All emergency departments need to think about the best way to deploy new advanced nursing roles to meet future demand, says the director of nursing at Sheffield Children’s NHS Foundation Trust.
Sally Shearer, director of nursing and quality at the trust, predicted advanced nurse practitioner roles would become increasingly important to ensure the smooth running of emergency departments in the future and so it was vital to start preparing that workforce now.
“What we need to look at is advanced nurse practitioners and other models of working”
“Today roles between nurses and doctors are becoming increasingly blurred as nurses advance their skills, so it is thinking about the advanced nursing skills we need for the future and where we place certain individuals with those skills,” she told Nursing Times.
“There aren’t a whole cupboard full of these people, so when you are thinking about the nursing workforce you have to think several years in advance as it takes time to train people up,” she said.
Her comments follow a modelling exercise to look at patterns in A&E attendance and patient flow in Sheffield Children’s Hospital’s A&E.
The exercise, commissioned by Sheffield Clinical Commissioning Group, saw a team from Sheffield Hallam University use advanced data analysis and computer simulation techniques.
“There were no huge surprises but what it does do is give us that evidence base”
Ms Shearer said the findings did not contain any “huge surprises”, but had confirmed patterns already identified by staff and in-house analysis.
“The work has given us an understanding of how many children and young people come through the door, where they are coming from, what conditions they are presenting with, their age group and has given us that level of detail per hour, per day,” she said.
“We have very good four hour ED performance at Sheffield Children’s, but you can never take the foot off the pedal, so we’re always looking for projects that can help us. There were no huge surprises but what it does do is give us that evidence base,” she added.
The trust has already used similar analysis to devise staggered shift patterns in the emergency department to match peaks and troughs in demand, Ms Shearer noted.
Its in-house team has also used simulation techniques ahead of the launch of a new outpatients department to ensure optimum patient flow and minimise waiting times.
Specialist nurse for seriously ill children in Sheffield
While the latest analysis will not lead to any immediate changes in the configuration of A&E at the trust, Ms Shearer said she was keen to explore new ways to deploy nurses to best effect in what was “a very exciting time for nursing”.
“Nursing and the nursing family is changing – we have nurse apprenticeships, the nursing associate role, the traditional roles we already have, and, at the higher end, advanced nurse practitioners and non-medical prescribing,” she said.
“Like many chief nurses, I’m looking at the model we have got in place now give all of those options,” she told Nursing Times.
She suggested that one option was to deploy more advanced nurse practitioners in emergency care.
“We already have emergency nurse practitioners in the department, but what we need to look at is advanced nurse practitioners and other models of working,” she said. “But there aren’t that many people with those skills so we need to train them up.
“This is partly to give us sustainability around our workforce, but it is also better for patients if they can get what they need straight away without having to wait for a doctor to come down,” she said.
The trust has worked with the University of Sheffield to develop an advanced nurse practitioner course – launched 18 months ago – and a number of staff are already part-way through the training.
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As well as A&E, it deploys advanced nurse practitioners in other areas – such as critical care, transport services for neonates and intensive care – that it operates across Yorkshire and in its nurse-led “hospital at night” team.
“Nationally we need to think about the range of services provided in the emergency department,” added Ms Shearer.
“If you’re coming in the helicopter with major trauma you’re going to need access to specialist individuals,” she said. “Yet in order to free up specialist individuals to do that type of care we need to have a full range of skills working in ED, so when a child comes through the door they can be directed to the person best suited to help them.
“For some it will be a specialist, but for others it will be someone with advanced clinical skills with that breadth of skills as well,” she noted.
The Sheffield trust is set to launch a new nursing strategy in the New Year. As well as developing nursing roles, it will place a greater emphasis on nurse-led research.