DEPARTMENT OF NURSING
St. Vincent’s University Hospital
Annual Review 2005
Philosophy, Mission and Values of the Hospital
Philosophy
The philosophy of St Vincent’s Healthcare Group is based on
that of the Religious Sisters of Charity. The principles are
observed in the treatment and care of patients, in dealings with
staff and are based on the core values.
Mission
We strive for excellence in meeting the holistic needs of our
patients in a caring and healing environment in which the
essential contribution of each member of staff is valued.
Values
The values of human dignity, compassion, justice, quality and
advocacy rooted in the mission and philosophy of the Religious
Sisters of Charity guide us in our work.
We will, within the foregoing context, make every effort to
maintain excellence in clinical care, teaching and research.
Comh mheas, comh bhá, comh phártíocht agus comh oibre
bunsraith ár gcuid saothar uile.
Core Values
Human Dignity
Compassion
Justice
Quality
Advocacy
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Table of Contents
1
INTRODUCTION ............................................................... 7
2
SERVICE DEVELOPMENTS ........................................... 8
3
NURSING PRACTICE ..................................................... 10
4
BED MANAGEMENT ...................................................... 12
5
NURSE EDUCATION ...................................................... 13
5.1 NURSE EDUCATION CENTRE .......................................... 14
5.2 NURSE PRACTICE DEVELOPMENT .................................. 15
5.3 CONFERENCE PRESENTATIONS ...................................... 16
5.4 CONFERENCES HOSTED IN ST. VINCENT’S UNIVERSITY
HOSPITAL ................................................................................ 19
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HUMAN RESOURCES .................................................... 20
6.1
6.2
6.3
WORKFORCE PLAN......................................................... 20
NURSING STRUCTURES .................................................. 23
RETIREMENTS................................................................. 23
7
FUTURE DEVELOPMENTS .......................................... 23
8
CONCLUSION .................................................................. 25
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Forward
Welcome to this our first annual nursing review for St.
Vincent’s University Hospital. This publication gives us the
opportunity to share some of our many achievements throughout
2005 and celebrate nursing’s contribution to patient care.
The Annual Review for the Nursing Department encompasses
the contributions of all Nurses, Healthcare Assistants, Ward
Orderlies, Ward Secretaries and the Nursing student population.
In preparing for this report I have taken the opportunity to
reflect on my first year in St Vincent’s University Hospital. I
took up my position in January 2005 following my tenure as
Director of Nursing and Midwifery Services in Our Lady of
Lourdes Hospital, Drogheda. I am most impressed with how the
mission and values of the Religious Sisters of Charity are
evident in all aspects of care provided to patients and their
families.
I would like to take this opportunity to express my gratitude to
all those who made me feel so welcome here in the Healthcare
Group. I extend my personal thanks to the Religious Sisters of
Charity, Board of Directors, Group CEO and colleagues on the
Group Executive team, for their support and help.
I acknowledge the support received from the senior nurse
managers and I would like to thank them for their leadership and
professionalism throughout the year.
I am very proud of the fact that I lead such a dynamic and
committed team of professional staff within the Nursing
Department. Once again I thank them for all they do to ensure
patients receive holistic care in a healing compassionate and
safe environment.
Mary Duff
Director of Nursing
May 2006
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1 Introduction
Despite the many challenges faced by all nursing teams
throughout the hospital we are very pleased to report that
patients continued to receive high quality nursing care.
This was only possible through staff’s commitment towards
innovative and creative approaches to the delivery of patient
care and education programmes.
We look forward to the successful transition of services to the
new development throughout 2006. The preparatory work for
the transfer of services continued throughout the year and many
senior nurse managers and their staff were involved in the
development of standard operational policies. We wish the team
in the Emergency Department every success as the first transfer
to the new building and wish all the remaining teams every
success in planning subsequent transfers.
Emergency Department Staff Prepare for the Opening of the New Department
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Work continued on implementing quality improvement plans
following the outcome of the Irish Health Service Accreditation
Board’s survey in preparation for the mid cycle review in early
2006.
