Optimising the role of the

nurse practitioner a

Queensland overview

Dr Frances Hughes, RN, DNurs, Col (ret RNZNC) ONZM

Chief Nursing and Midwifery Officer,

Queensland

4th Annual Conference: Developing the Role of the

Nurse Practitioner, Tuesday 18 March 2014

Outline

• Queensland context

• Wider context

• Crucial questions and observations

Challenges for the Healthcare system

Health Reform in Queensland

Blueprint for better healthcare in Queensland

released by the Queensland Government in February 2013

Government Objectives:

1. Health services focussed on patients and people

2. Empowering the community and our health workforce

3. Providing Queenslanders with value in health services

4. Investing, innovating and planning for the future

Empower people

Lead, empower and trust

Play to everyone’s strengths

Develop yourself and those around you

Customers First

Know your customers

Deliver what matters

Make decisions with

empathy

Ideas into Action

Challenge the norm and

suggest solutions

Encourage and embrace

new ideas

Work across boundaries

Unleash Potential

Expect greatness

Lead and set clear expectations

Seek, provide and act on

feedback

Be Courageous

Own your actions,

successes and

mistakes

Take calculated risks

Act with

transparency

Five Whole of Queensland

Government Values

– informing how we practice

Queensland’s health budget:

The Queensland Government will spend $12.3 billion

on health in 2013-14

• This is a 3.9 per cent ($464.3 million) increase on the

2012-13 health budget

• The major component of the budget is employee

expenses

• In 2011-12, employee expenses were $7.3 billion (64.51

per cent of total expenditure)

• In 2011-12, the total expense for the nursing workforce

was approx. $2.64 billion (36% of employee expenses)

Nursing Workforce

As at 30 June, 2013:

• 66,795 nurses and midwives were employed in

Queensland

• 49% employed in the public sector

• The Queensland Health nursing workforce comprises:

42% of the entire workforce

61% of the clinical workforce

• Registered nurses equate to

83% of the nursing workforce

(including nurse practitioners)

Nurse Practitioners

in Queensland

• Queensland currently has the

largest number of NP in

Australia

• 274 NP as at December 2013

• Almost 50 NP working in

private and self employed

models, in areas including

primary care, rural and

remote, aged care and

chronic disease.

• Greater growth in private and

self employed models in Qld

compared to public sector

models in past 2 years

• By having nurse

practitioners as part of

Queensland public and

private health services

we are challenging the

status quo, promoting

new options and

embracing reform to

ensure our communities

have safe, accessible

and timely health care

Strengthening health services through

optimising nursing

Five Strategies:

1. Enable nurses to work to their full scope of practice across all

settings.

2. Expand the delivery of nursing services in a range of settings

to increase service capacity and consumer choice.

3. Optimise the influence of nursing, improving quality and value

for money in health services.

4. Support high-performing nursing services through continual

learning and evidenced-based practice.

5. Support nursing services to enhance patient outcomes

through information systems and decision making tools.

Nursing and Midwifery Office, Queensland (2013)

Optimising the contribution of the

registered nurse to healthcare

Nursing and Midwifery Office, Queensland (2013)

1. Enabling nurses to work to their full

scope of practice across all settings

Legislative, regulatory and policy frameworks

to maximise the potential of nursing:

• Remove the barriers to nurse practitioners

practicing to their full scope of practice in

Commonwealth and state legislation

• Expand access to MBS and PBS

• Remove requirement for collaborative

arrangements

• Ensure local policies and procedures support

nursing

1. Enabling nurses to work to their full

scope of practice across all settings

(cont’d….)

A flexible work environment supports efficient and effective

models of patient centered healthcare:

• Expand current provisions enabling access rights to public and

private hospitals for nurse practitioners (admission and

discharge privileges)

• Promote flexible employment opportunities and new ways of

working

• Strengthen the business acumen of nurse practitioners

2. Expand the delivery of nursing services

in a range of settings to increase service

capacity and consumer choice

Increase nurse-led services to reduce

avoidable hospital admissions:

• Expand NP clinics and role of advanced

nurses with NP’s

• Integrated NP clinics (pilot: HF, Renal,

Diabetes- chronic disease)

• Develop sustainable NP models in priority

areas in palliative care, chronic disease,

gastroenterology, aged care, mental health,

primary healthcare

2. Expand the delivery of nursing services in a

range of settings to increase service

capacity and consumer choice (cont’d…)

Increases nurse-led services, improves access to

diagnostic and therapeutic procedures:

• NP in gastroenterology, primary healthcare,

mental health

• Nurse-led triage models to streamline referral

pathways

3. Optimise the influence of nursing,

improving the quality and value for

money in health services

Access to the healthcare system and

outcomes are improved through

strengthening nursing governance and

leadership:

• Disseminating evidence

• Networking

• Building relationships

• Strategic leadership

4. Support high-performing nursing services

through continual learning and evidenced-

based practice

The public have confidence in appropriately

qualified and authorised nurses providing their

care:

• Setting expectations and leading from the front

• Mandatory post graduate qualifications

• Facilitate education responsiveness

• Culture of research

5. Support nursing services to enhance

patient outcomes through information

systems and decision making tools

Quality of care is improved through nursing-

focussed targets and indicators:

• Appropriate information and communication

technology systems

• Nursing-focussed targets and indicators

• Owning and leading nursing data and

interpretation

State wide

Nursing Scorecard

• Nursing as percentage of total workforce

• Nursing skill mix

• RN skill mix

• Internal-external

Skill

Mix

• Age profile

• Graduate profile

• Workcover and leave over limit

• Leave profile S

usta

inab

ilit

y

• EB8 HR measures

• EB8 HR efficiency

• Draft productivity measures. Eg. Nursing cost per WAU

Pro

du

cti

vit

y a

nd

E

ffic

ien

cy

• Blood transfusion incidents

• Medication admin incidents

• Falls

• Pressure Injuries

Qu

ality

HITH Dashboard – Cellulitis W/O CSCC

• 977 referrals into HITH

• Average HITH utilisation 11.80%

• Average in Victoria approx. 90%

All A

BF

F

acilit

ies

•280 referrals into HITH

•Average HITH utilisation 39.60%

•Estimated HITH efficiency for single DRG at this facility totals $470,000 (based on Deloitte modelling)

Sin

gle

Facilit

y

Commission of Audit – progress to date

Nurses (and Nurse Practitioners)

are the key

• Reduce hospital

presentations

• Reduce length of stay

• Reduce duplication of

services

• Improve health outcomes

• Improve patient quality of life

• Improve demand

management

• Improve value for money

and sustainability

• Build research and apply

research into practice

Nurse practitioner -

political reality - why

so few and so much

need?

Thank you,

come work in

Queensland