Nurses and Midwives

The workbook will be owned by yourself and we would hope it will assist you with reflective conversations with your practice Assessor/ supervisor. We hope that you will gain practical experiences of the scenarios we have provided and the Student workbook will give you additional direction of what to consider when supporting a patient in the community .

They will also highlight that it will be through discussion between the practice supervisor / assessor and the student that will identify if part or all of the document is to be completed. 

The document will be your (students) property, it is not required as part of your university work but will inform your practice supervisor / practice assessor of your progress in placement and the evidence from this will inform interim and final assessment.

Take a few minutes to read through the following scenarios and think about what you would do as the newly qualified Staff Nurse in each scenario.  Think about how you would act at the time, what actions you would likely take, what you would do with the patient, who you would inform, and if you would follow this up with another visit/referral to specialists etc.

Discuss your answers with your Practice Supervisor or Practice Assessor. These are designed to give you scenarios to discuss are part of a reflective discussion.

Question 1

You are asked to visit a gentleman who has a sore bottom and it turns out he has a pressure ulcer on his right buttock. How would you assess this and what would your care plan consist of? What else would you do?

Assessment – Have you considered…

• What grade of pressure ulcer this is?  Pressure Ulcer Grading Chart
• Have you measured the wound?
• Have you considered the reason for the patient developing this pressure ulcer and looked at ways in which to minimise further damage?  (Think SSKINS)
• Have you informed the caseload holder?

Planning Care

• Think about dressings – what would you likely want to use for the different grades?
• Consider how much exudate (fluid) is coming from the wound
• Consider how often to visit and change dressing
• Consider what you want dressing to achieve (absorb, reduce bacterial load, protect, progress to healing etc)
• How often would you measure the wound?
• How often would you change / update the care plan?

Question 2

You go to visit a lady who has type one diabetes who requires the nurses to administer her insulin. What are the steps you would take prior to administering her insulin?

Have you considered…

• Have you checked her Nursing notes to ensure no-one else has visited this patient prior to your arrival?
• Have you checked her Direction to Administer?
• Once you have checked the patients Blood Glucose level, have a think about what the ‘normal range’ would be for this patient – discuss with your mentor.
• What steps would you take if the patient is hypoglycaemic / hyperglycaemic?
• If safe to do so, are you familiar with the device used for administering insulin?
• Is your device in line with the safer sharps policy?
• Have you disposed of the sharps appropriately?

Question 3

One of your patients who has a wound on their leg has phoned to say his wound is very painful and his dressing has fallen off. When you saw him yesterday there was minimal pain at dressing change however you did think it was exuding more fluid than before. What things would you consider when you go to visit this man? What would your assessment include?

Have you considered…

• Is the current dressing appropriate for the increased exudate levels
• Frequency of visits (may need increased)
• Are you expecting the wound to increase in pain?
• Consider wound infection – if likely, what steps might you take?  (Remember, is it localised or systemic?)
• Does this gentleman need referral to Vascular / TVN?
• Would you change his care plan, nursing assessment, waterlow?

Question 4

A patient phones to advise that their catheter bag has been empty all morning and their stomach is becoming painful. What would you do? Is there any advice you can give over the phone initially?

Have you considered…

• Asking them to change position to allow gravity to assist
• Asking the patient about their bowels (are they regular / constipated)
• Ask about fluid intake over past 24 hours
• Provide reassurance
• If requiring a visit – what would you be looking for?
• What would indicate a change of catheter is required
• Are there any signs of CAUTI
• How would you record your visit?  (Think about Catheter Assessment Procedure)

Question 5

The carer of a palliative patient calls to say that their loved one has become very distressed and is trying to get out of bed. They had been administered 2mgs midazolam only an hour before hand and are on a syringe driver with diamorphine for their pain. How would you assess this situation? Is there anything else that could be causing this agitation?

