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Support the ICU Nurse Practitioner Program at Royal North Shore Hospital

Although well-established internationally, nurse practitioners (NPs) within an Australian adult intensive care unit (ICU) are rare. There are fewer than 10 in Australia, with five of them currently working at Royal North Shore Hospital (RNSH) and there is a clear need to create more of these roles to meet emerging demand.

In 2015, the ICU NP role was implemented at RNSH ICU. The role has expanded since this time to focus on four key areas which may have traditionally been seen as the role of a doctor. These core areas include: tracheostomy management, vascular access, transfer of the ventilated patient within the hospital, and case management. The ICU NP service plays a pivotal role in the management of complex ICU patients, impacting the length of stay and reducing stress for staff and patients.

RNSH is motivated to become the first hospital in Australia to implement an NP led case management program and a fellowship style training program for adult ICU NPs. A program of this nature will allow NPs to train at RNSH, broaden and refine their skills before taking these learnings back to their own communities.

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ICU nurse practitioner team at RNSH

“We want to develop the first ICU Nurse Practitioner Fellowship Program to develop future NPs in Australia, to increase the number of advanced practice nurses and providing education to meet community healthcare needs.”

 

The ICU NP team at Royal North Shore Hospital

What is a nurse practitioner?

A nurse practitioner (NP) is a registered nurse (RN) experienced in their clinical specialty and educated at Master’s level, who is endorsed by the Nurses and Midwives Board of Australia (NMBA) to provide patient care in an advanced and extended clinical role.

Although both RNs and NPs focus on patient care, the main difference between the two roles is that NPs are authorised to prescribe treatments, order tests, and diagnose patients—duties that are typically performed by physicians as well as collaborate with other healthcare professionals to ensure the provision of holistic care. NPs are endorsed by the Australian registration board after meeting rigorous academic and clinical requirements including a Master’s degree and 5000 hours of supervised advanced clinical practice respectively.

NPs provide high quality care in the assessment and management of patients, with the clinical expertise and academic education to expand the boundaries of nursing practice. This is particularly important within the current healthcare climate as there is an urgent need for improving access to care, particularly for at-risk populations including Aboriginal and Torres Strait Islanders, the elderly and those in remote and rural and regional areas.

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ICU nurse practitioners in Australia

While there are more than 450,000 RNs in Australia, there are only 2,500 NPs, and less than 10 of them work in ICU.

NPs have been providing care within a range of specialties in Australia for more than 20 years. The initial intent of NP introduction was to expand and increase patient access to health services including remote area and primary care (aged care and residential aged care, paediatrics, mental health, drug and alcohol, oncology, haematology, renal, endocrine, cardiac, perioperative care, women’s health, critical care, chronic disease management, and cosmetics). Intensive care was not included in these categories.

In 2015, the RNSH ICU NP service was piloted and has since grown significantly. Currently, there are four endorsed NPs and a transitional NP who provide a sustainable, efficient, and now indispensable model of care for patients in the Northern Sydney Local Health District.

RNSH ICU cares for patients with some of the longest stays in Australia including burns, spinal cord injury and brain injury patients. These high-risk patients often have complex medical cases, and families with emotional and social needs, and are at risk of infections, delirium and other complications.

While there is considerable interest from current nursing staff to upskill into ICU NP, many are unsure where to begin the journey.

ICU NP team

“What I love about my role is that I am able to advance my career as a nurse, and continue to stay at the bedside providing direct patient care. I also love that I work in a wonderful team of caring, innovative and extremely skilled nurses. Most of all, I love that this team is going to change the future for training ICU nurse practitioners all over the country!”

Kelly Harbour, ICU nurse practitioner

What does the ICU Nurse Practitioner Program involve?

The case management program will expand on the existing service which increases the continuity of care for complex, long stay ICU patients. The program also provides opportunity for increased education and training for nursing and medical staff. Patients will be identified using a ‘trigger system’ with known indicators such as protracted length of stay in ICU. Based on current data there are potentially 60 patients per year suitable for the ICU NP case management program.

These long stay ICU patients often have multiple teams involved in the treatment of care (complex and prolonged treatments), delayed mobilisation and rehabilitation opportunities, and difficulty when transitioning between hospital wards. These factors immediately place these groups of patients at risk of healthcare-associated infection, iatrogenic complications, delirium, and prolonged need for basics of care, nutrition, mobilisation, pain management, and ventilation weaning.

