• Login
Focus - An important voice

Nurses and midwives are contributing at all levels of the National Clinical Programmes, writes Geraldine Shaw

The HSE Nursing and Midwifery Services are led by Dr Michael Shannon, National Director Nursing and Midwifery Services (ONMSD). With the continued support of nursing and midwifery staff nationwide, significant progress and contributions have been made to the National Clinical Programmes at both a clinical and a national strategic level. The aim continues to be to improve patient care while also meeting the objectives of both the HSE and Department of Health.

The following is a reflection on some of the achievements to date of the National Clinical Programmes, focusing on some of the areas of contribution from nursing and midwifery staff. Note: please be mindful that this article only gives a snapshot and does not cover all of the programmes’ achievements due to the confines of space. Therefore it is not intended to be exhaustive.

National Clinical Programme for Acute Medicine (AMP)
Introduction of the National Early Warning Score (NEWS): NEWS has been implemented in all acute and single specialty hospitals in Ireland. This initiative was enabled by the National Clinical Programme and led by the National Nursing Lead for Acute Medicine. This tool has proved to be of great benefit to both nursing and medical staff while also providing benefit to our patients. The tool received the Public Service Excellence Award from An Taoiseach in 2013. For more information on this tool visit: http://www.hse.ie/go/nationalearlywarningscore/

National Clinical Programme for Obstetrics and Gynaecology
Introduction of the Irish Maternity Early Warning Score (I-MEWS): In 2013 the National Clinical Programme in conjunction with ONMSD established a multidisciplinary design team to develop a national standardised I-MEWS, observation chart and associated material. Midwives from 19 maternity hospitals contributed, collaborating on its development and implementation, thus demonstrating the benefit of multidisciplinary ‘top down – bottom up’ workings.

The I-MEWS is used for all pregnant women from the time of confirmation of a clinical pregnancy up to and including 42 days post delivery. The design, development and implementation of this work was presented by lead midwives at the International Confederation of Midwives (ICM), Prague in May, 2014. For more information on this tool visit: www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/imews

A Midwifery Workforce Planning Review has been jointly commissioned by the Office of Nursing and Midwifery Services Director and the Joint Standing Maternity Committee of the Dublin Maternity Hospitals. This review is supported by the National Clinical Programme for Obstetrics and Gynaecology and the National Director Clinical Strategy and Programmes Division. This review incorporates a Birthrate Plus® (BR+) study in six maternity units in Ireland. The data when analysed will provide a benchmark for the group which will inform national staffing figures.

Midwives and healthcare professionals have contributed to the production of 32 National Clinical Guidelines which are available on the HSE website: www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/obsgyneguide.html

National Clinical Programme for Paediatrics and Neonatology
Introduction of the Paediatric Early Warning Score (PEWS): A National steering group was established in early 2014 and is actively progressing the development of PEWS. This group has a Group Children’s DON to provide direction and support. The roll out will be led and driven by a nursing project co-ordinator in 2014.

Nursing has led on the initiation of a National Senior Paediatric Nursing Network in collaboration with the National Clinical Programme for Paediatrics which includes all paediatric units in the country. This was established in Q1 2014. This will enable sharing of information and standardisation of best practice initiatives nationwide. To date, two national network events have been run successfully.

National Clinical Programme for Stroke
Nurses and stroke clinical nurse specialists, along with the medical staff and multidisciplinary teams, are providing and leading on patient care and service initiatives which are delivering the following outcomes;

  • Thrombolysis rates have increased from 2.4% in 2007 to 9.5% in 2013 (10.5% in Q3 2013) exceeding targets and leaving Ireland with one of the highest rates in the world (UK is 5%, Sweden 6.6% and US 2.4%)
  • Thrombolysis available in all model 3 and model 4 hospitals either directly or via transfer. Ambulance access protocols in place so that acute stroke patients are taken to nearest hospital providing 24/7 thrombolysis
  • Stroke Foundation Education Programme developed and rolled out through the Centres for Nurse Education.

National Clinical Programme for Diabetes
The Integrated Care Diabetes Initiative was an agreement between primary and secondary care and identifies best practice for the management of the condition based on the type and severity, and a commitment on behalf of the HSE to ensure that the model of care for Integrated Care Diabetes will provide that:

  • Uncomplicated type 2 diabetes patients will be managed in primary care only. This covers approximately 100,000 patients
  • Patients with complicated type 2 diabetes as defined by the national model of diabetes care will be managed by both primary and secondary care. This is estimated to be 60,000 patients
  • All patients with type 1 diabetes, genetic causes of diabetes (mody diabetes) secondary causes of diabetes, post-transplant diabetes and gestational diabetes, will be managed in secondary care only. This is estimated to be 30,000 patients.

To implement this initiative 17 integrated care diabetes nurse specialists were approved for appointment (many of these nurses are in place working across primary and secondary care). These nurses are dealing with patient caseloads, providing specialist care to maintain patients in the most appropriate setting.