Have you considered…

• Patients’ position in bed / chair
• Bladder
• Bowels
• How many breakthrough doses over past 24 hours
• Is the breakthrough dose sufficient
• Should we consider adding Midazolam to the Syringe Driver?
• Medication review from GP / Independent Nurse Prescriber
• Support for family
• Home Care / Marie Curie

• NMC student standards
• PEF portal
• Diabetes UK – Resources for Professionals and Patients
• NMC – The Code
• Gibb Reflection cycle toolkit Edinburgh University
• NMC – Reflective accounts Revalidation

The documents in this section are to support you when you are troubleshooting patients with Catheters problems. They should be used to support your decision making skills when communicating with patients and their carers via SPOA.

• Decision aid for the management of Catheter care
• Definitions and recommendations for Unplanned Catheters
• Guidance for use when receiving SPOA calls.

This framework sets out a vision for the next five years, outcomes and ten commitments to support improvements in the delivery of palliative and end of life care across Scotland. It will give an understanding of the definition of Palliative care and the link to preferred place of death.

Palliative and end of life care: strategic framework for action.

Whilst Anticipatory Care Planning may be particularly useful for people receiving palliative care, it is a tool that can be used with anyone. Staff should encourage everyone to start to think about what matters to them and what their wishes and preferences may be. More information and resources to help guide conversations can be found on the ACP Resources Page.

As part of the GGC Unscheduled Care Anticipatory Care Programme, a standard operating procedure has now been published giving detailed guidance to staff regarding the process of having and recording anticipatory care planning conversations. This guidance is applicable across all areas of NHSGGC, including the 6 HSCPs, Primary Care, Acute settings and the independent care sector.

The SOP is very comprehensive with a quick guide to support navigation. These can be accessed via the ACP Resources Page or via the links below:

• Anticipatory Care Planning – Standing Operating Procedure (Full)
• Anticipatory Care Planning – Standing Operating Procedure (Summary Guide).

We hope existing and newly recruited staff, managers, GPs and Nursing/Care Homes will find the SOP helpfully provides guidance around ACP conversation initiation, use of the ACP Summary document, saving to Clinical Portal and KIS.  Example ACP Summaries are also included providing extra support. All staff can also access ACP training via the emodule or attending a virtual communication skills workshop (dates available on the webpages).

We will be promoting this document over the next month via tweets, core briefs, e-bulletins etc. and would appreciate your help in spreading the word. You can follow us on twitter at @NHSGGC_ACP or forward any emails you receive to colleagues and networks you feel may be interested. 

Any feedback or questions regarding the documents or the programme can be sent to ACPSupport@ggc.scot.nhs.uk.

NHSGGCs 2016-2020 Advanced Nurse Practitioner Strategy

NHSGGC Generic Advanced Nurse Practitioner Job Description 

Standard Operating Procedure for new ANP roles 

Transforming Nursing Roles – Introduction (TNR Phase 1 Paper)

Transforming Nursing Roles – Advanced Practice (TNR Paper 2)

Transforming Nursing Roles – Advanced Practice (TNR Paper 7)

Transforming Nursing Roles – Advanced Practice (TNR Paper 8)

NES Resources

NES Service Needs Analysis Tool 

NES ANP Competency Page

NES Clinical Supervision 

NMC Resources

Becoming a Prescriber 

RPS Resources

Designated Prescribing Practitioner Competency Framework

Useful Websites

 Advanced Practice Toolkit

ACAP Scotland (a forum for ANPs in Scotland( (Registered Charity SC042116) 

Nursing 2030 Vision

Trainees are expected to record the following in their Portfolio:

• Personal details including NMC PIN Number.
• Learning Plan – the ‘Professional Journal Plan’ in the Portfolio can be used for this purpose.
• Record of Learning – All learning activities (these can be grouped into themes e.g. modules completed, eLearning, supervised practice etc)

• All supervision sessions
• An anonymised list of patients seen (gender, approx age, presenting complaint, diagnosis, management/referral and any key learning points). Trainees may wish to keep this as a spreadsheet or word file and upload into their portfolio periodically. A blank template can be found on the trainee ANP moodle site. 