Nursing teams are to be commended for their
commitment and contribution to all aspects of risk management
throughout the hospital.
2 Service Developments
The Department of Mental Health moved into the new Elm
Mount Unit and the services of St. Vincent’s University
Hospital merged with the HSE Mental Health Services in Area
Two. The feedback from both clients and staff was most
positive and the implementation of full integration of the
services is ongoing.
A Clinical Decision Unit (CDU) for the Emergency Department
was established in July to provide an effective and safe
alternative to inpatient admission for patients who require shortterm diagnostic or therapeutic intervention.
A Rapid Assessment Treatment (RAT) service staffed by senior
nursing and medical personnel, for patients attending the
Emergency Department was introduced. This service provides
an opportunity to enhance the scope of practice for emergency
nursing, with a view in the future, to the development of a nurse
led service.
The infrastructural work for the development of a six-bedded
unit in St. Johns Ward was completed. The new service provides
accommodation for patients with respiratory failure requiring
Non-invasive Ventilation (NIV). The initiative contributes to
the enhancement of multidisciplinary teamwork, which will
result in improved patient outcomes.
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An education programme for patients with Type 1 Diabetes
(The Daphne Programme) was launched in November 2005.
This focuses on self-insulin adjustment based on diet and
lifestyle, addressing quality of life issues and empowering
patients to manage their own diabetes/ health.
Access to the Tissue Viability service was enhanced with the
introduction of a formalised consultation process. This enables
nurses to evaluate the success or failure of intervention and
provides a mechanism for wound surveillance. Wound cleansing
guidelines were also introduced for use across the hospital.
The Cardiac Rehabilitation team developed patient information
booklets on discharge advice for patients post angioplasty and
myocardial infarction
The Biologic Clinic was established for arthritis patients
receiving specialised medication and is staffed by medical staff
and Clinical Nurse Specialists in the Department of
Rheumatology. This type of treatment further enhances the
quality of life for patients.
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3 Nursing Practice
An extensive policy document on the Administration of
Intravenous Medications by Nurses was prepared, by the IV
Policy Working Group and approved by the Group Drugs and
Therapeutics Committee and Medical Executive. This policy
provides for the administration of first dose of IV medications
by nursing staff, thus expanding their scope of practice, and
ensuring more timely delivery of medications to individual
patients. A policy for the administration of intravenous opiates
in the Post Anaesthetic Care Unit was also introduced.
The Clinical Nurse Specialists in Palliative Care led the pilot
study of the Liverpool Care Pathway for the dying patient,
which is unique to the Irish healthcare system. A project
facilitator was appointed in anticipation of its role out to the
hospital and the Healthcare Group.
The Clinical Nurse Specialists in Infection Control introduced
an Infection Control Link Nurse system of care.
This
programme enables nurses to create and maintain an
environment, which will ensure safety of the patient, relatives,
and healthcare workers using infection control knowledge
appropriate to the situation. The nurse managers and their
nursing teams were instrumental in reviewing infection control
standards at ward/unit levels in preparation for the first Hygiene
Audit undertaken by the Health Services Executive. The
outcome was positive for the hospital and provided reassurance
for users of the services provided. The result created the
motivation to continue to improve the quality of the hygiene
services at all levels within the organisation.
As part of a multidisciplinary initiative led by the Nutrition
Committee protected meal and rest times were introduced on a
pilot basis in Our Lady’s and St. Josephs Wards. The aim of
this initiative is to ensure that patients receive appropriate
assistance at mealtimes and only appropriate interruptions are
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made during this time. It is planned that following evaluation
this quality improvement will be extended to all patients.
A new step to the clinical career pathway for nursing has been
established within the Healthcare Group with the appointment of
the first Advanced Nurse Practitioner (ANP). The National
Council for the Professional Development of Nursing and
Midwifery approved Ms Mary Murray as the first Advanced
Nurse Practitioner in Breast Care in Ireland.
