Brief Report
Building a Model of Mental Health Nurse Practitioner–led Service Provision in Australia

https://doi.org/10.1016/j.nurpra.2015.01.008Get rights and content

Highlights

  • Mental health liaison nurse (MHLN) services have existed in emergency departments (EDs) in Australia and internationally for many years. However, there is great variation in the way these services are structured, and no standardized model of care has been explicated.

  • In Australia, the added value associated with establishing mental health nurse practitioner positions based on the MHLN model is emerging.

  • This article describes the successful establishment of an extended hours- mental health nurse practitioner–led MHLN service based in the ED of an inner city teaching hospital in Sydney, Australia.

  • Evaluations of the service indicate that a nurse practitioner–led extended-hours MHLN service integrated within the ED team structure provides prompt access to specialized mental health care to people with undifferentiated health problems and removes a significant workload from ED nursing and medical staff.

  • A deliberate process of consultation, evaluation and publication was central to building a model of care that meets the needs of the ED and the public.

Abstract

In Australia, the nurse practitioner (NP) role remains in the early stages of development. The first NP was endorsed in 2000, and in 2014 the Australian College of Nurse Practitioners announced the endorsement of the 1,000th NP. The future challenge is to ensure the continued growth and sustainability of NP models within the local health care system. This brief report documents the research processes and stages involved in establishing a mental health NP-led team based in the emergency department of an inner city teaching hospital in Sydney. Early and ongoing consultation with key stakeholders and a systematic process of evaluation and publication were pivotal to gathering support for the service and constructing a model that meets the needs of patients, clinicians, and the organization.

Section snippets

The Local Context

The Royal Prince Alfred Hospital (RPAH) is an inner city teaching hospital affiliated with the University of Sydney, and the ED is a major trauma center that manages over 75,000 presentations per year. A mental health NP position has been embedded within the ED team for many years and is based on the principles of mental health liaison nursing (MHLN5). Developing this NP role has involved a systematic process of consultation with key stakeholders, evaluation, and publication. The mental health

Implementing an ED-based Mental Health NP Outpatient Service

The scope of the mental health NP role at RPAH was expanded through the establishment of a structured and formalized outpatient service. The mental health NP outpatient service provides an in-house referral service for ED nursing and medical staff and aims to provide prompt follow-up care. The outpatient service represents an extension of the existing mental health NP role and involves individuals who have presented with mental health concerns returning to the ED for consultation based on a

The NP-led Extended-hours MHLN Service Based in the ED

In recognition of the feedback obtained from staff and patients for an expanded MHLN service in the ED at RPAH, the authors acquired a grant from Health Workforce Australia (a federal government–funded body) as part of an Australia-wide program titled “Expanded Scope of Practice for Nurses in EDs.” Funding was provided for 18 months to implement and evaluate a mental health NP-led extended-hours MHLN service and to articulate a model of care that is transferable across a range of ED settings.

Planning Ahead

The specialized skill set of NPs and the in-depth knowledge of the particular health care context that NPs develop requires conscious consideration of how to transfer such knowledge and skills from 1 practitioner to another. Effective succession planning for NP roles is identified as key to promoting safe practice and the long-term survival of NP models.16 A transitional mental health NP role has been introduced to work in conjunction with the current mental health NP in the ED at RPAH. The 2

Conclusion

Jane-Llopis and Barry18 recognize the need to identify mental health programs that are effective, feasible, low cost, sustainable, and transferable across diverse cultures and settings. The model of ED-based mental health NP-led service provision described here is a safe, flexible, and cost-effective method of enhancing access to health care that is adaptable to a broad range of ED settings. Interest in contemporary evaluation research is concerned with documenting the process of successful

Acknowledgments

The evaluation of the NP-led MHLN team was funded by a grant from Health Workforce Australia as part of the Expanded Scope of Practice (ESoP) for Nurses in the Emergency Department Project. This article does not represent the views of Health Workforce Australia.

Timothy Wand, RN, NP, MN(Hons), PhD, is an associate professor at the University of Sydney and a Sydney Local Health District nurse practitioner at Royal Prince Alfred Hospital in Camperdown, NSW, Australia. He can be reached at [email protected].

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Timothy Wand, RN, NP, MN(Hons), PhD, is an associate professor at the University of Sydney and a Sydney Local Health District nurse practitioner at Royal Prince Alfred Hospital in Camperdown, NSW, Australia. He can be reached at [email protected].

Kathryn White, RN, MN, PhD, is a professor of nursing at Sydney Nursing School, University of Sydney.

In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

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