The role of the ICU NP for these case management patients will be to participate in daily consultation and communication with the ICU and treating teams. This would entail care planning and coordination, intra hospital transfer for scans, line and drain insertion or removal, tracheostomy management, and mobilisation.

The concurrent objective of the project is to build a pathway towards the standardisation of the ICU Nurse Practitioner role in Australia. The initial ICU NP role developed at RNSH reflects the livelihood of the intensive care unit. The role provides the opportunity for highly transferrable skills beneficial and well suited to all levels of intensive care units in Australia. The ICU NPs at RNSH hope to train registered nurses from metro, regional and rural areas to become ICU NPs in their own health districts.

While the RNSH ICU NP team are ambitious, it is intended that one day, when entering any ICU within Australia there will be NP’s working within them. This will be a new way of operating within the healthcare sector, and a refreshing outlook at patient care for the years to come.

The proposed outcomes will support patients by having reduced complications, partnering with patients and their families, and being part of the conversation for comprehensive care planning. In addition to these areas the program will contribute on a larger scale where it will help reduce ICU and hospital length of stay.

The cost of enabling these two pilot projects is approximately $560,000 across two years. Ongoing funding of $280,000 per year will be needed to facilitate the long-term establishment of this program.

BENEFITS FOR PATIENTS
  • Reduced waiting times for vascular access procedures
  • Consistency and continuity of care for complex and long stay ICU patients
  • Improved patient and family satisfaction
BENEFITS FOR STAFF
  • Increased continuity of care for complex ICU, tracheostomy and vascular access patients
  • Increased governance around tracheostomy and vascular access management
  • Increased education and training for nursing and medical staff
  • Increased career opportunities for nurses
  • Increased nursing staff retention and work satisfaction
  • Improved work and organisational efficiency

Meet the ICU NP team

Sarah Webb

Sarah is an ICU nurse practitioner and was the driving force behind the creation of an ICU NP model of care at RNSH ICU in 2014. Sarah has over 19 years experience in Intensive Care where she has worked as a Clinical Nurse Specialist, ICU Clinical Educator and Resuscitation clinical nurse consultant. Since 2014, Sarah has been building the adult intensive care NP model and promoting the NP role. Sarah has completed a Master of Nursing (Intensive Care), a Graduate Diploma of Midwifery and a Master of Nursing (Nurse Practitioner).

Jessica Butler

Jess has over 12 years experience in ICU and has worked in various roles within the ICU such as the Quality Coordinator, Clinical Nurse Specialist, Clinical Nurse Educator and a member of the Rapid Response Team. Since 2016, Jess has been an NP at RNSH ICU, striving for clinical excellence, collegiality and further development of other advanced practice nurses. After commencing a RNSH ICU, Jess went on to complete a Graduate Certificate in Critical Care Nursing, a Master of Advanced Nursing (Education) and a Master of Nursing (Nurse Practitioner).

Elliot Williams

Elliot has worked in ICU RNSH for 10 years, and has a Master of Nursing (Nurse Practitioner). Elliot is a member of the ACI NSW ECMO Advisory Group, runs the ECMO course at RNSH, and is the nursing lead for ECMO in the ICU at RNSH. Elliot also teaches post-graduates at the University of Sydney Faculty of Medicine and Health. In addition to these roles, Elliot has had a long affiliation with the pre-hospital care space through his work with St John Ambulance NSW, where he is currently the Deputy Commissioner, Clinical Systems. 

Kelly Harbour

Kelly Harbour is an Intensive Care Nurse Practitioner at the Royal North Shore Hospital in Sydney, and has been nursing in intensive care for more than 10 years. She has a Master of both Advanced Nursing and Nurse Practitioner, and previous experience as a Nurse Manager, Research Nurse and Rapid Response Team nurse. Her special areas of interest are neurocritical care and end of life care for the critically unwell patient. Kelly has a strong passion for empowering the nursing workforce to provide exceptional care.  

Katie Kelleway

Katie is an experienced ICU nurse working within RNSH ICU for over eight years and is currently a part-time Transitional Nurse Practitioner (TNP) in ICU as well as a Clinical Nurse Specialist Grade 2 as part of the Vascular Access Service. As a TNP in ICU, Katie provides advanced practice nursing and education to the unit, with roles including vascular access, intrahospital ventilated patient transfers, nursing lead of the RNSH Tracheostomy team and long-term case management of complex ICU patients. 

How much would you like to donate?

Your donation will help develop future NPs in Australia, to increase the number of advanced practice nurses and providing education to meet community healthcare needs.

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