An
interdisciplinary project group was established to lead on the
development of further ANP services focusing; heart failure,
stroke care, eating disorders, dermatology, and chest pain
evaluation.
Mary Murray Advanced Nurse Practitioner (ANP) Breast Care
A most welcome development for patients was the introduction
of a Clinical Nurse Specialist service for people with
Parkinson’s disease. This new service will have a strong patient
focus: providing direct and indirect clinical care; access to
expert knowledge and advice; along with education and service
evaluation.
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In response to an increasing demand for renal replacement
therapy a second Clinical Nurse Specialist for Continuous
Ambulatory Peritoneal Dialysis (CAPD) was appointed.
4 Bed Management
Nurses continued to play a very important role in leading and
managing the complex task of optimising the use of beds and
responding to the increased demand on the overall bed capacity
within the hospital. There was sustained pressure on the limited
number of ICU beds in the hospital with the requirement to
establish a temporary emergency bed in the Post-Anaesthesia
Care Unit on 49 occasions during the year. Increased acuity
level of patients placed additional pressure on the need to access
inpatient beds more speedily. We acknowledge the tremendous
support and good will demonstrated by all clinical managers and
their staff in responding to the difficult and challenging
situations.
The admission discharge and escalation policy was reviewed,
updated and widely circulated.
A number of initiatives were introduced to address the
increasing number of patients in the Emergency Department and
those on urgent waiting lists: they are as follows.
 Nine beds were opened in St. Camillus’s Ward to cater for
medical admissions.
 A discharge lounge was created to facilitate optimum use
of inpatient beds. Discharged patients awaiting collection
are accommodated in a designated area on the ground
floor.
 An initiative was undertaken in partnership with St
Vincent’s Private Hospital during the summer months
whereby beds were made available to public patients to
assist the team in St Catherine’s Ward, in reducing
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medical and surgical waiting lists. The outcome was very
positive for both patients and staff concerned.
An action plan for the reduction of the liver biopsy waiting
list was devised and implemented. A waiting list of 46
was reduced to 4 by the end of December 2005.
To improve bed utilisation a pilot project of Out-patient
Assessment (OPA) was introduced by the Liver Transplant
Coordinators in April. As a result 65% of patient
assessments were managed by the co-ordinators as day
attendees.
A team from theatre led by the Chair of Anaesthetics and
the Divisional Nurse Manager established a chronic pain
programme in St Michael’s Hospital. This initiative
achieved a significant reduction in the number of patients
waiting for treatment
During the year ward beds were reopened in the
refurbished area of St. Brigid’s Ward and HDU beds were
opened to accelerate transfer of patient from ICU post liver
transplant and provide access for liver related surgery.
An intermediate care service was introduced in
conjunction with the Health Services Executive for
patients whose acute phase of treatment had been
completed and were certified medically fit for discharge
from the acute Hospital.
5 Nurse Education
Education continues to be a given the highest priority. The
nursing departments aim of fostering an environment of
personal growth and professional development was facilitated
though the continued implementation of policy to provide paid
study leave and financial assistance with academic fees. This
aim was realised through the generosity of clinical staff in
sharing their expertise with all learners.
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5.1 Nurse Education Centre
The Director and her team in the Centre of Nurse Education
provide and organise continuing education and professional
development programmes for nurses, and health care personnel
working in St Vincent’s Healthcare Group and the East Coast
Area.
The Nursing Graduation ceremony marked the end of the
Undergraduate Diploma programme and fifty-nine graduates
received their hospital badges. Special awards were also made
to seven nurses for their nursing achievements.
5.1.1 Post Registration Nurse Education
The Post Registration Nurse Tutor is a member of the Centre for
Nurse Education staff and her principal focus is the planning
and co-ordination of the Higher Diploma in Nursing Studies
programmes, which are run in conjunction with School of
Nursing & Midwifery, University College Dublin and partner
hospitals. The first year of the new Higher Diploma in
Gastroenterology Nursing commenced in September.
