Wendy Wood, Peter MacCallum Cancer Centre - Advancing Nursing Practice: Improving Staff Retention...
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Transcript of Wendy Wood, Peter MacCallum Cancer Centre - Advancing Nursing Practice: Improving Staff Retention...
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Advancing Nursing Practice:
Improving Staff Retention
and Patient Outcomes Wendy Wood
Deputy CEO and
Executive Director Cancer Nursing
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The Peter MacCallum Cancer Centre
• Australia's only public hospital solely dedicated to cancer
• A national leader in multi-disciplinary cancer care, and
• A national and international leader in laboratory, clinical
and translational research
Our vision
• The best in cancer care, accelerating discovery,
translating to cures
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Our mission
• Improve the outcomes for individual cancer patients and
reduce the impact of cancer on our community.
• Ensure that all Victorian patients, regardless of where
they live, have access to the expert care they require
• Ensure that discoveries translate to the development of
improved cancer treatments
• Provide the best in educational opportunities resulting in
the training of high-quality cancer clinicians for today and
the future
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Cancer statistics – Cancer Council Australia (Feb 2011)
• 114,000 new cases of cancer were diagnosed in
Australia in 2010.
• 1 in 2 Australians will be diagnosed with cancer by the
age of 85.
• Cancer is a leading cause of death in Australia – more
than 43,000 people are estimated to have died from
cancer in 2010.
• Nearly 15,000 more people die each year from cancer
than 30 years ago, this is due mainly to population
growth and aging.
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Demand drivers
• The death rate (number of deaths per 100,000 people )
has fallen by 16%.
• More than 60% of cancer patients will survive more than
five years after diagnosis.
• The survival rate for many common cancers has
increased by 30 per cent in the past two decades.
• Cancer costs $3.8 billion in direct health system costs
(7.2%).
• $378 million was spent on cancer research in 2000-01,
22% of all health research expenditure in Australia.
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The Cancer Workforce
• Workforce shortages and systemic inefficiencies are restricting
access to care across all domains of cancer control:
– Chemotherapy utilisation in Australia could be as low as 19%
(50.8% of cancer patients should receive chemotherapy (Ng et al,
2010), due largely to medical oncologist shortages (MOGA, 2010);
– Under-utilisation of radiotherapy (ROJIG, 2003) is linked to
shortfalls in the radiation oncology workforce;
– There are widely reported barriers for cancer patients requiring
psychosocial support (COSA 2003).
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Career Wisdom
• Really successful people are clear about what they want
• They can tell you want they want to do with their career
• About 14% of people have a plan; the rest just hope for
the best
• Peter Mac’s ANP Framework aims to improve this
statistic
(Further reading; Career Wisdom – 101 proven Strategies to Ensure
Career Success by John McKee)
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Peter Mac’s Nursing Workforce Strategy
• Investing in the training and retention of cancer care
professionals
• Redesign of professional roles
• Innovative roles: nurses as 1st assistant in robotic
surgery, nurse practitioners and other advanced practice
roles, built around patient-centred, multidisciplinary care.
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The Development of an Advancing
Nursing Practice Framework
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Advanced Practice Exemplars (adapted from McCaffery Boyle 1996)
• Active case finding
• Chronic illness care (Griffiths & Jones 2001)
• Interpersonal competence and responsive communication skills
• Skilled clinical inquiry
• Skilled documentation
• Skill in anticipating the future
• Role assertion
• Awareness of limits
• Facilitation of change
• Ethical decision-making
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The Purpose of Advanced Practice Roles
• Contribute to improved outcomes for patients and families
• Develop and lead improvements in nursing practice and care delivery
• Foster innovation and support change management
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Purpose of the Framework:
• To guide the advancement of nursing practice in the
interest of better care and improved patient experience
• Some very experienced cancer nurses use it to pursue
endorsement – NP
• Others are using it to advance their abilities to perform
more effectively and increasingly independently
• Some quite junior nurses are using it to guide their study,
professional development and career choices
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What’s Does The Framework Cover?
