‘Think, question, change practice’ the transformative potential of an Advanced Practice Nursing group to explore evidence based practice

In a previous blog, Dr Andrew Finney outlined the reasons for developing and the purpose of the Critically Appraised Topics or CATS. A group of General Practice Nurses and ANPs came together with the academics at Keele University to look into clinical questions that were raised from their practice, search and critique the evidence base and then share clinical bottom lines that make best evidence interpretable.  Now in its 7th year the group has a number of successes under its belt and is now on a road of progression and growth.

This blog comes from Rachel Viggars, Strategic Nurse Lead for the Staffordshire Training Hub since January 2021.  Rachel is passionate about GPN recruitment and education and has been a driving force behind GPN engagement with research and ‘best evidence’.  Her role involves ensuring that the education and development opportunities are accessible and relevant for the whole primary care nursing workforce across Staffordshire, but also to raise the profile of GPNs locally, regionally and nationally.  As a founder member of the Keele CAT group Rachel continues to work clinically in North Staffordshire and holds the title of Queen’s Nurse

At the start of the group in 2015 we were all day-to-day GPNs /ANPs working in practices across the North Staffordshire foot print with minimal knowledge, and I would have to admit “enthusiasm” for the research process.  However, during our launch event for the group we started to recognise the types of questions that were relevant to our practice…why do we do things in certain ways? Is it because “that’s the way we’ve always done it” or “that’s what we are told to do” etc? Or is there an evidence-base to our decisions and processes?  Do we think about why we do something in practice and would there be a better way of doing it?   From the first few CAT questions that our group addressed it was clear that we had a strong well-supported forum in which we were encouraged to question of what we do.  On a fundamental level, we as nurses found we had a voice, we had space and time to think and to share our views in a supportive peer group.  Even the research element wasn’t daunting!  The academics offered bite size learning support and this enabled us all to grow.  We gradually learnt how to read the research papers, get a broad understanding of the statistics and research terminology then confidently make decisions based on our findings.  The best part of this was that we got to do this in a group.  As we progressed and generated more clinical questions, smaller groups would work together to synthesise the evidence ready for the meeting where we would discuss and agree the clinical bottom line.

The professional growth of the members of this group has been phenomenal.  The academics are thrilled by how we as clinicians have developed over the past 7 years.  From isolated GPNs / ANPs not believing in ourselves or feeling that we were not listened to, to becoming leaders and confident to question practice and make evidence-based-practice recommendations across the system.

Over the years, we are proud to now have a large number of our group who have received Queen’s Nurse Awards.  We have had multiple publications across the group from a wide range of topics, cervical cytology, frailty and evidence in to practice, with many of the group becoming co-authors, achieving things we had never considered possible.  On a personal level, I credit this group with developing my confidence and leadership skills.   I have been able to develop significantly as a GPN, ANP, undertaking an MSc and now I have a role as Strategic Nurse Lead for the Staffordshire Training Hub.  Other nurses have developed as Clinical leaders, and lecturers but many have remained in their GPN / ANP roles feeling more confident to question and change for the better. .

During the Covid pandemic, the pressures in Primary Care have been immense but the members of this group valued the interaction that the group offered and we successfully switched the meetings to online.  These continued to be facilitated by Dr Andrew Finney and were well attended. Interestingly we could see first-hand the benefits of some of our work regarding vitamin B12 oral treatment v intramuscular B12 for which we had already developed into a CAT and were making significant changes in practice to be both cost effective and clinically effective.  As the pandemic hit, we were already ahead of the curve with our patients in North Staffordshire and Stoke with the push to switch to oral meds and were able to reassure both patients and other clinicians of the evidence base for this intervention and support the continued change in practice.

As the country has eased the Covid restrictions, we have returned to face-to-face meetings, which has been great.  However, we now offer a hybrid model where colleagues can join us remotely if they cannot make it in person.  This has worked really well and has enabled, Staffordshire Training Hub who from this year now fund the group jointly with the Staffordshire and Stoke-on-Trent Integrated Care System (previously North Staffordshire CCG) to offer this hybrid model providing the opportunity to offer involvement in the group by all GPNs / ANPs across the entirety of Staffordshire regardless of geography.

The EBP group really develops nurses to think, question, change practice, to have a voice and to believe that they can and do, lead. Confidence is developed and crucial professional relationships formed and most importantly, patient care is  improved.


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