Page 30 - QARANC Vol 14 No 12 2016

28 QARANC THE GAZETTE
Military Advanced Nurse Practitioner Attachment to NHS Orkney
In February 2015, I was offered the opportunity to undertake a number of clinical attachments in NHS Orkney. This initiative arose from the close links established with NHS Orkney by the former Director, Col Bates L/ QARANC and Col McArthur OBE L/ QARANC, Military Medical Liaison Officer to the Scottish Government. It provided an opportunity for military Advanced Nurse Practitioners (ANPs) to experience remote and rural healthcare delivery in the firm base, as well as fostering closer ties with NHS colleagues in Scotland.
A scoping study had been undertaken by Maj Lynda Ricketts in December 2014. The comprehensive report that followed recommended the Accident and Emergency (A&E) department at the Balfour Hospital, Kirkwall, and the remote island of North Ronaldsay as ideal locations for military ANPs to undertake clinical attachments. Maj Ricketts also identified that the attachments could be mutually beneficial for both the military clinician and NHS nursing colleagues, particularly in the A&E setting, as the Balfour Hospital do not generally employ ANPs.
With a view to maintaining clinical currency and conscious of the new NMC revalidation requirements, I received the full support of my Commanding Officer at 225 (Scottish) Medical Regiment, to undertake these attachments. Following liaison with Lt Col Charlton, Lt Col Kenward and the Human Resources Department at NHS Orkney, mutually agreeable dates were identified for a series of three short attachments to run from May 2015 to August 2015. Flights from Edinburgh to Kirkwall and inter-island flights and accommodation were booked and paid for by NHS Orkney.
The small A&E department at the Balfour Hospital provides an ideal learning environment as it is the only receiving unit for the 22,000 population across all the Isles. NHS Orkney struggle to recruit sufficient numbers of nurses and the department was understaffed with a typical staffing level of two qualified nurses and a health care support worker during a day shift. Medical staff were on hand 24hrs a day.
presentations, spanning all ages. Many of the admissions arise from GP referrals but there is a large number of walk-in minor injury presentations. Equally, due to the number of ferries that operate to the outer islands, the fishing industry and movement of small aircraft for inter-island transfers, there is scope for major trauma arising from maritime and air incidents as well as road traffic incidents. During my time at the A&E department there was a near drowning, a diver with suspected decompression illness and a patient with multiple injuries arising from a fall from a cliff. Overall, there is enormous variety and a lot of opportunity for an ANP to work autonomously.
I was made to feel very welcome during my attachments to A&E. The staff were supportive and genuinely appreciated the assistance offered by an extra pair of hands. I have no doubt that NHS Orkney would benefit from having experienced military ANPs working in their A&E department and with the variety of presentations and opportunity for professional development, this benefit would be mutual.
Most of the clinical attachment time was completed on the idyllic island of North Ronaldsay, the most northerly and remote of the Orkney Islands. The Island can be reached by the once weekly ferry but there is a very regular air service, operated by Loganair in an 8 seater aircraft, flight time 20 minutes. This is how the majority of the islanders on North Ronaldsay get on and off the island.
My two visits here consisted of an initial orientation visit in May 15, followed by a subsequent visit in July 15 for 5 days, to provide leave relief for Bernie Holbrook, the NHS ANP. These visits were thoroughly enjoyable and I
was greeted and hosted extremely well throughout.
North Ronaldasy is also famed for the rare breed sheep that spend most of the year living on the shore-line, eating seaweed. Their mutton and wool is sought after as the nature of their unique diet gives a certain taste to the former. I did indulge myself to a woolly hat made from the latter, as essential bit of kit for the Scottish winters, woven on the island and knitted by the resident post-mistress.
The medical centre is located on the ground floor of a former manse, with the upstairs providing the accommodation for Bernie and her husband. During my attachments to North Ronaldsay, I stayed at ‘Dennishill’, a two-bedroom, self-catering, converted croft cottage. As I was only there for short periods, I didn’t submit a pre-order for shopping to be delivered by the ferry so I opted to take lunch at the ‘Lighthouse Café’ (run by Bernie’s husband) and evening meals at the restaurant at the ‘Bird Observatory’ (prepared by the practice manager who runs the observatory with her husband, who was the Island GP prior to retirement) – all falling comfortably within the daily subsistence rate. Bernie went ‘off- Island’ so left me her car, provided by the NHS to facilitate house-calls and for generally getting about.
With a resident population of just over 50, it is quiet from a clinical perspective. However, North Ronaldsay attracts many visitors who come to observe the bird life, seal population and to see the lighthouse, one of the largest brick build lighthouses in the UK. This can increase the ANPs population at risk considerably, with visiting families with babies and small children. As the sole healthcare professional on the Island, this places an additional burden of
There is a vast spectrum of
Scottish Air Ambulance Service visit to North Ronaldsay – inaugural visit of their new air ambulance