University College Dublin will be introducing modularisation
for post-graduate nursing students next year. While a most
welcome development for students and academic progression,
this change will present some challenges for the clinical areas. It
is most important that the current emphasis on clinical
competency is maintained in any changes introduced and every
effort will be made to continue to work in collaboration with the
academic staff to ensure that this happens.
5.1.2 Continuing Education
The Centre continued to provide a wide range of education and
training programmes including; staff orientation; intravenous
policy; reflective practice, assessing student learning and
preceptorship. A leadership programme titled Leading an
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Empowered Organisation (LEO) commenced in October 2005
for nurses from all organisations within the East Coast Area. A
total of ten healthcare assistants undertook the FETAC level 5
Healthcare Support Certificate.
5.2 Nurse Practice Development
We acknowledge the work of the Nurse Practice Development
team and clinical staff in the development of evidenced based
policies, procedures and guidelines that underpin nursing
throughout the hospital. It is not possible to list all in this report
however a comprehensive index can be located in each clinical
area.
The process of introducing amended and new nursing care plan
documentation commenced following wide consultation with
clinical staff.
A new innovative Management Development Programme for
CNM1s using action-learning sets was rolled out across the St.
Vincent’s University Hospital.
Third year BSc Nursing Students were on rostered placement
for the first time as members of the nursing team augmenting
their clinical experience while being supported by working with
formally prepared preceptors. This “internship” is a strong
aspect of the new degree programme that aims to marry the best
of traditional nurse training with an academic qualification. The
4th year of the BSc in Nursing (General) commenced in
September and it marked the first year that all four years of the
programme were fully operational; with a total allocation of 260
general nursing students.
A journal club for pre-registration overseas nurses was
established in February with the aim of supporting and helping
new nurses with their integration into the Irish healthcare
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setting. The benefit of peer support generated from the weekly
meetings had a very positive outcome for all the participants.
5.3 Conference Presentations
We congratulate staff that represented the hospital by presenting
and sharing their work at national and international conferences.
The following gives a sample of the ongoing commitment to
professional development, research and service advancement.
 Advanced Practice in Oncology Nursing. Paper
presentation by Mary Murray, at Dublin City University,
Dublin.
 Bringing it all Together. Poster presentation by the
Clinical Placement Coordinators on an aspect of the BSc
in Nursing rostered service at the National Council for the
Professional Development of Nursing and Midwifery
Annual Conference, Dublin.
 Competencies and Teaching Tools for Stoma Care. Paper
presented by Grace McEvoy, at Hollister International
Nursing Day, Dublin.
 Evaluation of a risk assessment tool for the prediction of
falls in an acute hospital setting. Paper presentation by
Imelda Noone, and MaryAnn Furigay, at the Irish
Gerontological Society Conference, Dublin.
 Liver Transplantation for Alcohol related Liver Disease.
Paper presented by Jennifer Fleming at the National
Transplant Coordinators Meeting, Newry.
 Liver Transplantation. Paper presented by Aoife Coffey at
the Consultative Council Information Day, Dublin Castle.
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 Liver Transplantation. Paper presented by Jennifer
Fleming at National Link Nurses Organ Donation
Meeting, Red Cow, Dublin.
 Liverpool Care Pathway: Our Experience of Establishing
a Care of the Dying Project in a University Teaching
Hospital, Poster presented at the 3rd Annual National LCP
Conference, London.
 Mortality, length of stay and discharge destination of
stroke patients: A comparative study. Poster presentation
by Imelda Noone at the Irish Gerontological Society
Conference, Dublin.
 Nurse Led Clinics. Paper presentation by Mary Murray at
M&K Updates Conference Malahide, Dublin.
 Nurse Specialists in Breast Care. Poster presentation by
Mary Murray, at the National Council for the Professional
Development of Nursing and Midwifery Annual
Conference, Dublin.
 Nurses’ perspectives on quality of care provided for dying
patients in an acute hospital setting- questionnaire study.
