Careers

Different dimension As a nurse consultant in the intensive care unit at the Royal Devon and Exeter Hospital NHS Foundation Trust, Carole Boulanger helped create the national role of advanced critical care practitioner (ACCP) – a title she holds herself. She recently joined the board at the Faculty of Intensive Care Medicine to represent ACCPs nationally and is the only UK critical care nurse elected to the Council of the European Society of Intensive Care Medicine. Stephanie Jones-Berry reports. CAROLE BOULANGER has more than 25 years’ experience in nursing, mostly spent in critical care. After beginning her career in 1987 as a junior staff nurse in the intensive care unit (ICU) at the Royal Devon and Exeter NHS Foundation Trust, she completed specialist training in critical care nursing before becoming senior staff nurse, then sister. In 1994, Ms Boulanger took what she calls a ‘career break’ from the ICU, spending two years in Germany working as a nurse for the army. However, on her return to the UK, she knew her future lay in intensive care and took a job back at the Devon and Exeter trust. Development of the advanced critical care practitioner (ACCP) role started in 2004 when five pilot sites took it on, including the Royal Devon, as part of a Modernisation Agency project on new ways of working in critical care. Ms Boulanger was the only ACCP to continue working in the role after the pilot formally finished in 2006. ‘ACCP has added a different dimension in career progression for nurses who have several years of critical care experience,’ she says. The two-year training programme allows nurses or physiotherapists to extend and consolidate their clinical skills and be actively involved in managing episodes of critical care. Staff are trained in history taking, clinical examinations, the endotracheal intubation of invasive NURSING MANAGEMENT

lines and the solo transferral of critically ill patients for tertiary care. Ms Boulanger is enthusiastic about being co-opted to the board of the Faculty of Intensive Care Medicine as its only non-medical member. ‘I am here to represent ACCPs who are trained and in training; this is a huge step forward in recognition of the role as a new workforce solution.’ She is working with the board to provide registration and regulation for the role and has helped produce a curriculum with a competency framework, which will ensure standardised training across the UK. More responsibility One of the quirks of the ACCP role is that Ms Boulanger now works to a medical on-call rota. Her role, and that of the 60 future ACCPs now in training around the country, fills a tier in the medical rota. ‘People say I am not a nurse any more, but I am – just one with additional skills,’ she says. ACCPs diagnose, treat and refer patients, make high-level clinical decisions and often have their own caseload. Ms Boulanger is banded as an 8C, but her role differs to that of a nurse consultant; she reports to the clinical lead for intensive care medicine and the nursing director. ‘I undertake the same work as the doctors in ICU, but am actively involved in supporting nurses’ development.

‘I have an understanding of medical and nursing issues and can understand problems in both corners and move things forward,’ she adds. Ms Boulanger also helps to train junior doctors in the ICU, ‘buddying up’ with them and supporting them in learning new skills and offering advice and reassurance. ‘I have the skills they are trying to acquire, and the trainees can ask me things they might feel they cannot ask the ICU consultant.’ In 2002, Ms Boulanger gained a master’s degree in health and education with a critical care major at the University of the West of England. The experience gave her knowledge of research enquiry and data interpretation, she says. ‘I learned a lot about being formally taught and assessed and now have a high-level teaching qualification, which is important as I teach a lot in my day-to-day role.’ Ms Boulanger also chairs the National Association of ACCPs, established last summer, where her goal is to establish a clear educational and clinical practice career pathway for experienced critical care nurses. ‘We should value what impact and benefit we have on patients and their families, and there should be more opportunities for nurses like me to extend their skills and care for patients at the bedside.’ Stephanie Jones-Berry is a freelance journalist March 2014 | Volume 20 | Number 10 39

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Different dimension.

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