Where are all the paediatric advanced nurse practitioners?

The role of children's nurses should be recognised as pivotal to general practice

The role of children's nurses should be recognised as pivotal to general practice

General practice nurses have frequent contact with children, but often no formal
qualification. Picture: Neil O'Connor

Since qualifying as a registered children’s nurse in 2002, I have had a varied and stimulating career. I have worked on general children’s wards and emergency departments (EDs) in differing cities and towns. In 2009 I had the opportunity to do a master's degree in advanced practice alongside an emergency nurse practitioner course. These two components paved my career path.

While undertaking the master's I moved from a children’s tertiary centre to a district general hospital so that I could complete the emergency nurse practitioner programme with competencies specific to children and adults. I had a fantastic few years working as a paediatric advanced nurse practitioner (PANP) in the ED of a large city centre hospital but I felt that, while I had worked in secondary and tertiary care, I had not experienced the role of an advanced nurse practitioner (ANP) in primary care. 

Avoidable ED attendances

I moved post in 2015 to gain some experience in a general practitioner service. I was aware, anecdotally, from my role in the ED that children were attending with minor illnesses that could have been managed in primary care. The RCN published a self-assessment tool in 2017 for general practice nurses and those in other first-contact settings providing care for children and young people to ensure all staff caring for these patients can meet their needs. In general practice services, the practitioner will often have experience with children and young people but may not have a formal qualification. Yet primary care provides precious chances for issues to be identified – whether physical or mental health – and for the best interests of the child or young person to be acted on.  

'My audit found the paediatric advanced nurse practitioner role contributed to a reduction in acute paediatric referrals of 36%'

After being in post for two years I decided to audit the general practice surgery on the acute paediatric referrals made to the district general hospital before my employment and eight months post-employment. The audit of the first period – between April and December 2015 – found 67 acute on-the-day referrals of children aged from birth to 16 years. The subsequent audit, covering April to December 2016, identified 43 such referrals.

All of the PANP referrals were deemed ‘unavoidable’, however there was discrepancy with other clinicians, which included GPs and ANPs with a qualification in adult nursing.  Patients were accepted by the district general hospital for paediatric review for conditions including respiratory – predominantly bronchiolitis and asthma, gastroenterology, urinary tract infections, tonsillitis and surgical issues. Of these patients, the average length of hospital stay was one day. Although it is difficult retrospectively to assess whether all of the admissions were appropriate, some conditions did not require immediate assessment by a paediatrician. These included reflux, milk allergy, general non-life-threatening allergies, non-blanching rashes above the nipple line in well children and hip pain in children under five years. Overall, the audit found that the PANP role contributed to the practice achieving a reduction in acute paediatric referrals of 36%.

Improving long-term outcomes

PANPs are part of the wider multidisciplinary team and have a vital role in promoting and improving the health and long-term outcomes of children and young people. In the GP service, the role of PANPs is in line with the RCN's 2012 guidance in that they provide complete episodes of care for paediatric patients with diverse healthcare needs including acute episodes, chronic conditions, health promotion and public health.

There are times when the PANP will refer to specialist healthcare professionals and work collaboratively with multi-agencies. The Royal College of General Practitioners estimated in 2010 that 25% of a general practice population are children and young people, therefore it is important to have clinicians with children’s qualifications available. 

The audit demonstrated the value of a PANP. With nursing continuing to evolve and the UK population increasing, now is the time for registered children’s nurses to play a pivotal role in general practice.

The author, who wishes to remain anonymous, practises in the West Midlands

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