Primary Care – Practice Nursing

This post hopes to outline information regarding the procedure and requirements to enter practice nursing in Ireland. The first step required to work as a practice nurse is to hold a relevant NMBI Pin.

Med Doc will assist you in entering practice nursing but if you are a hospital nurse and looking to transition, there will be a period of learning which will be required. You will not be paid for this but it will pay great dividends to you should you be certain you wish to enter practice nursing.

Med Doc have a very strong demand by both HSE primary care and GP practices for both adhoc and permanent practice nurse jobs right across Ireland. This also includes triage nurses in out of hours which is part of the primary care function. You will however need triage/emergency medicine experience to be considered for these roles.

This document should be used as a guide only and as regulations and requirements may change by various governing bodies, you should not take this document to be an exact guide to entering the workforce as a practice nurse.

1. The role of a Practice Nurse

A Practice Nurse’s role is wide and varied. The care provided will depend on the needs of the patient population and the qualifications/skills/competencies of the individual Practice Nurse. The list below is just a sample of what Practice Nurses do.

IMMUNISATIONS

• Infant vaccinations, (DPT, HIB, Polio, Meningitis C, MMR).
• Childhood vaccinations, (MMR, Meningitis C, pre-school booster vaccines for children attending private schools).
• Travel vaccinations, (Tetanus, Polio, Typhoid, Hepatitis A, Yellow Fever).
• Hepatitis B, Tetanus boosters, Rubella boosters.
• Flu and Pneumococcal vaccines.

WOMEN’S HEALTH / ANTENATAL & POSTNATAL CARE

• Cervical Screening.
• Advice on various methods of contraception and H.R.T.
• Pre-conceptual advice.
• Pregnancy testing, antenatal care, postnatal care, breastfeeding advice.
• Antenatal classes.

CARDIOLOGY

• Cholesterol testing & dietary advice
• ECGs.
• 24 hour blood pressure monitoring.
• Monitoring patients on anti-coagulant therapy.
• Smoking cessation.
• Stress management.
• Heartwatch Programme

SKIN & WOUND CARE / MINOR SURGERY

• Treatment of venous leg ulcers and other skin injuries.
• Suturing of skin lacerations.
• Post-operative suture removal.
• Treatment of warts and verruccae / cryotherapy.
• Nursing management of skin conditions – excema, psoriasis.

DIABETES

• Nursing management of Diabetes

RESPIRATORY CARE

• Nursing management of Asthma and COPD.
• Lung function testing.

HEALTH PROMOTION

• Smoking Cessation
• Weight management

GENERAL NURSING DUTIES

• Health Promotion and Education.
• Counselling.
• Telephone triage and advice.
• General phlebotomy.
• Ear syringing.
• Administering prescribed long-term medications/injections, (e.g. Cytamen, Depoprovera, Depixol, Myocrisin)

EXTENDED NURSING ROLES

Some Practice Nurses have undertaken post-graduate education in order to gain the qualifications and skills needed to carry out extended nursing roles, for example:
• Cryotherapy
• Insertion of Mirena
• Insertion of Implanon

INDIRECT NURSING DUTIES

• Liaise with other health professionals in the community and hospitals.
• Co-write and regularly review practice protocols.
• Audit of patient care and practice services.
• Maintenance and sterilisation of surgical instruments.
• Maintenance of emergency equipment.
• Education of practice staff (e.g. CPR, First Aid).

NURSE PRESCRIBING

Some Practice Nurses have completed the post-graduate Nurse Prescribing Programme and are now Registered Nurse Prescribers (RNP).

1. Qualifications required for a Practice Nurse

Minimum Requirements:
As with all nurses in Ireland, registration with the Nursing and Midwifery Board of Ireland (NMBI – formerly An Bord Altranais) is mandatory in order to practise as a Registered Nurse or Registered Midwife.
In order for the GP employer to avail of the Practice Nurse subsidy, the Practice Nurse must be a Registered General Nurse (RGN).
Additional Qualifications:
The range of nursing care and extended roles which may be provided by a Practice Nurse is extensive. Each Practice Nurse, like all other nurses, must practise within his/her own Scope of Practice, (see “Scope of Nursing and Midwifery Practice Framework, 2000”, available from An Bord Altranais and “must take measures to develop and maintain the competence necessary for professional practice” (Code of Conduct, available from An Bord Altranais). Therefore, Practice Nurses have a responsibility to ensure that they are suitably qualified and competent to undertake all aspects of their role. The autonomous nature of practice nursing means that issues pertaining to the Scope of Practice require constant reflection and vigilance on the part of the individual nurse.
Any Practice Nurse who provides antenatal care must be a Registered Midwife, i.e. on the current Midwives Register of An Bord Altranais. There is also a requirement for a Practice Nurse who is a midwife to notify their local HSE office of their intention to practice midwifery in the community. For further information, please refer to the An Bord Altranais document “Practice Standards for Midwives”, 2010.

2. Salary of a Practice Nurse

The Practice Nurse is employed privately by the General Practitioner. Therefore, as each Practice Nurse’s employment contract is negotiated between the GP and the PN, it is difficult for any organisation or union to set or enforce a defined salary scale. However, the Irish Nurses & Midwives Organisation recommends that the minimum salary of the Practice Nurse should be the salary at the maximum point of the staff nurse scale, plus any other allowance which is applicable (such as dual qualification or qualification allowance, etc). The INMO recommends that if the Practice Nurse is an accredited Clinical Nurse Specialist or Advanced Nurse Practitioner, the relevant salary scales for CNS and ANP grades should be applicable.
The INMO also recommend that Practice Nurses should receive the same annual leave entitlements as their colleagues in the public health service, which are in excess of the Statutory Minimum Requirements.

For further information, contact the Irish Nurses & Midwives Organisation, Whitworth Building, North Brunswick Street, Dublin 7.
Telephone: 01-676 0137 Fax: 01-661 0466
Website: www.inmo.ie or e-mail: inmo@inmo.ie

3. I want to be a practice nurse, who do I contact regarding training and relevant requirements

The IPNA strongly recommends that you make contact as soon as possible with your local Professional Development Coordinator for Practice Nurses (PDC). Please contact Med Doc for contact details of your local PDC.

If you found this post useful or you are interested in working in Ireland as a practice nurse, please feel free to contact Med Doc on +353 1 901 1306 or register with is on www.meddoc.ie