Military Nurse Co-ordinators: An integral part of the patient care pathway at RCDM

Published: 20 January 2010

Flt Lt Amy Marsden PMRAFNS describes a new concept in which specialist nurses act as key facilitators for all military patients, MOD civilians and dependants, improving the patient experience while maintaining the "military bubble". It's a role that is already proving of great benefit to patients and relatives alike. 

First, a bit of background. In 2001, University Hospital Birmingham was selected by the Ministry of Defence to be the Royal Centre for Defence Medicine (RCDM) with the primary function of providing medical support to military operational deployments. It also provides secondary and specialist care for members of the Armed Forces, MOD civilians and dependants.

RCDM is a dedicated training centre for military personnel and a focus for medical research. It is a tri-service establishment, meaning that there are personnel from all three Armed Services, and is based at Selly Oak Hospital although military personnel are fully integrated throughout both sites and treat both military and civilian patients. The trust also holds the contract for providing medical services to military personnel repatriated from overseas via the Aeromedical Evacuation Service.

The key facilitator

The military nurse co-ordinator (MNC) is a relatively new concept, initially formed in 2007. The MNC team was created to provide an interface between all admitted military patients (battle and non-battle casualties), entitled personnel and the NHS, in order to achieve a smooth transition of care for each patient

Although this role has evolved and developed over the past few years, the team’s primary function remains the same – that is, is to "act as the key facilitator for all military patients, MOD civilians and dependants who are admitted via RCDM Birmingham". This ensures that, with the co-operation of the NHS, each and every patient receives the highest standard of care. We also see that each patient is fully aware of their own care pathway and that any subsequent treatment / rehabilitation is organised prior to discharge.

MNCs can visit any hospital in the Birmingham area (excluding children and mental health establishments) and see patients each day as many times as is clinically appropriate, normally twice a day.

RCDM Birmingham is the only military establishment in the UK to have MNCs, owing to the high levels of military patients admitted through RCDM and the need for our unique service to assist with specialised care pathways. For example, between January and May 2009, the MNCs processed and facilitated care pathways for over 200 patients. 

Service design

The team consists of seven trained military nurses, drawn from all three services. It is imperative that the individuals selected for this role have a solid nursing background so they can provide a credible clinical service to all patients. The MNC must therefore be able to understand, interpret and explain to patients and relatives all aspects of their care.

Excellent communication skills, discretion, approachability and genuine compassion are key skills. MNCs are dedicated to improving the patient experience while maintaining the "military bubble" and this role has proven of great benefit to patients and relatives alike.

Because of exceptional circumstances, it is sometimes extremely difficult for NHS workers to fully understand the environment, living conditions and stressful experiences that these military patients have endured in the battlefield. It is potentially stressful for these patients to be placed on civilian wards, isolated from their comrades, at a time when they feel most vulnerable.

Co-operating with the NHS

MNCs are experienced in dealing with these types of individuals and so can help the NHS understand their concerns. They do this by working closely with all disciplines of the NHS, building solid relationships and explaining the additional information required for these unique patients.

We cannot emphasise enough how the co-operation which the MNCs receive from the NHS does indeed make the patient's journey a better experience. The patient and relatives have access to the MNCs seven days a week to discuss any aspects of their care or discharge procedure.

Not only do we work closely with patients admitted from the operational setting, we provide the same service for individuals having elective surgery.

Rehabilitation

Any military patient having undergone any surgical intervention or who has suffered from any neurological symptoms will require some degree of rehabilitation follow-up.

The rehabilitation pathways for military patients are quite complex, containing many variables depending entirely on clinical condition. Therefore an additional role of the MNC is to liaise closely with the NHS physiotherapists, occupational therapists and clinical staff to ensure a robust rehab package is in place prior to discharge.

This information is collated by the MNCs and passed on to the most appropriate rehabilitation facility, both in the UK and abroad. This system saves a great deal of time, enabling the patient to be referred and to commence rehabilitation in a timely fashion. Ultimately the aim is for all patients to start on the road to recovery and regain full fitness in the most realistic time frame. 

A family affair

We also do not underestimate the amount of time MNCs might dedicate to patients' relatives. Receiving the news that a loved one has been injured in battle is both shocking and deeply upsetting. MNCs are always there to provide support to relatives at this difficult time, thus freeing up specialist nurses on the ward to continue with their care.

Explaining treatments, providing information, listening to their concerns and involving them in the decision-making process is part of the MNC's everyday role. This has proven to releive a great amount of stress and anxiety for all involved.

Working closely with other military welfare providers available at RCDM is also a high priority to ensure a fully rounded care package is maintained.
 
MNCs are a team who work tirelessly to improve patient care through a unique and innovative approach. Highly professional, their focus is on the patient and their relatives to provide the most appropriate patient pathway.

The success of this team is undoubtedly strengthened through solid links with the NHS. This relationship has proved pivotal in providing our Armed Forces and dependants with the best standard of care – physically, clinically and emotionally.