Transforming Nursing, Midwifery And Health Profession (NMaHP) roles: review of Clinical Nurse Specialist and Nurse Practitioner roles within Scotland

Annex G Metrics

All new roles developed should be associated with relevant metrics, in order to help demonstrate the impact and effectiveness of the role.

A number of factors have led to the current focus on outcomes of care in health care, including increased emphasis on providing quality care and promoting patient safety; regulatory requirements for health care organisations to demonstrate care effectiveness; increased health system accountability, and; changes in the organisation, delivery and financing of health care.

It is recognised that Level 6 Clinical Nurse Specialists and Level 7 Advanced Clinical Nurse Specialists play a key part in developing and sustaining the capacity and capability of the health and care workforce now and in the future. There is growing evidence of the positive impact Level 7 Advanced Clinical Nurse Specialists' care have on patient outcomes in terms of promoting access to care, reducing complications and reducing costs of care through improving patient knowledge, self-care management and patient satisfaction.

It is important therefore that Level 6 Clinical Nurse Specialists and Level 7 Advanced Clinical Nurse Specialists are able to measure the impact of their care on patient outcomes, their professional impact as well as being able to demonstrate their effectiveness and contribution to health and care delivery. This is particularly important in relation to integration and the extensive reform agenda where commissioners of services are looking for best value and maximising contribution of all practitioners.

Principles

Developing metrics that relate to quality of care measures as well as patient outcomes based on the specific practices of an ACNS, will support identification of impact of ACNS care. To date from the literature there has been a tendency to use a range of measures which compare Advanced Practitioners to other roles including medics using performance measures such as length of stay, admission rates and mortality. Clinical Nurse Specialists and Advanced Clinical Nurse Specialists may have metrics and outcomes which are specific to their field of practice; this should be further explored outwith the scope of this document.

Across all specialist posts and roles the following principles should be applied as identified in the Phase II Advanced Practice document.^[31]

Principle 1: Metrics can be both qualitative and quantitative but must be triangulated to demonstrate effectiveness.

Principle 2: Metrics that measure effectiveness of practice must be based on key result areas/patient outcomes and fit to service needs.

Principle 3: Where possible data/instruments used to measure should already be available from existing systems i.e. "Use once for Scotland".

Principle 4: There must be clear methods for displaying ongoing outcomes of ACNS practice (scorecards/dashboards etc.) that are aligned to the National Nursing Assurance Framework 'Excellence in Care'.

The metrics employed should be limited in number but be able to demonstrate safe, effective and person-centred care. It is recommended that at least one measure is chosen for each of these. Metrics may change over time to reflect changes to services and priorities.