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What’s not to like about advanced practice in a care home setting?

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Advanced Nursing Practice is well established within Hospital settings and has established it’s importance within community nursing practice, explains Erskine’s director of care, Derek T. Barron. 

Having recently moved from working in NHS Scotland to the care home sector I was struck by the many and varied clinical skills required by the nursing (and care) workforce in care homes. 


Here at Erskine we have employed a full time advanced nurse practitioner (pictured left), as far as can be ascertained the first ever directly employed by a care home in the U.K.

Deborah Sturdy, Visiting Professor at Bucks New University and Honorary Nursing Advisor to Care England, said about care homes:

“The social care workforce provides complex care for thousands of people living in long term care settings… Care home nursing teams deliver complex, skilled care in nurse led units across the country. We can help encourage nurses into the sector by creating confidence about their role’s prominence in the wider nursing community, and influence the next generation of the profession.”

“At Erskine our residents live with a wide range of illnesses and it is our role to help minimise the impact of those illness.”

There’s a temptation to fall into the trap of explaining the complex technical intervention versus ‘soft’ skills (which are about people). To do so however undermines the very fundamental of being a nurse, we are people people.

So why bother with advanced nursing practice in a care home setting?

At Erskine our residents live with a wide range of illnesses (e.g. COPD, dementia, Parkinson’s, diabetes, heart failure, depression, delirium) and it is our role to help minimise the impact of those illness, enabling our residents to remain as well as possible.

By knowing our residents well as people and being able to recognise changes in presentation, alongside being able to promptly reach differential diagnosis and treat symptoms early we can only improve the delivery of care.

The ANP isn’t an outsider who comes in prescribes a treatment and moves on, the ANP is an integral part of the whole team, they share Care decisions with the care teams in each house across our two Bishopton Homes as well as sharing care with the local GP team.

“There is nowhere that this will be more impactful than when someone is receiving palliative or end of life care.”

From a wider ‘system’ perspective having an ANP on-site and able to commence, vary or stop treatment means our call on other resources e.g. GP or A&E should reduce, and when needed should be more focused. 

A&E, on a daily basis is faced with numerous presentations of frail older adults living on the edge of vulnerability who fall, become immobile, incontinent or delirious and need some form of advanced assessment – and often admission, due to lack of options/choice - care Homes contribute to that picture

There is nowhere that this will be more impactful than when someone is receiving palliative or end of life care. Removing/diminishing the need for hospital admission brings choice (and expertise) to the resident and their family.

Our ANP will still be completing an Advanced Practice Competency framework, supported and supervised by the Nurse Consultant for Advanced Practice in NHS Ayrshire & Arran.

Their day to day clinical practice will still be supported, as a shared care arrangement, with our local GP practice (that’s a win-win for us both), and our residents get faster access to assessment and treatment and continuous assessment.  

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