Nurses’ contribution to Clinical Programmes

The Nursing and Midwifery workforce nationwide has made a significant contribution at both clinical and national strategic level to the progression of the National Clinical Programmes, thus improving patient care whilst also meeting the objectives of the HSE, writes Prof. Geraldine Shaw.

Geraldine Shaw
Prof. Geraldine Shaw

The Nursing and Midwifery workforce nationwide has made a significant contribution at both clinical and national strategic level to the progression of the National Clinical Programmes, thus improving patient care whilst also meeting the objectives of the HSE. This article reflects on some of the achievements of the programmes to which Nursing & Midwifery have significantly contributed.

Note; please be mindful that this article only gives a brief snap shot and does not cover all of the programmes achievements due to the confines of space. Therefore it is not intended to be exhaustive.

National Clinical Programme for Acute Medicine

Introduction of the National Early Warning Score (NEWS): This was led and driven by a National Nursing Lead with the support of the Office of the Nursing & Midwifery Services Director (ONMSD) and the Acute Medicine Programme (AMP). It received the public service excellence award from An Taoiseach in 2013. The National Early Warning Score (NEWS) has been implemented in all acute and single specialty hospitals in Ireland.

National Clinical Programme for Obstetrics and Gynaecology

Introduction of the Irish Maternity Early Warning Score (I-MEWS): In 2013 the ONMSD established a multi-disciplinary design team to develop a national standardised Irish Maternity Early Warning System (I-MEWS) observation chart and associated material. Midwives from nineteen maternity hospitals contributed, collaborating on its development and implementation, thus demonstrating the benefit of multi-disciplinary top down –bottom up workings. The I-MEWS is to be used for all pregnant women from confirmation of a clinical pregnancy and up to 42 days post-delivery. The design, development and implementation of this work was presented by Lead Midwives at the International Confederation of Midwives (ICM), Prague in May, 2014.

A Midwifery Workforce Planning Review has been jointly commissioned by the Office of Nursing and Midwifery Services Director and the Directors of Nursing & Midwifery with the approval and input of the Obstetrics and Gynaecology National Clinical Programme, and the National Director Clinical Strategy & Programmes Division. This project incorporates a Birthrate Plus® (BR+) study in seven maternity units in Ireland.   The data will be analysed to produce benchmarking data for the HSE to validate and inform national workforce planning.

National Clinical Programme for Paediatrics

Introduction of the Paediatric Early Warning Score (PEWS): A National steering group was established in 2014 and is developing the National Paediatric Early Warning Score (PEWS). The development, roll out is being led and driven by a Nursing Project Coordinator.

National Clinical Programme for Stroke

Nurses and Stroke Clinical Nurse Specialists are providing and leading on patient care and service initiatives which are delivering the following outcomes;

  • Quality and Patient Safety Audit shows Thrombolysis rates have increased from 3.3 % in 2008 to 9.5% in 2012 (10.5% in Q3 2013) and leaving Ireland with one of the highest rates in developed countries (UK is 5%, Sweden 6.6% and USA 2.4%)

National Clinical Programme for Emergency Medicine

Nursing within the programme, in conjunction with ONMSD have;

  • Published in 2013 a “Guide to enhancing Advanced Nurse Practitioners (ANP) in Emergency Departments in Ireland”. Since then an additional 14 ANPs are in post in the system. This document gained an international ANP award in 2013.
  • Developed role profiles for ED Nursing Staff to complement the current National General Job descriptions for staff working specifically in EDs namely staff nurse, shift leader and CNM grades.
  • Developed an Irish Children’s Triage System (ICTS) in conjunction with other key nursing and medical personnel , which is an international first and is presently being rolled out to Emergency Departments s nationwide.
  • Developing an ED Workforce Planning Toolkit which is in the advanced stages. This is for Nursing Management & staff to utilise in emergency departments to assist the maximisation of the use of human resources and assist with workforce planning.
  • National rollout of an Ambulance handover protocol is being led by a Nursing Project Lead to improve handover from ambulances to EDs.

Author; Geraldine Shaw RGN,BA,MA,Adjunct Associate Professor UCD School of Nursing, Midwifery & Health Systems has extensive Senior Nursing Management experience in both the Irish and UK Acute Health Care Systems.  She is currently undertaking a Doctorate in Governance and works as Director of Nursing & Midwifery / National Clinical Programmes, in a National Strategic Management capacity for the National Nursing & Midwifery Services Director and the National Director for Clinical Strategy & Programmes Division, Health Service Executive. E mail geraldine.shaw@hse.ie