Advanced Nurse Practitioners are Registered Nurses who have done extra training and academic qualifications to be able to examine, assess, make diagnoses, treat, prescribe and make referrals for patients who present with undiagnosed/undifferentiated problems.
My day starts at 8.30am when I switch on my computer followed by a quick trip into reception to check whether any of our patients have needed to contact the Out of Hours Service overnight and to arrange any follow up from those contacts. My first appointment is at 8.45am and my morning surgery continues until 11.30 am. My main role is first contact consultations i.e health matters that the patient feels has to be seen today such as acute illnesses like coughs, colds, sore throats, minor injuries, aches/pains but I can manage most patient problems presented which can be complicated with some long term health conditions such as diabetes or COPD. Occasionally I ask the doctors to give some advice in my consultations and sometimes I will make a patient an appointment with one of the doctors when I am unsure of the problems and how it should be managed/treated.
At 11.30am I often have a list of telephone calls to make where patients have a clinical or medication query that cannot be answered by our reception staff. I cannot promise to return calls before 11.30 am as often my surgery appointments are completely full. If you request a phone call please make sure that you are available for me to ring back as quite often I only get answer phones or engaged signals.
After surgery and phone calls are finished I check my various electronic in boxes for laboratory results and clinical letters and annotate them with any further actions required so reception staff can tell the patients when they ring in for the results. I will try and complete any referrals to hospitals/outside agencies and sign routine prescriptions before lunch at 1pm. I will also check my e- mails and send replies. The period before lunch is also the time I catch up with my Practice Nurse and HCA colleagues and help them with any clinical or organisational problems as I am their line manager and clinical supervisor.
Two afternoons a week are spent supporting the health of the residents at a local nursing home who have multiple physical and mental health needs. I visit the home, see anyone who is unwell that day and undertake a full health review of each resident every 6 months with a rolling programme of reviews. When I return to the surgery I make notes in the patient records, do any prescriptions that may be required and write referral letters for the patients seen that day.
My other work includes reviewing the needs of our older patients following up on the questionnaires we send out to the over 75’s and arranging the annual review of anyone with a diagnosed learning disability. I lead the practice’s work regarding osteoporosis and this includes reviewing the causes and follow up of older people who may have had a fracture, arranging scans and possibly medication to strengthen bones, if required. I also try to keep my clinical colleagues informed of any new research or changes in treatments for osteoporosis.
Some lunchtimes are taken up with professional meetings such as the Advanced Nurse Practitioners/Nurse Clinicians forum (there are more than 20 nurses working at an advance level in local primary care services), the Non- Medical Prescriber’s meeting or the Nursing Home Network meeting. The Primary Health Care Team, which includes Doctors, District Nurses, Health Visitors, Macmillan Nurses and Community Matron also meet formally once a month. Working lunches are a good way of using time effectively but are not always good for the digestion!
In the afternoons, if not at the nursing home, I have a surgery from 2-5pm. I have 15 minute appointments in all my surgeries, which is about the right length of time and I don’t often run very late but this can happen when someone needs more time for some problems. It is a very busy and hectic day, which is sometimes stressful but mostly very satisfying.
Mrs Nicola Wallace
Advanced Nurse Practitioner