A national model of care to deliver CS11 therapy to children with type 1 diabetes under five years of age has been developed and implemented. This model has been implemented through the work of nursing and clinical nurse specialist staff, working with the local multidisciplinary teams.

For more information on the work of the programme visit: www.hse.ie/diabetesprogramme

National Clinical Programme for Emergency Medicine
The programme in conjunction with ONMSD has:

  • Published in 2013 a Guide to enhancing ANPs in EDs in Ireland. Since then an additional 14 ED ANPs are in post in the system. This document gained an international ANP award in 2013
  • Developed role profiles for ED nursing staff to complement the current national general job descriptions for staff working specifically in EDs namely staff nurse, shift leader and CNM grades
  • Developed an Irish Children’s Triage System (ICTS) in conjunction with other key nursing and medical personnel, which is an international first and is presently being rolled out to EDs nationwide
  • Developing an ED Workforce Planning Toolkit which is in the advanced stages. This is for nursing management and staff to utilise in EDs to assist the maximisation of the use of human resources and assist with workforce planning
  • Assigned a national nursing project lead for the EMP to develop an ED physiological monitoring tool to meet the requirements of Recommendation 8 of the HIQA Tallaght Report
  • Developed a national ambulance handover protocol and the national rollout is being led by a nursing project lead to improve handover from ambulance staff to ED staff.

National Clinical Programme for Productive Ward
This nurse-led initiative has been successfully piloted in many sites across Ireland in two distinct phases. Every participating ward and site has reported improvements (under various headings) to their environment, the direct patient care times or an element of patient safety. The national team won the International Lean Healthcare Academy award in 2013. Sligo General Hospital won the award in 2014.

In a recent communication from the National Directors Clinical Strategy and Programmes Division and ONMSD to service managers (Hospital Groups and ISAs) it was articulated how this initiative will transition to operational business as usual during 2014.

The ONMSD and the Nursing and Midwifery Planning and Development Units will continue to provide training and advice for sites commencing the Productive Ward Initiative. The transition from a national initiative, to being fully implemented and owned operationally within a three-year period, illustrates what works well within nursing and midwifery services.

National Clinical Programme for Anaesthetics
Work is underway to develop a condensed nursing foundation education programme for 2015 to enable professional development and succession planning for this specialist area. This is being led jointly by the national clinical lead and ONMSD in association with the College of Anaesthetists.

National Clinical Programme for Acute Coronary Syndrome
The programme introduced a national optimal reperfusion service (ORS) in January 2013. The ORS service, provides that a patient with an acute heart attack who is within 90 minutes travel time from a designated primary percutaneous coronary intervention (PPCI) centre is transported straight to the PPCI centre where they receive emergency treatment in the cardiac catheter lab. These centres were in part enabled by nurses up-skilling and changing their rosters to provide this service, as well as an on-call service.

National Clinical Programme for Audiology
The National New Born Screening Service for children, which is conducted within four weeks of birth is fully operational nationally. To date, more than 100,000 babies have been screened. This service continues to be supported by nursing and midwifery services through PHNs throughout the country.

National Clinical Programme for Epilepsy
Since 2010 the epilepsy service has been driven and delivered by 10 ANPs, supported by a further 20 nurse specialists. The Programme was awarded an international nursing award for its description of the new National Epilepsy Service of Ireland. (The ‘Limelight’ award is part of the international care challenge series by Sanofi that allows nurses from around the world to showcase nursing innovations).

A National Director of Nursing & Midwifery Reference Group, chaired by Dr Shannon, provides impartial input and endorsement to clinical programme material as required on an ongoing basis.

Detailed information on all programmes is available at: www.hse.ie/clinicalprogrammes

Geraldine Shaw is director of Nursing and Midwifery/ National Clinical Programmes, ONMSD, Clinical Strategy and Programmes Division HSE


  1. Chemers M. (1997) An integrative theory of leadership. Lawrence Erlbaum Associates
Focus - An important voice
September 2014 Vol 22 (7)
Questions and answers - Bulletin Board
September 2014 Vol 22 (7)
Focus - An important voice
September 2014 Vol 22 (7)
Media Watch - Trolley Watch hits headlines
September 2014 Vol 22 (7)
Interview - Soak up the experience
September 2014 Vol 22 (7)
Student focus - College and careers
September 2014 Vol 22 (7)
Student Focus - An exciting future awaits
September 2014 Vol 22 (7)
Book review - Cooking on a budget
September 2014 Vol 22 (7)
September 2014 Vol 22 (7)
Site Map
Irish Nurses & Midwives Organisation (Cumann Altrai agus Ban Cabhrach na hEireann). The Whitworth Building, North Brunswick Street, Dublin 7. T:+353 1 664 0600 E:inmo@inmo.ie