Poster presented by, Pallitative Care Multidisciplinary
Team at the 3rd Annual National Liverpool Care Pathway
Conference, London.
 Opening Address given by Mary Murray at Irish Breast
Care Nurses Association Annual Conference. Four
Seasons Hotel, Dublin.
 Osteoporosis and Evidence Base for Practice. Paper
presented by Susan Van der Kamp at, the Annual Age
Related Nursing Conference, Adelaide and Meath
Hospital, Dublin incorporating the National Children’s
Hospital.
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 Perspective study on ambulatory blood pressure in
haemodialysis. Poster presentation by Martina Kiely,
Michele M Quaid, Frank Kelly and Alan Watson at the
European Dialysis Transplant Nephrology Association
(EDTNA), Vienna.
 Protected Meal Times. Paper presented by Siobhan
Stewart at the Irish Nursing and Midwifery Practice
Development Association Conference, Galway.
 Rapid Assessment Treatment (RAT) Reorganisation of
Services within the Emergency Department. Paper
presentation by Margaret Boland and Alan Doyle at the
National Irish Society for Quality and Safety in Health
Care Conference, in Croke Park, Dublin.
 Stoma Care Nursing in Ireland Today. Paper presentation
by Nicola McLoughlin, at Hollister International Nursing
Day, Dublin.
 Stroke risk factor management: A comparative study.
Poster presentation by Imelda Noone, at the Irish
Gerontological Society Conference, Dublin.
 Survey of Bereaved Relatives of Patients who Died in an
Acute General Hospital setting. Poster presented by the
Palliative Care Multidisciplinary Team at 3rd Annual
National LCP Conference, London.
 The Acutely Ill Dermatology Patient. Paper presented by
Sheila Ryan at the Irish Dermatology Nurses Association
Meeting, Dublin.
 The Development of a Nurse Led Bone Densitometery
Service. Paper presented by Susan Van der Kamp, at the
Royal College of Nursing Rheumatology Nursing Forum
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and Irish Rheumatology Nursing Forum combined
Conference, Dublin.
 The Outcome of Stroke in the Very Old. Poster
presentation by Imelda Noone, at the Irish Gerontological
Society Conference, Dublin.
 Van der Kamp, S. (2005) Osteoporosis, Irish Practice
Nurses Journal.
 Working Backs Programme. Poster presented by the
Occupational Health Team on in conjunction with
Catriona Cunningham UCD at the International
Conference of Health Promoting Hospitals, Dublin.
We commend all who presented on behalf of the St. Vincent’s
University Hospital.
We congratulate Imelda Noone Clinical Nurse Specialist on her
appointment to the Irish Gerontological Society Executive
Committee.
5.4 Conferences hosted in St. Vincent’s University
Hospital
 The first Critical Care Nursing Conference was held in
February with over 80 participants from within the group
and across the country.
 The third Hepatology Nursing Study Day was hosted in
March with the focus on cirrhosis; particularly
Haemochromatosis, Primary Billary Cirrhosis and alcohol
related liver disease.
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6 Human Resources
We welcome all new staff who started during 2005, we wish
them success and fulfilment during their career at St. Vincent’s
University Hospital.
6.1 Workforce Plan
Changes in the undergraduate education programme for nursing
students resulted in having no graduates available for service
this year. This impacted significantly on the workload of the
team in Human Resources (Nursing) with a subsequent increase
in national and international recruitment. Over 170 new staff
were recruited and 26 staff members were promoted within the
organisation.
A workforce plan was developed to proactively manage the
deficit in availability of nursing graduates and a number of
initiatives were introduced which resulted in the avoidance of
disruption to service delivery. These initiatives include:
 The eighteen-month rotation programme offering newly
qualified nurses the opportunity to gain six months
experience in medicine, surgery and a specialist area was
implemented with a view to providing career development
and retention of staff.
 A total of five orientation and induction programmes for
overseas nurses were conducted throughout the year,
facilitating a total of 131 nurses from India, Philippines
and Singapore. This almost doubled the overseas intake for
2004.
