Pushing boundaries in paediatric intensive care: training as a paediatric retrieval nurse practitioner

Abstract

Traditionally in the UK, the transportation of the critically ill child to a paediatric intensive care unit has been carried out by a medically led team of doctors and nurses. However, in countries such as the USA and Canada, appropriately trained nurse practitioners have proven to be competent in the transportation of these vulnerable children. This nurse-led team model has also been shown to be successful in the speciality of neonatal care in the UK. The impact of changes in the National Health Service (NHS) has led to an increased demand for the transportation of the child requiring paediatric intensive or high-dependency care, the lifting of restrictions on nursing practice and the reduction of doctors' hours in keeping with the European Working Time Directive. This has led to one NHS Trust in the UK developing the role of paediatric retrieval nurse practitioners (RNP): nurses who lead the retrieval team. The purpose of this article is to describe a pilot initiative to develop the role of RNPs. The comprehensive process of recruitment, training and assessment of competency will be detailed. Personal reflection on the project will also explore the pertinent nursing issues around; role impact and definition, conflict and change management, communication, legislation and personal and professional growth. Recommendations for future initiatives will also be explored.

A literature review of conflict communication causes, costs, benefits and interventions in nursing

“…Role perception gaps were also found within a spinal cord rehabilitation team (Pellatt 2005). The introduction of new nursing roles, that were previously medical roles, was linked to conflict among professionals (Price & Williams 2003, Davies & Lynch 2007). Conflict between nurses and other non‐physician health care professionals was documented in a study involving hospital‐based midwives (Kennedy & Lyndon 2008).…”

“…The introduction of brand new roles and protocols positively affected conflict communication. Training for the specialized new role of a paediatric nurse practitioner enhanced conflict management abilities (Davies & Lynch 2007). Implementation of dedicated charge nurses in a busy medical–surgical nursing department significantly increased perception of teamwork, especially regarding conflict resolution (Hughes & Kring 2005).…”

The state of paediatric intensive care retrieval in Britain

“…Other staffing models, such as the use of advanced nurse practitioners (ANP), respiratory therapists and critical care paramedics are commonplace in the USA and Canada 15. ANPs have been increasingly used in Britain over the past few years in neonatal as well as PIC retrieval, and the development of advanced nursing roles has been significantly accelerated by recent changes to postgraduate medical training, junior doctor working hours and shortage of trainees in high intensity specialties 16 17. The development of ANP roles has the potential to improve staff recruitment and aid retention of experienced nurses in retrieval.…”

Attitudes of paediatric intensive care nurses to development of a nurse practitioner role for critical care transport

“… Advancing nursing skills and responsibility Retention of experienced staff in the clinical area Creation of a stable workforce of skilled retrieval personnel Diversification of the retrieval team Provision of an additional resource for PICU outreach teaching Pioneering a template for development of similar practitioners (Davies & Lynch 2007). …”