1. Principles
2. Career Structure
3. Description of specialist roles and advanced practice
nurses
4. Clinical competencies for advanced practice
5. Governance process
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1. Principles
• The priorities, needs and experiences of people affected
by cancer are the key driver of the development of
nurses and the pursuit of advanced nursing practice
• Nurses are uniquely placed to positively impact on
outcomes for people affected by cancer
• The ANP process is governed by our values as well as
the regulatory bodies requirements
• The ANP Framework assists nurses to expand their
scope of practice in a context of appropriate
organisational and professional support
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3. Description of Specialist & ANP Roles
• Clinical Nurse Specialist
• Practice Development Nurse
• Clinical Nurse Coordinator
• CNC Advanced Practice Nurse (credentialed)
• Clinical Nurse Consultant
• Nurse Practitioner
• Senior Clinician Researcher
• Lecturer Practitioner
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Credentialing Framework for Advanced
Practice Nurses & NPs
• A clear pathway
• Identification of a perceived patient care gap
• Completion of Post Graduate Studies
• Peter Mac Formal endorsement & credentialing
• Nurse practitioner AHPRA credentialing
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Data to indicate service gap might
include:
• Numbers of in-patient admission due to uncontrolled
symptoms;
• Numbers of patients presenting for unplanned clinic
appointments;
• Numbers of calls from patients or family members for
symptom advice;
• Numbers of patients presenting to an ED elsewhere;
• Extended Length or repeated admission
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Retention and Advanced Practice
Peter Mac 2010-2011
• Since launching the framework in October 2010
• 8 nurses have been credentialed as APNs
• 4 nurses are completing studies and preparing their
applications
• 3 NP
• 4 nurses commenced Master’s of NP in 2011
• All nurses who have been credentialed as APNs or NPs
and those who have been identified as having the
capabilities of progressing to APN have continued at
Peter Mac
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Qualifications
2012 Number of RNs with postgraduate level qualifications
0 50 100 150 200 250 300 350 400 450
Tot al post graduat e qualif icat ion
2012 Type and proportion of post graduate level qualification of RNs (n =238)
4 9 %
3 1 %
1 9 %1 %
Postgraduate certificate
Post graduate diploma
M aster
PhD
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Nurse Agency Spend by Financial Year
from BI
Source: Business Intelligence (BI)
Nurse Agency Spend by Financial Year
from BI
$1,022,048$1,102,597
$1,514,223
$1,895,409
$1,445,117
1,069,414
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
$1,800,000
$2,000,000
2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012
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Improved Patient Outcomes
• Satisfaction with nurse-led telephone follow up for low to
intermediate risk prostate cancer patients treated with
radical radiotherapy: A comparative study
• There was no statistically significant difference in patient
satisfaction on any of the study measures between the
nurse-led and standard medical follow up at six months
following treatment completion. However, where there
was a trend towards significance (p ¼ 0.051), it favoured
the nurse-led follow up regimen.
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Outcomes cont.
• Trial: evaluate the acceptability, feasibility and safety of a
post transplant nurse-led clinic (NLC) model, with the
aim to reduce risk through managing ongoing symptoms
and thus minimising unnecessary in-patient admissions
• A total of 154 patients have attended the post-transplant
NLC between November 2009 and March 2011. All
patients were seen in the NLC within the first week of
their discharge following their transplant, replacing the
traditional medical follow-up appointment that patients
usually received at this time.
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Current Evaluation Activities
• Nurse-Led Survivorship Care Intervention for Long-term Survivors of Hodgkin Lymphoma.
Primary aim: To establish whether receiving a health promoting intervention from a specialist cancer nurse demonstrates capacity to improve HL survivors’ knowledge of and motivation to adopt health promoting behaviours.
Secondary aims: To establish whether receiving a health promoting intervention from a specialist cancer nurse demonstrates capacity to:
• Improve HL survivors’ perceptions of their health status
• Reduce patient-reported unmet information needs in relation to late effects
• Reduce health worry associated with the knowledge of risk of developing late effects.
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Advancing Nursing Practice at
Peter Mac www.petermac.org/AdvancingNursingPractice
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Acknowledgements
• Associate Professor Meinir Krishnasamy, Director of
Nursing and Cancer Experienced Research, Peter
MacCallum Cancer Centre
• Professor Sanchia Aranda, Former Director, Department
of Nursing and Supportive Care Research, Peter
MacCallum Cancer Centre and the University of
Melbourne
• The Nursing Executive Team, Peter MacCallum Cancer
Centre
• Trevor Saunders, former Nurse Director Clinical Practice