the consultants and aim to promote same day emergency care (SDEC) pathways, especially in the AAU.

We thrive on looking at new ways of working to ensure the best patient Journey is given to the patient. We are all able to prescribe and arrange diagnostics which means we can work more independently Working as an ACP in acute medicine means I am able to support the doctors who are rotated as we provide sound knowledge of the pathways like SDEC as well as the services we offer to try and discharge patients the same day. We also work closely with the emergency department to ensure patients who require a medical review can have this the same day, preventing a need for a bed. Having a nursing background really does provide diversity to our patients and enables us to also support the team holistically. We can also provide teaching to our nursing colleagues improving their clinical knowledge thus improving clinical decision making and patient care.

It’s a very rewarding job and each day we are learning new skills and knowledge which we can share with each other.

Diane Keeling, Advanced Neonatal Nurse Practitioner (ANNP).

It is almost 20 years since a team of ANNPs were founded at Derriford. As we celebrate Advanced Practice week, we have a well established team of eight ANNPs with an additional trainee ANNP and a MSc ANNP pathway to secure our future workforce.

As ANNPs, we work across the four pillars of advanced practice. Adept in enhanced clinical skills, across a wide range of gestational ages, form those born as early as 23 weeks gestation to those born at full term; whilst having comprehensive knowledge, clinical reasoning and complex decision making capabilities, enabling us to lead in the management of neonatal care and interventions.

The team practice across several areas of neonatal care from delivery room resuscitation, within the Neonatal Intensive Care Unit (NICU), Transitional Care ward and postnatal wards and transportation within the south west peninsula, supporting our medical, nursing, and midwifery colleagues in providing a high standard of care to our smallest, most vulnerable patients and their families.

Rosie Forbes, Trainee Advanced Clinical Practitioner (ACP) in Oesophago-gastric.

I am a Trainee Advanced Clinical Practitioner with the Oesophago-gastric (OG) team at the Trust.

Prior to progressing into the advanced practice field, I gained experience in surgical and critical care nursing. I am currently studying for a Masters in Advanced Clinical Practice which enables me to assess and examine patients, formulate a working diagnosis, request investigations and prescribe medications to support efficient and timely care for patients. 

My day-to-day role involves requesting and interpreting investigations, reviewing and prescribing medications, and assessing deteriorating patients who are under the care of the UGI/OG team across the surgical wards. I also frequently spend time with the surgical on-call team on the SAU; assessing, diagnosing, and commencing treatment plans for surgical patients. From time-to-time I attend outpatient clinics, theatre, and MDT meetings to enhance my knowledge and broaden my skills in the field of UGI/OG surgery.

I plan to finish my MSc in 2022. I am also keen to continue improving my skills in assessing and diagnosing surgical conditions, both in the inpatient and outpatient clinic setting. Furthermore, I hope to undertake training in surgical skills so that I am able to assist my surgeon colleagues in theatre.

Louise Walker, Advanced Nurse Practitioner (ANP) in Plastic Surgery.

There are three ANP’s within the Plastic Surgery Team (currently two trainees and one qualified). Working primarily within the remit of Trauma our role was originally used to take the on-call bleep away from the junior doctors so they would be able to attend theatre for training.  

When we are on-call we receive referrals from all over Devon and Cornwall from a variety of practitioners. On a day to day basis we speak to people working in ED’s MIU’s, GP practices as well as dealing with referrals from inside Derriford. It is a wide and varied job; we make clinical decisions about treatment and follow up, deciding whether the patient needs to be seen immediately, at some point that the same day or within the next couple of days in our trauma clinic. We are also the first point of call for any patients in our own Emergency Department who need a Plastic Surgery input. The role also includes being part of the trauma meeting and ward round (if possible) each day.

As part of our work to develop the Plastic Surgery service one of our ANP’s implemented a telemedicine system for burns referrals in the Southwest. We were the first Trust to use it and it is now being utilised in other areas of the network. We would like to develop the role further with the implementation of a minor ops training programme so patients with less complex injuries do not have to go to main theatre, and the trainees are moving forward with Non Medical Prescribing to provide further autonomy to the role. 

Ash Lowther, Advanced Clinical Practitioner (ACP) in Emergency Medicine.

We are a good sized team and have literally gone from strength to strength over the last five years, we still have two of the original ACP’s that started at the inception of the project – Emma and Becky.

We have 17 in total made up of one Senior ACP who has already credentialed and was the first ED ACP in Devon and Cornwall to credential with RCEM. Four senior ACP’s (post masters and NMP and in the third year of the RCEM portfolio), 10 trainee ACP’S (a mix of year one, two and three), and three military trainee ACP’s and varying levels on the programme. Our ACP’s are from both a nursing and paramedic background.

The ACP team now cover an almost 24/7 service and we hope that one day there will be a senior ACP on every shift in ED and that we will all have a core set of skills such as US skills, advanced resus skills, experienced decision making skills with the ability to work at the front door of the department and leadership skills to be able to manage individual areas within the ED. We work alongside the medical team in ED and are expected to see the next patient in the queue regardless of their presentation, we are really well supported by an excellent ED consultant and senior doctor team. The senior ACP’s closely supervise the trainee ACP’s to develop them in readiness for their year 1 ACAT (end of year sign off).

Some of the things we do but not an exhausted list; Majors Clinician, START Clinician, Trauma Primary Survey, Trauma Team leader, Cardiac arrest team leader, Ultrasound in trauma and for venous access, Chest drain insertion, Paediatric ED, Covid ED Clinician, Nurse education, Governance presentations, Management Meetings and Quality Improvement projects We hope to increase our team at a steady rate to what the departmental needs are, we are excited to be involved in helping to shape the future of the department which includes assisting with focus groups around the new department, teaching and mentoring the workforce both nursing and medical, but mostly we look forward to continuing to see patients as there are plenty of them in ED!

Wanna know more come and find one of us for a chat. We are so excited about the UHP celebrations for Advanced Practice Week 2020.