Remember – no patient identifiable information should be kept in your portfolio.

• Competencies
  • Trainees are expected to work through the appropriate competency document and upload a scanned copy to their Portfolio prior to any supervision meetings (relevant competency documents will be given to trainees during the training). The trainee should self-assess and then the Practice Assessor should go through with the trainee. Competencies should be signed as complete when the assessor has seen satisfactory evidence, within the Portfolio, that the competency has been met. Items listed below can contribute towards evidence of competence achievement and should be cross referenced within the Portfolio. 
• Reflection
  • Trainees are encouraged to regularly write up anonymised reflective accounts relating to patients they have seen or from appropriate learning situations.  
• Feedback
  • Supervisor in Practice Reports. Practice Supervisors are expected to feedback at various points throughout a trainees training using the Generic Feedback form in the Portfolio.
  • Trainees are expected to get feedback from a variety of different people for components 1-3 described below:
    1. Mini-CEX – Trainees should include a number of mini Clinical Examination assessments in their portfolio. A mini-CEX should be used where a Practice Supervisor gives formal formative feedback to a trainee on a consultation. Forms can be found on the Portfolio and ‘a ticket’ can be raised so the supervisor can complete. 
    2. DOPS – Direct Observation of Procedural Skill. Once a trainee has learnt a new procedural skill, the Practice Supervisor should give formal formative feedback using the DOPS form. Forms can be found on the Portfolio and ‘a ticket’ can be raised so the supervisor can complete. 
    3. Case Based Discussion – Trainees will discuss numerous cases with their Practice Supervisors. Trainees are encouraged to keep notes on all their significant discussions and to write up formal case based discussions. The Case Based Discussion template within the Portfolio should be used for this.
    4. Multisource feedback (MSF) – Trainees should request feedback from different clinicians (e.g. ANPs and medical staff) and non-clinicians. The generic feedback form in Portfolio can be used and a ‘ticket’ can be raised for the respondent to complete. 

Ultimately, the Portfolio will become a central part of the final sign-off process and trainees should familiarise themselves with the requirements for this on the Final Sign-Off area on this web page.                                                              

Prior to being recorded as an ANP your line manager needs to confirm that you have completed all the required training for the role and have evidence that you meet all the required competencies. This process is termed ‘final sign-off’.

Final sign-off is required when an individual:

• Completes initial training
• Changes job (especially if it’s in a new speciality)

For final sign-off the ANP trainee should select out the ePortfolio evidence which best demonstrates their learning and competence. The trainee ANP will submit a ‘Share-Pack’ of this evidence to their line manager when they are ready for ‘final sign-off’.

The Final Sign-Off Process

Final Sign-off involves:

• The individual’s line manager who will take the lead on the sign-off process
• The Practice Supervisor or a nominated Practice Assessor
• The Education Institution – this would usually be through evidence of completion of a programme of education (for example a copy of the Postgraduate Diploma in Advanced Practice and/or academic transcript)

STEP 1

The trainee ANP will develop a share pack of evidence within the ePortfolio which meets the requirements of final sign-off. 

STEP 2

The tANPs manager sets a date for the tANP to submit the ‘Share Pack’ and shares this with the Practice Assessor. Both would be expected to review the portfolio and confirm it meets the criteria for final sign-off. As a minimum the following is expected:

