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Unpacking the question: What is
advanced practice in nursing?

Alison McMillan
Chief Nurse and Midwifery Officer Departmen...
Context – Department of Health Victoria

Who are we?
• Created in August 2009
• 2011-12 output budget of $13.1b
• Portfoli...
Context – Department of Health Victoria

Our roles
• System management
• Policy, planning & strategy
• Funding & performan...
Chief Nurse & Midwifery Officer!
The Chief Nurse & Midwifery Officer is a key thought
leader and advisor to government and...
Rules of Dialogue
• Treat everyone as a colleague
• Conduct a shared inquiry into mutual concerns
• It’s okay to disagree
...
Looking ahead – the challenge

Sustainability/efficiency

Improving Patient Outcomes

Ageing population/workforce

Reducin...
Putting it nicely

Providing consistently high quality
care is an ongoing challenge for
healthcare systems, despite huge
i...
What is advanced practice in nursing?
What is the problem we are trying to solve?
The International Council of Nurses
definition for advanced
practice nurse

The advanced practice nurse (APN) is a registe...
The Strong Model of Nursing Practice
Five Areas of Advanced Practice

1. Direct Comprehensive Care Patient focused activit...
In the United Kingdom

The characteristics demonstrated by an individual when
functioning at an advanced practice level, i...
The Canadian Nurses Association 2008
Advance practice nurses build on their expertise in a specialty area, integrating and...
What is advanced practice in nursing?
What is the problem we are trying to solve?

“The nursing profession must now
deline...
Some questions we need to consider
What are the key issues?
What do other professions do in this space?
What are the risks...
Let’s discuss
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Alison Mc Millan, Department of Health Victoria: Unpacking The Question: What Is Advanced Practice In Nursing?

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Alison J McMillan, Chief Nurse & Midwifery Officer , Department of Health Victoria delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is designed for organisations and managers looking to better understand, utilise and grow the role of the nurse practitioner in their health service. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/nursepractitionersconference

Published in: Health & Medicine
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Transcript of "Alison Mc Millan, Department of Health Victoria: Unpacking The Question: What Is Advanced Practice In Nursing? "

  1. 1. Unpacking the question: What is advanced practice in nursing? Alison McMillan Chief Nurse and Midwifery Officer Department of Health Victoria
  2. 2. Context – Department of Health Victoria Who are we? • Created in August 2009 • 2011-12 output budget of $13.1b • Portfolios: – health – mental health & drugs – aged care
  3. 3. Context – Department of Health Victoria Our roles • System management • Policy, planning & strategy • Funding & performance management • Health promotion & protection
  4. 4. Chief Nurse & Midwifery Officer! The Chief Nurse & Midwifery Officer is a key thought leader and advisor to government and the public health system of Victoria in relation to the nursing and midwifery professions. The role aims to build effective relationships with key industry and professional bodies across the spectrum of nursing and midwifery practice, as well as the broader clinical stakeholder community. The Chief Nurse & Midwifery Officer role motivates debate and developmental thinking in representing government and the Victorian health sector on matters of strategic and operational significance to the health system around professional nursing and midwifery issues.
  5. 5. Rules of Dialogue • Treat everyone as a colleague • Conduct a shared inquiry into mutual concerns • It’s okay to disagree • Build shared understanding that leads to something new • Discuss the undiscussable Robert Hargreaves Your First 100 days in an Executive Job 2011
  6. 6. Looking ahead – the challenge Sustainability/efficiency Improving Patient Outcomes Ageing population/workforce Reducing waiting times Changes in technology Seamless care Therapeutic advances Clinician owned and lead reform Diminishing workforce supply (esp nursing)
  7. 7. Putting it nicely Providing consistently high quality care is an ongoing challenge for healthcare systems, despite huge improvements in science, technology and clinical practice. This challenge is magnified by the continued increase in complexity, demand and variability across the system. Professor Nick Black BMJ April 2010
  8. 8. What is advanced practice in nursing? What is the problem we are trying to solve?
  9. 9. The International Council of Nurses definition for advanced practice nurse The advanced practice nurse (APN) is a registered nurse who has acquired an expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. Titles in this category vary from country to country and are applied inconsistently, even within the same country. Titles such as nurse practitioners, clinical nurse specialist, and clinical nurse are used in conjunction with this category. A Masters degree is recommended for entry level. (Nursing care continuum framework, ICN 2008)
  10. 10. The Strong Model of Nursing Practice Five Areas of Advanced Practice 1. Direct Comprehensive Care Patient focused activities that include assessments, procedures, interpretation of data and patient counselling. 2. Support of Systems Professional contributions to standards, quality initiatives, and development of policies, procedures and practice guidelines to optimize nursing practice within the institution. 3. Education Contributions to caregiver, student and public learning related to health and illness. 4. Research Practice that challenges the status quo and seeks better patient care through scientific inquiry and incorporating evidencebased practice into direct patient care. 5. Publication and Professional Leadership Promotion and dissemination of nursing and health care knowledge beyond the individual practice setting.
  11. 11. In the United Kingdom The characteristics demonstrated by an individual when functioning at an advanced practice level, including: • Clinical/direct care practice • Leadership and collaborative practice • Improving quality and developing practice • Developing self and others
  12. 12. The Canadian Nurses Association 2008 Advance practice nurses build on their expertise in a specialty area, integrating and consistently displaying specific features and characteristics. They further describe the specific knowledge, skills, judgement and personal attributes required for advanced nursing practice: • Provision of effective and efficient care, delivered with a high degree of autonomy, to an identified population; • Demonstration of leadership and initiation of change to improve client, organisation and system outcomes; • Deliberate, purposeful and integrated use of in-depth nursing knowledge, research and clinical expertise, as well as integration of knowledge from other disciplines; • Depth and breadth of knowledge that draws on a wide range of strategies to meet the needs of clients and to improve access to and quality of care; • Ability to explain and apply the theoretical, empirical, ethical and experiential foundations of nursing practice; • Understanding, development and dissemination of evidence based nursing knowledge; • Ability to initiate or participate in planning, coordinating, implementing and evaluating programs to meet client needs and support nursing practice; • Demonstration of advanced judgement and decision making skills; and • Critical analysis of and influence on health policy.
  13. 13. What is advanced practice in nursing? What is the problem we are trying to solve? “The nursing profession must now delineate what is advanced practice from the practice profile of other nursing roles and titles, in order to inform new nurse led service delivery models in the contemporary Australian health care system “. Gardner et al, 2012
  14. 14. Some questions we need to consider What are the key issues? What do other professions do in this space? What are the risks? Does all reform need to be nurse led? How will this benefit patients? How will this effect efficiency? How will this stimulate innovation? Is clarity of roles and titles necessary?
  15. 15. Let’s discuss
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