Employees of external private / voluntary
organisations were also facilitated for their adaptation and
assessment placement.
 Creative approaches to the provision of flexible working
arrangements continue to allow nursing staff to achieve a
balance between their work and private life.
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The first phase of the new Human Resource information system
Wiztec was introduced. This system when fully implemented
will provide timely information and the nursing department
welcomes it’s potential for improving the efficiency and
effectiveness of this service.
A project group was established to implement the
recommendations of an internal audit on processes for
contracting agency nurses. Ongoing recruitment assisted in
reducing the requirement for agency staff to be employed.
However there continued to be a need to provide staff due to:
unplanned opening of beds; increased use of nurse / healthcare
assistant specials; workload in the emergency department; and
constraints of the staff ceiling; resulted in a requirement to
continue to contract agency staff along with the overtime
through the bank nursing system.
Registration at the Open Day for Nurses September 2006
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6.1.1 Open Day for Nurses
A successful Open Day was held to recruit registered nurses, an
intensive media campaign and the development of a suite of
information leaflets resulted in 103 nurses attending on the day.
Staff promoting Cardiology and Respiratory Nursing at the Nurses Open Day
Attendants at the Nurses Open Day, September 2006.
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6.2 Nursing Structures
Following a series of workshops with senior nurse managers the
organisational structure for nursing was reviewed in
consultation with senior nurse management. This ensures that
the structure “fits” within the future strategic direction of the
organisation and the HSE East Coast.
6.3 Retirements
During the year Ms. Mary Murphy, Out of Hours CMN 3, Ms.
Louise Hederman CNM2 and Ms. Colette Kingston, CNM2
retired after a long and committed service to the organisation.
We wish them and all who retired in 2005 good health and
happiness during their retirement.
7 Future Developments
The Department of Nursing is committed to the provision of
high quality nursing service through the continued provision of
evidenced based nursing care and support for professional
development.
We look forward to the implementation of new initiatives in
2006 as outlined below and their contribution to patient care:
 Continue to work towards the standardisation of nursing
practice within the Healthcare Group.
 The establishment of a pre-dialysis renal service, which
will be based at the outpatient level and will assist in the
identification of patients who may progress to require
renal replacement therapy.
 The creation of Nurse led specialist services in
Rheumatology and Dermatology.
 Accreditation of Advanced Nurse Practitioner posts in
Stroke Care, Chest Pain Evaluation, Dermatology and
Health Failure.
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 Implementation of education and training initiatives
funded by the National Council for the Development of
Nursing and Midwifery, among these are: an emergency
nursing skills programme; programme to support and
enhance the role of Clinical Nurse Specialists; and meeting
skills workshops
 Appointment of project nurse manager to introduce a
multidisciplinary critical care outreach service for patients
discharged from ICU.
 Launch a number of multidisciplinary policies in areas
such as: care of patients requiring tracheostomy, care of
patients requiring nebuliser therapy and the management
of patients requiring non-invasive ventilation.
 Introduction of the first post-graduate programme in
Ireland for nurses in Stroke Care and Acquired Brain
Injury, in partnership with UCD and other health care
providers in the region.
 Integration of the Human Resources (Nursing) into the HR
Department.
 Introduction of team based performance management.
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8 Conclusion
Our year’s work provides real evidence of the ongoing
commitment to Mother Mary Aikenhead’s vision for patient
care.
The dynamic progressive nature of the nursing team and the
ability to embrace change is celebrated throughout this review.
We acknowledge the enhancement of patient care and nurses’
contribution to the delivery of an efficient and effective service
for all patients in 2005. During this period of change in the
delivery of health care we welcome the transformation arising
from the health services reform programme and look forward to
continuing to work with our colleagues in the Health Service
Executive and the National Hospitals Office.
We extend special thanks to all who have contributed to this
review. We look forward to continuing to work together as a
team in meeting the challenges presented in 2006.
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