• Record of their learning including clinical experience as a trainee.
  • A minimum of 400 hours of supervised practice[1] over a minimum of 1 year
  • Evidence of learning[2] covering the following areas:
    • Clinical assessment
    • Clinical reasoning, judgement and diagnostic decision making
    • Anatomy and physiology
    • Non-medical prescribing
    • Leading, delivering and evaluating care
    • Worked based learning
  • Completion of all academic requirements (record of all modules undertake, including copies of transcripts to evidence results and a copy of their final exit award certificate).
    • Copy of a masters level qualification in advanced practice (or evidence of equivalence [this would normally be 120 credits with a minimum of 50% at masters level).
    • Evidence of being recorded with the NMC as a Nurse Independent Prescriber
    • Evidence of being recorded with Health Board as a Prescriber
  • Completed competencies – The competency framework should be completed and mapped to evidence within the ePortfolio.
  • A range of Work Based Practical Assessments[3] demonstrating competence is managing the broad range of patients seen within the role. This is likely to include:
    • Mini-CEX (min 6)
    • DOPS (min 2)
    • Case Based Discussions (min 10)
  • Reflective Accounts (min 10)
  • Evidence that a broad range of patients has been seen (e.g. an anonymised patient log)
  • Feedback from others (min 4 different people)
  • Satisfactory Practice Assessor reports which confirm the trainee has completed training and has been assessed as competent performing as an ANP

STEP 3

The Practice Assessor and Line Manager will together determine whether the trainee has:

• Passed – Satisfactorily passed all academic requirements and evidence of competence to practice in ANP role contained within ePortfolio.
• Provisional pass – satisfactorily passed all academic requirements, but some minor gaps in evidence of competence.
• Fail – either has still to pass all academic requirements or has major gaps in evidence of competence or both.

STEP 4

If the trainee has passed, the line manager would complete the final sign off form. The trainee will upload and add this to the share pack and forward the  completed share  pack to advancedpractice@ggc.scot.nhs.uk for internal moderation.

If the internal moderator agrees that the portfolio meets all of the requirements then the trainee, employed as Band 7 Annex 21 or Band 6, would be expected to move to a Band 7 at this stage. 

If a provisional pass by either line manager or internal moderator, the line manager would set a period of time (no less than 1 month and usually no-more than 6 months) for the individual to obtain the required evidence.

Trainees employed as Band 7 Annex 21 or band 6 would not normally move until competence has been achieved.

If a fail, the line manager, in consultation with others (which may include the clinical supervisor, education supervisor and Human Resources) the most appropriate course of action for the individual. This may include re-doing part of the training or termination of the traineeship.

If the Practice Assessor and Line Manager cannot agree on a grade the view of the internal moderator should be sought.

STEP 5

As part of quality assurance, it is current practice in NHSGGC for all share packs submitted for final sign-off to be internally moderated by an Advanced Practice Lecturer Practitioner.

STEP 6

A sample of portfolios will be externally moderated each year via the Advanced Practice Academy. This mechanism will involve a suitable expert from another Board reviewing ePortfolios and providing feedback to the line manager, the Board Advanced Practice Lead and the Board Nurse Director.

External Experts will be recorded within their employing Board as an ANP or NMAHP Consultant and either have teaching and assessing qualification or be recognised by the Academy as an ‘External Expert’.

The Academy’s recommendations will be advisory only. Ultimately it will be for the employer to determine whether an individual has met all the requirements to practice.

[1] Supervised practice may involve direct supervision where the supervisor is physically present with the trainee or indirect where supervision is provided at a distance or delegated to another clinician

[2] This may include formal academic modules/courses, clinical courses, eLearning, reflection

[3] Individual specialist areas may require higher numbers that specified here

Final Sign off documentation

Click here to see the ‘Final Sign-off’ documentation that the line manager and supervisor in practice will use to assess the ePortfolio.

Example of an ePortfolio share pack

Please click on the link below to see a dummy ePortfolio for a trainee ANP. In this portfolio you’ll see evidence being gathered to meet the requirements for final sign-off.

Please note the numbering system and ordering being used to make it easier for a reviewer to find the evidence.

Abbreviations used:

MCEX – mini-CEX

DOPS – Direct Observation of Procedural Skill (DOPS)

CBD – Case Based Discussion (CbD)

REF – Reflective Account

FFO – Feedback from Others

SPR – Supervisor in Practice Report

Professional Portfolio – View Share Pack (nhs.scot)

Please note this is ePortfolio is provided as a sample and do not scrutinise the evidence provided, it is indicative of whats required.