Brenda Bleach, a native of Tuamgraney, Co. Clare working in the Local Injuries Unit (LIU) at Ennis Hospital, is the first nurse in Ennis to achieve Registered Advanced Nurse Practitioner (RANP) status.

RANPs are the highest level of clinical experts in the nursing profession in Ireland today. LIUs are locally based services treating minor injuries and are a safe alternative to the Emergency Department (ED) for a number of injuries and conditions.

The LIUs come under the clinical governance of a consultant in emergency medicine and the RANPs rotate between the LIU and the ED at UHL so they are an integral part of the Emergency Medicine team. The LIUs are at all times staffed by a senior clinical decision maker, qualified in emergency care. A wide range of diagnostic supports are available to staff in the LIUs and protocols are in place for the transfer to University Hospital Limerick of patients who clinical staff have decided are too unwell to be treated in the LIUs or whose condition falls outside the criteria for care in the LIU.

The LIU in Ennis saw an average of 157 patients per week in the first half of 2015, with June being the busiest seeing 192 patients presenting at the LIU. Brenda Bleach joined as Clinical Nurse Specialist at the LIU in Ennis in 2012 with the objective of studying to become an RANP. She already had over 20 years’ A&E nursing experience behind her having worked in Australia, St. James’s Hospital and in Galway University Hospital. Having obtained her Masters in Advanced Practice with Nurse Prescribing, Brenda submitted her portfolio to the Nursing and Midwifery Board of Ireland and was awarded RANP status this Summer.

Working in the LIU in Ennis, Brenda specialises in non-complex, soft-tissue injuries, such as sprains, suspected broken bones and lacerations. She treats patients from 5 years up within an agreed scope of practice and loves her role, in particular the holistic aspect of it. “RANP status allows me to develop as an independent, autonomous practitioner and strive for continuous improvement and excellence in practices – ultimately the patient will benefit from this more holistic approach.

From the moment the patient arrives until they are discharged or referred, I can look after them as an RANP, assess their injury, request x-ray or other interventions, prescribe analgesia or tetanus, suture wounds and provide discharge advice, all under the clinical governance of a consultant in Emergency Medicine," said Brenda. “Patients coming to the LIU are generally seen within the hour after arriving, they can either self refer or get a GP referral. Of course there are times when patients do need to go to the Emergency Department in University Hospital Limerick, such as when they are experiencing chest pain, abdominal pain or after a serious head injury.

In those situations patients should always attend the ED. Now that there is an alternative for minor injuries, which is open 7 days a week, we would encourage patients to consider whether they could more appropriately travel to their nearest LIU where the supports are available, “ concludes Brenda.

“The introduction of RANPs in emergency nursing is a new and exciting initiative for the nursing profession and for UL Hospitals, who have five RANPs in total across the Group. The RANP, with the medical staff, can care for the majority of patients who attend the LIU and whose conditions are within the criteria of conditions that can be treated in the LIU. They are a very welcome addition to the team, “ said Dr. Cormac Mehigan consultant in Emergency Medicine at UL Hospitals. All patients should, in the first instance, consider whether they can be more appropriately treated by their GP or out-of-hours GP service such as Shannondoc before presenting at either an LIU or the Emergency Department.

HSE