Advanced Practice Nursing in Emergency Departments improves access to quality and affordable care

Case Study Submitted by: Emily Lockwood
Country: Ireland
A lot of the injuries and conditions that we see are undiagnosed and undifferentiated. It is the ANP-Emergency who makes the clinical diagnosis for her or his patients and who develops the treatment plan. The scope of practice of the ANP-Emergency includes taking patients’ clinical histories, conducting physical examinations, ordering tests, prescribing medications and ionising radiation, planning and administering treatments, referral or discharging patients, as required. Patient education and health promotion are integral to the ANP-Emergency role. ANPs also supervise and train new ANP-Candidates and they provide bedside education and training to members of nursing and multidisciplinary teams. ANPs undertake continual professional development, clinical guideline development and evidence-based practice.

Advanced nursing roles at the University Hospital Waterford have evolved because of a need for nurses to expand their role and profession. Advanced nurses now provide high quality and cost-effective care to persons who seek emergency health care for unscheduled, acute and chronic conditions, and all minor injuries. Nurses in this hospital are making a significant difference to access to quality affordable care for conditions requiring emergency care.

Waiting for treatment for many hours in emergency departments (Eds) can be distressing for patients, as can waiting for months for elective surgery, only for it to be cancelled at the last minute. Long waits are inconvenient and frustrating, but they can also be painful, emotionally scarring and detrimental to health and wellbeing.

In Ireland, there has been a significant problem with waiting times of four to six hours in EDs. With no clear clinical pathway and no way of streamlining care this led to high number of complaints, and people with undiagnosed fractures and significant injuries leaving the department without being seen by a health professional.

The Advanced Nurse Practitioner (ANP) in Emergency Care service in the southeast area of Ireland facilitates the development of an integrated model of care and makes a tangible difference to patients visiting the ED.

The ANP works autonomously and is integrated into the ED multi-disciplinary team. They use a holistic care model in which they assess, treat and educate patients and relatives. The ANP manages the patient’s complete episodes of care, including diagnosis and discharge or referral to other allied health professionals, if needed.

The ANP caseload includes unscheduled care, acute and chronic conditions, all minor injuries, maxilla-facial injuries, plastics, orthopaedic acute and chronic limb conditions including trauma, management of open and closed limb dislocations, head injuries, infected joints, dental problems, soft tissue injuries, sporting injuries and surgical conditions.

The key to success is clinical wisdom, expert practice and high levels of clinical decision-making skills. The future of the position looks positive and, as always, it is important to remember that it is not about the ‘I,’ it is about the ‘team’ when developing and sustaining advanced nursing practice in any service.

As a result of this model of care, the waiting time in the emergency department was reduced from four to eight hours to less than 1.5 hours. In addition, clinical pathways and guidelines have been developed and implemented so that the level of care is consistent, safe, evidenced-based and measurable. Patient outcomes as a result have improved.

ANP Emily Lockwood explains the impact of her work.

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