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ANP Oncology Masterclass presentation - Dr J Richmond

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    ANP Oncology Masterclass presentation - Dr J Richmond ANP Oncology Masterclass presentation - Dr J Richmond Presentation Transcript

    • Letterkenny General Hospital, Co.Donegal
      • The development of an Advanced Nurse Practitioner Post Oncology
      • Dr Janice Richmond
      • [email_address]
      • [email_address]
    • Structure
      • Local context and pre-site facilitation work
      • Site preparation-working to site accreditation
        • Working as an ANP site-facilitator
      • Job components
      • ANP accreditation working to submit portfolio
        • Working as an ANP candidate
      • Conclusion
    • Local context and pre-site facilitation work
    • LGH context 2006
      • Regional General
      • 300 nurses
      • 300 beds
      • 1 Haem/Onc DSU
      • 1 Haem/Onc ward
      • 1 Cons Onc
      • 1 Cons Haem
    • Service history up to 2006
      • 1990s-Staff nurses in oncology commenced service
      • 2001/2002-Consultant Oncologist and Haematologist appointed
      • 2002 CNM2 Haem/Onc DSU appointed
      • 2002 CNS Haematology appointed
      • 2002 CNS Oncology appointed
      • 2002 OPD clinics commenced
      • 2003 CNS Oncology Liaison appointed
      • 2005 ANP Site-facilitator Oncology appointed
      • 2005 CNM1 Oncology DSU appointed
      • 2005 CNM2 Haem/Onc In-patient ward appointed
      • 2006 ANP appointed and nurse-led clinics commenced
    • Oncology/Haematology Service up to 2006
      • 1 Day services Unit
      • I In-patient ward (11 beds) opened 03/2006
      • 1 OPD Oncology Clinic Monday pm
      • 1 OPD Haematology Clinic Monday am
      • 3 satellite St Luke's clinics/month
        • Visiting radiation oncologist
      • 2 nurse-led Oncology Clinics/week & 1 walk-in clinic per week
    • Pre-site facilitation work
      • DoN had a vision for ANP Oncology in 2002
      • ANP posts must be service-led
        • Behind in review clinics
        • Psychological support at clinics minimal
        • Delay in reviewing consults
        • Delays in Haem/Onc Day Services for review patients
    • The route taken
      • CNS Oncology given the job of leading out on development of ANP job description
      • Key stakeholders group set up to lead/develop this role
        • CNS oncology, CNS haematology, CNM2 oncology, DoN, A/DoN, CNM3, PD person.
        • Medical staff & NCNM not included at this stage
    • The route taken-4 meetings
      • Brainstorming sessions surrounding job components of ANP role
      • Analyse National Council requirements for ANP
      • Analyse existing ANP roles/job descriptions and other job descriptions
      • Analyse job components documented by nursing literature
      • Advantages/disadvantages of ANP role
      • Vision for ANP role within LGH
      • Developed complex job description
        • Needed reduced and redefined
    • Job purpose ANP Oncology Job Purpose The ANP is a senior member of nursing staff able to function as an autonomous practitioner responsible for leading a comprehensive oncology nursing service for cancer patients and their families in Letterkenny General Hospital. The ANP, as an expert practitioner, is an integral member of the multidisciplinary team, linking hospital care with the community, and is a recognised leader within oncology nursing practice and research .
      • Autonomy in Clinical Practice
      • Advanced case load management &
      • embracing the expanding nurses’ role
      • Autonomous and holistic assessment
      • St-Luke's Clinic
      • Out-patients Clinic
      • In-patients
      • Day Centre care
      • Planning of care for oncology patients
      • Liasing with other professionals
      • Implementing care complementary to the
      • effective management and treatment of
      • patients
      • Evaluating care
      • Replanning care if necessary
      • Discharge planning & follow-up care
      • Researcher
      • Perform nursing research to examine
      • practice
      • Initiate & develop research strategies
      • within the Hosp/Board
      • Participate in audit of own practice
      • Use an evidence-based practice approach
      • review and update nursing policies/practice
      • within the Hosp.
