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A day in the life of ... a practice nurse facilitator

Helen Keeping is practice nurse facilitator and Donna Davenport is assistant practice nurse facilitator for Stockport Primary Care Trust. Here they explain exactly what their titles mean, and what their jobs entail

A practice nurse facilitator
There has been an abundance of professional titles in nursing, leading to confusion not only among patients but also among the profession.(1) We welcomed the opportunity to describe a day in the life of a practice nurse facilitator and the challenges this role brings.

Last year our Annual Report began with the quote: "Never doubt that a small group of thoughtful committed citizens can change the world: indeed it is the only thing that ever has." (Margaret Mead, anthropologist). The department still considers this to be fundamental in their daily practice.

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A practice nurse (PN) facilitator's role can be broken down into three distinct areas:

  • Leadership - being able to react quickly to changes, being strategic and flexible in the support of PNs.
  • Facilitation - supporting PNs in their training and professional development.
  • Being an advocate - developing practice nursing on behalf of Stockport Primary Care Trust (PCT), by responding to regional and national initiatives.

The aim each day is to ensure that issues are addressed within realistic timeframes.

PN training and professional development is situated in the newly created PCT. The week's schedule for the department is required to be both proactive and reactive if it is to meet the needs of 59 general practices, which employ three nurse practitioners, 102 PNs, 22 healthcare assistants and support two BSc community specialist students. Every practice has a very different population profile and professional development requirements.

In the two years since Helen became PN adviser, the role has evolved into a largely strategic position, with meetings arranged morning, lunch and afternoon. Agendas for meetings are varied, addressing local, regional and national topics, such as a "PN Training and Education Strategy", a "Primary Care Nursing Strategy" (involving the organisation of a day trip to Yorkshire for the key people involved in the implementation of an integrated nursing team to visit a "beacon site"), clinical governance, information technology (IT), PN training for 2002, delivering on National Service Frameworks, and district immunisation and vaccination policies and targets (the current issues being prepared include a Patient Group Direction for the new diphtheria, tetanus and acellular pertussis vaccine (Dtap), and raising awareness regarding the international concerns about bioterrorism).

Helen performs a strategic role that involves leadership, liaison, information sharing, information seeking, being a spokesperson, innovator, delegator, disturbance handler, negotiator, performance appraiser and trainer!

Donna concentrates on the delivery and implementation of policies and strategies, a position that allows her to be instrumental in further developing the role of the PN. Donna's previous experience of being a PN enables her to promote change by empowering nurses to change practice themselves. In the past, support and training for PNs has been inconsistent and inflexible.

The department works closely with local universities to ensure stronger, more effective working relationships between the NHS and higher education institutions. But a rich source of learning takes place at work and in everyday life experiences. PNs, like other professionals, need support in demonstrating this learning through experience using critical incidents, audit and reflection, supported by mentorship, clinical supervision and peer review.(2)

Within Donna's operational role PNs are offered one-to-one support with their continuing professional development (CPD) through an individual personal development plan. Workshops throughout the year facilitate development of personal portfolios, and reflective practice is encouraged as an ongoing process, not just as part of a course or other study event.

The day begins at 8.30am. On a typical Thursday morning, say, Donna and Helen meet with the dietetic facilitator of the department for a weekly debriefing. This gives them the opportunity to keep up to date and share knowledge of local, regional and national issues, as well as individual issues that may have arisen during the week. The current climate of rapid change, both nationally and in our newly formed PCT, means good communication between them is imperative.

By 9.30 the small administration team are busy dealing with a steady flow of phone calls and faxed responses to available training, development and support. Requests for advice come from both primary and secondary care professionals. Every fortnight the department produces a newsletter, which has proved a popular way of communicating with PNs and networking with colleagues.

By 10am the department is buzzing; the majority of mail and messages, including email, have been responded to. IT is an integral part of the development and delivery of health services. In the past, healthcare professionals have had little access to IT training.(3) This situation is changing rapidly, and there have been major developments in this area for primary care, which in turn has had a major impact on improving patient services.

11am is time for Donna's first scheduled meeting. A typical day might include a meeting with a nurse new to practice nursing. This would take about two hours as there is a wealth of information to offer her and she would have many questions to ask. In return, data are collated, including her registration details, CV and CPD to date.

1pm: Donna arrives back at base to meet an experienced PN for her personal development plan (PDP)/portfolio meeting. This hour allows the PN to reflect on her experiences and identify her learning needs for the forthcoming year. Donna gives her information regarding relevant courses and other resources to support her CPD.The PN is interested in undertaking diploma studies, and Donna is able to advise regarding APEL and the various modules available. She also gives her contact details for personnel at local universities. Most of these meetings are arranged around lunchtime to ensure least disruption to clinical practice. Many PNs welcome this time out for themselves, and feedback has been very positive.

3pm: as the lead coordinator for clinical supervision for PNs, Donna spends some time updating the waiting list for clinical supervision. A supervisor has just become available so she is able to allocate her a group of PNs who have expressed interest in having clinical supervision.

Administration is crucial in supporting developments like this to ensure letters, contracts and meetings are arranged and planned appropriately. Stockport PCT fully supports clinical supervision and endorses the recommendations in Making a Difference(2) and Fitness for Practice.(4)

The UKCC(5) and the NHS Executive(6) expect every nurse to have access to clinical supervision and see it becoming an integral part of future practice. It is an excellent way for nurses to update their knowledge and improve the quality of patient care, and should be viewed as an essential part of CPD. Feedback from nurses so far has been extremely positive.

At 4pm Donna writes up reports from the day, and the admin staff update the database and files with relevant information from the visits, to assist workforce planning in the future. Once again Donna catches up on mail and answers any phone messages, which by now have built up.

5pm is time for home. No day is ever the same, bringing new challenges and opportunities. Six months into her post a PN commented to Helen that Donna had really made her think about her practice following a PDP meeting. Well, how's that for an evaluation?

References

  1. Castledine G . Can we standardize titles and levels in nursing? Br J Nurs 2001;10:13.
  2. Department of Health. Making a Difference. London: DoH; 1999.
  3. Russell A, Alpay L. Practice nurses' training in information technology: report on an empirical investigation. Health Inf J 2000;6(3):142-6.
  4. UKCC. Fitness for Practice. London: UKCC; 2000.
  5. UKCC. Position statement on clinical supervision for nursing and health visiting. London: UKCC; 1996.
  6. Department of Health and NHS Executive. Clinical Supervision for Practice Nurses. London: DoH; 1995.