Review of Post –Registration Nursing and Midwifery Education
Submission on Behalf of the
Irish Nephrology Nurses Association (INNA)
As we all know renal nursing is both challenging and rewarding; nursing patients
with chronic kidney disease (CKD) from pre dialysis to haemodialysis, peritoneal
dialysis to transplantation and beyond. The renal patient and family members
requires physical, psychological and social support whilst dealing with this chronic
illness. We have an ever increasing amount of patients in Ireland that require renal
replacement therapy to survive. The haemodialysis population in Ireland is projected
to increase by 50% in three years, 100% in six years and 150% by 2014 (Donnellan,
2007). Worldwide, the expanding number of patients with chronic kidney disease
and its associated link with diabetes, cardiovascular, obesity and smoking highlights
the demands for patient education within primary care and the strong need for
effective nursing interventions throughout what ever stage of CKD that the patient is
at.
The National Council for the Professional Development of Nursing (2001) identify that
the specialist nurse should act as a consultant in clinical practice and education to
both nurses and the wider multidisciplinary team. This highlights the evolving nature
of the specialist nurses' role, as one of change agent, management, leadership and
utilising evidence based practice to ensure the attainment of excellence in patient
care. It is, vital, therefore that nurses working within the renal specialist area have
the proficient knowledge, skills, and attitudes to undertake this role.
We currently are awaiting the review of the Renal Strategy which will undoubtedly
highlight the need for a comprehensive expanding efficient service for patients led by
staff that are clinically competent. The clinical expertise of the renal nurse is
currently under utilised. Furthermore, renal nurses are an important resource for
renal services and can be utilised in the establishment of nurse led clinics (such as
chronic kidney disease follow up clinics; anaemia management; access coordination; liaison nurse to facilitate care from paediatric to adult renal services,
liaison with primary health care providers in the follow up of patients in the early
stages of CKD, pre and post operative transplant follow up, and management of
satellite maintenance dialysis units). In light of the rapidly expanding numbers of
patients with CKD it is imperative that renal nurses are at the forefront in the
development and expansion of high quality patient care services in Ireland.
We, therefore, need to continue with the post graduate courses in renal nursing, so,
ensuring that the nursing population caring for renal patients are educated at a post
graduate level. These education programmes will provide the necessary knowledge,
skills, attitudes and clinical experience, so, enabling renal nurses to develop and lead
nurse led renal patient services. There is a need to continue with the partnership
approach between the service providers and the higher education institutes. The post
graduate courses need to be continued to be recognised by An Bord Altranais.
Renal nursing is nurse led in many areas including that of peritoneal dialysis,
haemodialysis, anaemia management, pre-dialysis and transplantation. We have
numerous clinical nurse specialist posts countrywide, however, in order to facilitate
the potential expansion of renal services renal clinical nurse specialist posts need to
be developed further. In addition, Advanced Nurse Practitioner posts in renal care
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also need to be developed for example in haemodialysis. Currently there is only one
candidate to date that is at this advanced level in Ireland. This is a great
educationally opportunity that is being missed at present. In order to effectively
utilise the clinical expertise of the renal nurse there is an urgent need for the
continued development and delivery of post registration renal courses.
These post graduate renal nursing programmes must remain clinically focused with
the assessment of clinical competence that focuses on the acquisition of specialist
competencies and clinical assessments which are carried out throughout the
students’ clinical placements. The students undertaking for example the renal
conjoint programme between Tallaght Hospital and Trinity College conduct four
clinical specialist modules; nephrology nursing, haemodialysis and allied therapies,
peritoneal dialysis nursing and transplantation nursing and two core modules:
research dissemination in clinical practice and health care management and quality
improvement.
There must continue to be strong collaboration and communication between the
service providers and the higher education institutes. There would be a need for an
educational audit of nurses needs within each renal unit countrywide along with a
needs analysis of the service providers. The issue of modularisation and the flexibility
of these courses must be addressed. As we know we have INNA members’ country
wide that may not be able to access renal courses based in Dublin. The modes of
teaching delivery must be explored such as distant learning or video conferencing
whereby the students could undertake their clinical placements within their own
satellite units and nearby tertiary hospital which has been audited by the higher
education institute as renal clinical learning areas and students could conduct their
core modules via distant learning. This would obviously cut down on the commitment
involved for example with commuting. Providing an education programme that
incorporates all facets of renal care is vital as a retention tool so ensuring that nurses
who wish to move can move to other renal units in the country and therefore will not
be lost from renal services area.
