Advanced Neonatal Nurse Practitioners (ANNPs)

1. Advanced Neonatal Nurse Practitioners (ANNPs) Neonatal Unit, Queen’s Park Hospital Joanne Gent, Andy Grady , Jack Best

2. Introduction • History of ANNPs • ANNP Training • Entry requirements • Course contents • The role of the ANNP in Blackburn • Clinical procedures • SHO / ANNP timeshare! • The team ANNPs

3. History of ANNPs • USA: Certification began in 1983 • Reason: an expected shortfall in medical staff • UK: First course approved in 1992 • Southampton University - ENB A19 • Reason: increase & maintain quality of care available to neonates ANNPs

4. History of ANNPs in Blackburn • 1997 – desire to provide holistic nursing care & retain experienced nurses in the clinical field – 1 nurse seconded • 2001 – need to reduce no. of GP trainees – 1 nurse seconded • 2003 – EWTD – 2 nurses seconded • 2004 – establishing ANNP team – 1 nurse seconded, recruiting more ANNPs

5. Course Entry Requirements • Current registration with NMC • ENB 997/8 or equivalent • ENB 405 or equivalent • Minimum 4 years neonatal experience • Undertake 12 week pre-course biomedical science learning package • Pass MCQ entrance exam & interview ANNPs

6. ANNP Course • 15wk intensive theory = 3yr pre-med(biochemistry, physiology, embryology, pathology, radiology, pharmacology) • Exams – MCQs, short answers & essay @ 18, 23 and 37 weeks • Continuous clinical assessment & competency evaluations • Viva voce @ 52 weeks • ANNP certification (+6m for dissertation) ANNPs

7. Role of ANNPs in Blackburn (1) • NICU based practitioners • Work alongside and support SHOs • Attend high risk deliveries & emergencies on CDS and in theatre • Ongoing medical management • Attend postnatal wards for reviews and emergencies ANNPs

8. Role ANNPs in Blackburn (2) • SHO induction, support & guidance • Link person between medical & nursing staff • Promote evidence based medicine / best practice • Teaching • Guidelines & protocols • Audit • Research ANNPs

9. Clinical Skills (1) • Advanced resuscitation of newborn • Examination of the newborn • IV cannulation / venepuncture • Arterial cannulation / stabs • CBG sampling & interpretation • Intubation • Initiation & management of ventilation • Surfactant administration ANNPs

10. Clinical Skills (2) • Insertion of UACs / UVCs • Insertion of percutaneous central lines • Lumbar punctures • Supra-pubic bladder aspirations • Insertion of chest drains / needle aspiration • Ordering laboratory investigations &x-rays and interpretation of results ANNPs

11. SHO / ANNP Timeshare • Need for all to acquire & maintain skills • Mon – Fri: 0830 – 1630NICU SHO ‘in charge’, ANNP supports401 bleep held by PN ward SHO • Mon – Fri: 1630 – 2045401 bleep held by ANNP • Sat – Sun: 0830 – 2100ANNP ‘in charge’ on NICUSHO goes to PN ward & holds 401 bleep ANNPs

12. The Team…so far Joanne Gent RGN ANNP Andy Grady RGN, RM ANNP Jack Best RSCN ANNP ANNPs

13. Any Questions?

14. Example Entrance Exam Questions True or false ? • The metabolism of glucose (C6H12O6) to CO2 and H2O is an example of a catabolic reaction • In double stranded DNA guanine and cytosine are complementary base pairs • All vitamins are easily dissolved in water • Sucrose can be hydrolysed into two glucose molecules • A hexose monosaccharide has six carbon atoms ANNPs

15. Example Wk18 Exam Questions • True or false as before • Explain the ionic basis for the generation of nerve action potentials and the mechanisms by which they are transmitted along unmyelinated and myelinated nerves • Write short notes on ventilation perfusion matching • A 6 hour old full term infant has been found to be cyanosed by the ward midwife. Briefly describe how physical examination might help in determining the cause ANNPs

16. Example Wk23 Exam Questions • True or false questions • Outline the histology of the conducting airways. How does this differ from the histology of the alveolar sacs? • Describe the control of cardiac output • Using protein as an example differentiate between oral and renal solute load • Write short notes on the causes of anaemia in the first month of life ANNPs

17. Example Wk37 Exam Questions • True or false questions • A 28/40 baby is noted to have signs suggestive of a PDA at 1 wk of age. Describe the characteristic clinical features of the condition in such a baby and explain their pathophysiological basis. Give an account of the investigations which may be used and outline the strengths and weaknesses of the therapeutic options • Describe the structure of the mononuclear phagocyte system and briefly explain its function ANNPs