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Developing the role of nurse practitioners

Managing demand and exploring new roles at Milton Keynes Hospital

Why was the initiative launched?

The creation of nurse practitioner posts was seen as a practical way of ensuring that a full service was offered to patients. Pressure on clinical resources and the consequences of the reduction in junior doctors hours had already stimulated staff in the hospital to look for ways to improve the use of resources.

Part of the problem was the inherent difficulty of balancing service and teaching needs in an ordinary district general hospital. They lack the flexibility available in teaching hospitals with their higher staff numbers overall. It was proving difficult to ensure that junior doctors were able to experience the full training cycle - from observation to application - during their six-month placement. Ways needed to be found to streamline the process and speed up patient management.

What was done?

A post for a laparoscopic nurse practitioner was set up to ensure that minimal invasive surgery was available to patients. Steps were taken to define - very carefully - the role and tasks expected of the nurse practitioner. Training was provided to enable the nurse practitioner to fulfil this role and to ensure that other members of the team understood it. A detailed clinical protocol defined standards of care, treatmen, and the roles of members of the clinical team.

Nurse practitioners have clinical autonomy and enhanced status within the clinical team. They are accountable to the surgeon and - professionally - to the Director of Nursing. Their presence enables clinical work to proceed even when the Consultant is away from the hospital, such as at training events or on annual leave. Because of the advanced level of practice, nurse practitioners have been recognised and paid appropriately (grade H).

The development was not without problems - many an inevitable consequence of introducing a new member to the clinical team. Detailed analysis was required to ensure that the ‘case' for the initial investment was strong - and successful. Nurse practitioners are now active in a range of situations in the hospital, in urology, and stoma and breast care.

Does it work?

Experience has shown that benefits can be seen in four areas:

  1. Better care for patients - surveys have shown that patients have welcomed the changes. They like the ‘familiar face' - from pre-admission assessment to post-discharge follow-up. Patients also welcomed the follow-up telephone call after discharge to check-up that all was well. Again the familiar voice - the nurse practitioner - was valued.
  2. More effective care and treatment - audits (in laparoscopic surgery) have shown a reduction in the number of ‘DNAs - did not attends'; an increase in the proportion of patients managed as day patients (up over twofold); a 25% reduction in the length of stay for cholecystectomy patients (down from 5.1 to 3.8 days) and fewer patients are now found to require open surgery (over three years this ‘conversion' is down from 16% to 2%).
  3. Better job satisfaction and appropriate rewards for nurse practitioners. The initiative ensures more appropriate use of clinical skills and clinical time.
  4. Better training for junior doctors - they can move through the full training cycle - from observation to application - within their six months placement. The clinical support available from the nurse practitioner is an important factor.

Tips for success

To find out more contact:

Catherine Caballero, Nurse Practitioner, Milton Keynes General NHS Trust Standing Way Milton Keynes. MK6 5LD
Telephone 01908 243153
A number of documents have developed which contain a considerable amount of useful information. Specifically, the following documents are available, and would be useful for anyone considering developing a nurse practitioner service in secondary care:

• Clinical protocols

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