In the interest of patient care and nurse education future renal courses should
require the successful completion of the following clinical placements: pre renal,
nephrology, haemodialysis, peritoneal dialysis and transplantation. In addition,
future renal courses need to incorporate content on issues relating to conservative
treatment and palliative care, withdrawal of renal replacement therapy and caring for
the older patient on dialysis. Each HSE area in conjunction with a 3rd Level
institution should provide sufficient places on post graduate courses in renal nursing
to meet the demands of local service.
It can be difficult from a service provider’s perspective to release nurses to
undertake a post graduate programme. There must be a strong commitment from
the HSE to invest more money in post graduate nurse education to allow nurses to
be seconded from the clinical areas and that these numbers are replaced so that
patient care is not compromised. The HSE must promote and encourage education
as it will improve the quality of patient care and improve staff retention.
Furthermore, there is a need for the HSE to standardise study leave for courses.
This review is an ideal opportunity for INNA members to have their voices heard and
to highlight how unique a speciality renal nursing is. There is a continual need to
have a renal nursing education programme that assists our nurses to deal with the
ever increasing challenges in caring for our renal patients.
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Q.1
Indicative list of issues/
questions:
Identify the top 5 principles
that the HSE should adopt in
developing a framework for
Post Registration for Nursing
and Midwifery Education.
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Q.2
Q.3
How might the HSE further
engage with other relevant
parties and stakeholders in the
future
planning
and
development
of
Post
Registration
Nursing
and
Midwifery Education?
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What are the structures or
processes that are needed to
strengthen the relationship
between service provision and
the educational development of
nursing and midwifery staff?
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Service delivery
 Identify gaps in service as
outlined by renal strategy
 Identify post registration renal
educational programmes that will
help address gaps in renal
services
 Renal educational programmes
must contribute to service
delivery and career progression of
the renal nurses for example
development of clinical renal
specialist or advance nurse
practitioners to develop and lead
nurse led renal services
Professional/academic requirements –
must be recognised by An Bord
Altranais and Third level institution
Collaboration between the service
providers and the Higher Education
Institutes.
Relationship between professional
competence & quality of patient care
and safety.
Value for money including
sponsorship arrangements &
monitoring service
Through meetings, discussions, open
forum, former students.
Involving various organisations
including for example nursing and
patient associations.
Recognition by the service providers
that every renal nurse should have a
post graduate education course in
renal nursing.
Recognition of the need to advance
the education of renal nursing
including the existent clinical nurse
specialist posts but also the advanced
renal nurse practitioner posts.
Structures should be put in place to
enable this to happen including
financial arrangements including
secondments, logistics of this,
logistics of releasing a reasonable
amount of staff to undertake the
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Q.4
How should the HSE in
partnership with the Higher
Education Institutes plan for
the future development and
delivery of nursing and
midwifery post-registration
education?
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Q.5
Q.6
How should the HSE procure
and finance the development
and delivery of future
programmes?
Extra questionWhat do you think is the
priority for postgrad
development for general
nursing
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renal course yearly.
Education programmes need to be
recognised by An Bord Altranais and
Third level education institutes
Ascertain the service needs, as we
are all aware the renal services are
ever expanding with more need for
example haemodialysis stations
countrywide.
The continued need that the current
renal nurse courses to be recognised
by An Bord Altranais.
The continued need for a partnership
approach between the staff in the
clinical area and in the higher
education institutes.
Recognition that renal courses need
to be modularised and flexible
Recognition that renal courses need
to facilitate those students who are
unable to access programmes in
major cities through the use of
different modes of teaching delivery
such as distance learning and video
conferencing.
Recognition that renal courses need
to include clinical placement in
following areas:- pre renal,
nephrology, haemodialysis, peritoneal
dialysis, transplantation
Recognition that renal courses need
to incorporate content nursing issues
relating to conservative management
of patients, withdrawal of treatment,
palliative care and caring for aging
population
Identify those institutions that have a
long standing history in the delivery
of post graduate renal education.
That it continues and develops further
into MSc specific programmes for
example the Advanced Nurse
Practitioner in Renal.
The care of the renal patient is so
nurse led, a prime example of this is
in the care of the patient on
peritoneal dialysis, and we have
clinical nurse specialist posts in
anaemia, in pre-dialysis education, in
post transplant. However one such
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development that is missing is that of
the Advanced Nurse Practitioner
positions, we currently have only one
Advanced Nurse Practitioner
Candidate in Renal Nursing and that
is in Sick Children’s.
The area of haemodialysis is so nurse
led and this is an area that can be
expanded upon for future posts.
Q.7
Any ideas for future
postgraduate courses- and
what level
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