National recognition for Prince of Wales nurse

Emergency Nurse of the Year Wayne Varndell says his proudest achievement is his involvement in the establishment of a new clinic that has motivated more of his colleagues to pursue nurse practitioner careers.

Prince of Wales Hospital has won two prestigious College of Emergency Nursing Australia (CENA) annual awards for its pioneering work in redesigning and advancing the delivery of timely emergency care.

Along with naming the hospital’s ED clinical nurse consultant Wayne Varndell its Australasian ED Nurse of the Year, CENA also named Prince of Wales as the Australasian Emergency Department of the Year.

The Prince of Wales emergency department cares for more than 54,000 adult patients a year and is one of the busiest departments in the 500-bed hospital. Its 35 beds are divided between the resuscitation area, acute, sub-acute and short stay unit and staffed by 89 registered nurses, including nurse practitioners, and 69 medical officers.

“Both awards have acknowledged the hard work of the entire team in innovating emergency healthcare,” Wayne said.

For the past two years Wayne, who is an active member of the Nursing Research Council at Prince of Wales, has been a vital member of a team that has collaborated with the local community, hospital service providers and administrators to address the key issues that confront emergency departments throughout Australia.

“This has meant that we’ve been able to meet the needs of the community on a very broad scale through a number of projects,” he said. “I think our most significant achievement – and the one I am certainly most proud of – has been the implementation of an ED Review Clinic

“It is an extended practice nurse-led service to provide short-term management of patients with low risk differentiated conditions suitable for rapid discharge.”

Prince of Wales Hospital ED treats many patients who have travelled from overseas or interstate and who might require review within 48 hours, but can’t readily access primary care for follow-up.

“Being able to ensure their care and recovery is on track, while ED continues to see new patient presentations, has reduced our unplanned representation rate and ED length of stay for Fast Track and enabled advanced nursing practice to develop,” Wayne said.

“As a consequence of implementing the Review Clinic we now have two endorsed nurse practitioners as part of the ED team and we have motivated others to pursue a nurse practitioner career.”

The clinic, staffed by three senior emergency nurses supported by a sub-acute senior medical officer, bridges the gap between primary and secondary care. This has led to an overall reduction in patients leaving before beginning or completing treatment and decreased sub-acute waiting times from 2.2 hours to 1.4 hours.

The success of the ED Review Clinic has led Prince of Wales to implement an extended practice area for transitional nurse practitioners, extending the professional profile of nurses in its ED and across the hospital.

Wayne has also been involved in the establishment of a nurse-led Aged Care Emergency Service (ACE). By working with community care services such as GPs, podiatrists, dietitians and outpatient services it has been able to reduce lengths of stay and diverted patients for management. It also directly admits patients to inpatient teams following domicile visits and discussions with primary care practitioners. This model of care has been integrated into the Age Specialist Emergency Service that provides 16 hours a day, seven days a week service for patients over 70.

Wayne also leads an in-house program that supports staff undertaking tertiary qualifications. So far he has mentored 25 nurses to achieve graduate certificates in emergency nursing and six of these have completed a masters.

He has also published a number of research articles and contributed chapters to international books*, is president of the NSW branch of CENA and has received more than $900,000 in research and project funding.

Wayne told The Lamp that when he graduated in the UK in 2001 he had no idea his career would take him so deeply into research. But he would never be involved to the exclusion of clinical practice.

“I always wanted to do both. Translating best evidence into practice is key, if patient care, better ways of working and safer standards of practice are to be realised and experienced by the patients in our care.

“Balancing clinical practice and research can be challenging, however the achievements that have been made are a direct result of the high degree of teamwork, collaboration and dedication of the ED staff and hospital management; patient focused, patient driven.”

Prince of Wales ED nurse manager Elizabeth Ryan said: “Wayne has been pivotal in developing the scope of clinical practice and mobilising multi-disciplinary support for initiatives across the hospital.

“He is the most inspirational emergency nurse I have worked with during my 26 years of emergency nursing,” she said. “I’m continually amazed how he fits so much into 24 hours. His clinical skills are of the highest standard and his intelligence and analytical ability are outstanding.

“He contributes to the department not only on a practical level but is able to impart his knowledge and experience to nursing and medical staff.”

*Wayne Varndell’s research interests include exploring the role of ED in supporting palliative care patients (Varndell, Mackenzie and Sands, 2013), management of post-intubation sedation of critically ill patients in ED (Varndell, Fry and Elliott, 2011, Varndell, Doug and Fry, 2014), the dependency of patients on emergency nursing workloads (Varndell, Fry, Gallagher and MacGregor, 2013) and the impact of noise on staff and patient wellbeing (Ortiga, Kanapathipillai, Daly, Hilbers, Varndell and Short, 2013).