Established 10 years ago to improve and streamline the care provided to emergency patients, the Emergency Nurse Practitioner (ENP) service in Western Isles Hospital has both improved the patient experience and increased the confidence, skills and knowledge of staff.
The Western Isles ENP service in Western Isles Hospital in Stornoway was established in January 2003, and has transformed the way emergency care is delivered locally.
Emergency Department Senior Charge Nurse, Agnes Munro, described how the service was established: “In the 1990s Emergency Nurse Practitioner services started in various places nationally, and we started considering the idea here in around 1997.
“At that time, we had problems recruiting doctors and also issues related to lone working. Establishing an Emergency Nurse Practitioner Service was the ideal solution and the staff here were keen to do it.”
In 2000 the Scottish Executive made a commitment to fund education programmes for specialist nurses and agreed to fund Emergency Nurse Practitioner training for three Western Isles nurses. NHS Western Isles took the decision to fund three further staff on the degree programme, so six nurses in total were given the opportunity to undertake the specialist training.
“This was quite something for people who had been nursing for years and hadn’t done a degree before,” Agnes explained. “It took three years of lots of sweat and tears – but without the blood thankfully! All passed and became Emergency Nurse Practitioners.”
Very soon after the initial training all became Independent Nurse Prescribers and that is now a requirement for all trained ED staff.
The first ENPs in the Western Isles were Agnes Munro, Betty Smith, Dene Fraser, Peggy Macleod, Louise Smith, Susan Macaulay and Ann Campbell. All the original ENPs still work in the Emergency Department at Western Isles Hospital, with the exception of Ann.
Following on from the ENPs’ successful completion of the degree course, the Emergency Department became a nurse-led department. Since then, all nurses who have joined the department have been mentored by the existing ENPs and are trained up over a five year period. This ensures that there are a number of staff available to take on the role of an ENP, should a vacancy arise.
“Becoming ENPs has benefited the staff by giving them the skills, knowledge and experience to be autonomous practitioners,” said Agnes. “It has given them a really deep insight into what they do and accountability is always at the forefront of their thinking. It’s really increased their confidence and they have become excellent patient advocates.”
The introduction of the innovative nurse-led ENP service has also considerably improved efficiency in the Department, with the ENPs able to manage up to 60 per cent of all people who present at the Emergency Department (ED).
“It’s given the ENPs a very positive and enthusiastic approach to new things. We are always happy to try out things like telehealth, building links between primary and secondary care, as well as helping our paramedic colleagues with their continuing professional development.
“We also work really well with allied health professionals and other colleagues, such as GPs and primary care staff, to make sure the patient pathway is as smooth as possible.”
In terms of the patient experience, satisfaction surveys conducted after the implementation of the ENP service reported that the vast majority (around 92 per cent) of patients rated the care they received in the department as either ‘excellent’ or ‘very good’.
The remit of the ENP service in the Western Isles is an example of the extent to which practice can expand and develop, with local ENPs having a much wider role than in many other areas. In other larger Board areas, ENPs usually manage minor injury units, whereas here in the Western Isles, ENPs are able to initiate the process from attendance at the Emergency Department to the point of onward referral for admission (if required).
In practice this means that ENPs do not have to wait for a doctor to attend prior to instigating treatment and the norm is that, by the time a doctor attends, pain relief will have been administered, blood specimens will have gone to lab and x-rays done.
Traditionally all patients attending ED had to be seen by a doctor but in the ED Agnes and her team are able to diagnose and treat patients, order investigations, prescribe drugs, discharge patients, or refer patients to another department leaving doctors free to deal with matters that require their skills and knowledge.
Agnes added: “Despite our enhanced role, we are not doctors and working with our medical colleagues is something that we enjoy and appreciate, and we value the time they spend teaching us. It is also important to stress that, without the Board’s ongoing support, the service would not be what it is today. We have had the benefit of excellent training and continue to receive support. Without that support, we wouldn’t be able to provide the service we do.”