      • Disseminate research through journal
      • publications/conference presentations
      • Maintain an up-to-date knowledge of
      • Clinical Trials
      • Professional/Clinical Leadership
      • Education and training of oncology
      • professionals and other non-oncology nurses
      • who encounter cancer patients in their work
      • Participate in hosp.wide educational programmes
      • Develop policies & protocols
      • Develop educational role with patients & families
      • Produce educational information for patients
      • Develop and foster links with professionals in
      • Ireland, UK & abroad
      • Own personal development
      • Develop nursing documentation
      • Involvement in clinical supervision
      • Expert Practitioner
      • Reflect expert clinical knowledge
      • Work in collaboration with other staff
      • within the Hosp. & Community
      • Role model best nursing care through daily
      • working with patients
      • Mentorship of staff/students
      • Develop patient led care and involve patients in
      • the care they receive
      • Encourage patient decision making
      • Empower nursing staff to improve nursing care
      • Increase the profile of nursing at
      • local, regional international level
      Partnership with patients MDT working Practice development Patient advocate Community Community Change agent Develop/review & implement a Service plan Consultancy Vision for service growth Evaluated through annual report Patient focused Consultant support & guidance
    • Taking this forward
      • Consult wider group (medical board)
      • NCNM involved
      • Funding sought (? NCNM, ? Health board)
      • Funding obtained (NCNM)
      • Job advertised Summer 2004
      • Interviews 16.07.04
      • Successful applicant informed 23.07.04
      • Site-prep commenced 21.02.05
    • Site preparation-working to site accreditation Working as an ANP site-facilitator
    • Successful applicant
      • RN, BSc(Hons) 1996
      • PGDip Advanced Nursing-1998
      • Doctorate in Nursing Science-2002
      • N.Ireland
      • Kenya
      • Ireland
    • Successful applicant
      • Oncology experience
      • Radiation-inpatients and hostel setting
      • Chemotherapy-in-patient and day services care
      • Palliative care
      • Teaching at QUB/UUC
      • Research-clinical trials and nursing research
      • Oncology mainly since 1997
      • Staff Nurse
      • Nurse Manager
      • Practice Development Nurse
      • Clinical Nurse Specialist
    • Site preparation stage
      • Site document prepared
      • Also undertook:
      • Physical examination module (UCD)
      • Psycho-Oncology Module (DCU)
    • Site-preparation
      • Job description already written
      • Site-preparation had unofficially been ongoing in ideas and conversations only
      • Nothing had been documented
      • Released full-time for site prep
    • The site-preparation file
      • Part 1: Application form (download)
      • Part 2: Job description
      • Part 3: ANP preparation
      • Part 4: Financial approval form (download)
      • Appendices
      • Reference list
    • The site-preparation file
      • Part 2:
      • Job description (pg 30 NCNM 2004)
          • Job title
          • Grade
          • WTE hours
          • Reporting relationships
          • Location
      • Background to post
          • Includes historical documents
          • Oncology Department information
          • National Developments
          • Service Need
      • Purpose of the post
    • The site-preparation file
      • Part 2:
      • Role responsibilities (pg 31 NCNM 2004)
          • Clinical practice
            • Autonomy
            • Expert clinical practice
          • Pioneering professional and clinical leadership
          • Researcher (Identify priorities for nursing research)
      • Descriptive
      • Talk through job description
    • The site-preparation file
      • Part 2:
      • Person specification (pg 32 NCNM 2004)
          • Qualifications outlined
          • Experience specified
          • Competencies
            • Autonomy in clinical practice
            • Expert practitioner
            • Professional and clinical leadership
            • Researcher
      • Make description in previous section (role responsibilities) into competencies
    • The site-preparation file
      • Part 3: ANP Oncology Site Prep (pg 33 NCNM 2004)
      • Took the 11 criteria and made them into 11 sections & 1 conclusion
    • The site-preparation file
      • Part 3:
      • Health service need (pg 33)
        • Background to post (description of route taken)
        • Results of audits
        • Service review, evaluation and case load analysis (service plan)
        • Review of relevant literature and documents
        • Epidemiological and demographical data (HSE and NWHB documents)
        • National and international developments
        • Conclusion
    • The site-preparation file
      • Part 3:
      • Relevant legislation, rules, regulations and guidelines
        • Relevant documents (ABA)
        • Areas of expansion in relation to ANP Oncology
          • Laws, rules, regulations and guidelines
        • Conclusion
    • The site-preparation file
      • Part 3:
      • Service insurance arrangements
        • Liaise with Clinical risk manager
        • Vicarious liability
    • The site-preparation file
      • Part 3:
      • 4. Guideline development
      • Outlined generic process
      • Identify caseloads
      • Consider scope of practice
      • Write guidelines (#19)
    • The site-preparation file
      • Part 3:
      • 5. Patient/client benefits (pg 34 NCNM 2004)
        • Introduction
        • Projected level of service to be provided
        • Current service provision
        • Identification of key projected outcomes in service
        • Audit of service provided
        • Potential value of ANP to pt/client
    • The site-preparation file
      • Part 3:
      • 6. Consistency with service philosophy
        • Statement of service
        • Philosophy of care
        • Role of ANP
        • ANP links with philosophy of care
    • The site-preparation file
      • Part 3:
      • 7. Facilitation of service plan
      • Described how ANP would complement and expand current service provision
    • The site-preparation file
      • Part 3:
      • 8 . Location of service
      • 1 paragraph outlining where the ANP should function
    • The site-preparation file
      • Part 3:
      • 9. Integration of the role to the MDT
        • Identified key stakeholders and methods of communication
        • Relationship of the role to other MDT members
        • Areas of role development that required negotiation
        • Effect of the role upon other health professionals
    • The site-preparation file
      • Part 3:
      • 10. Role context within nursing framework
        • Areas of responsibility
        • Levels of authority
        • Channels of accountability
    • The site-preparation file
      • Part 3:
      • 11. Resource implications
        • Rostering
        • Staff
        • Equipment and facilities
        • Research facilities
        • CPD
        • Audit facilities
        • Liaison arrangement with 3 rd level institutions
    • The site-preparation file
      • Part 3:
      • 12. Conclusion
      • Reiterated job purpose
    • The site-preparation file
      • Part 4:
      • Financial approval form (download)
    • The site-preparation file
      • Appendices
      • Audit tables/diagrams
      • Guidelines #19
      • Audit form(s) & documents
      • References
    • Site preparation
      • Commenced 21.02.05 to 04.04.05
      • Site visit by NCNM June 2006
      • Site accredited August 2006 by NCNM
      • ANP candidate job advertised Feb 2006
      • ANP candidate appointed May 2006
        • Only when achieved ‘candidate’ status can ANP portfolio be submitted
    • ANP job components
    • Clinical work of ANP Oncology
      • Caseload management of all patients with a breast cancer and colorectal diagnoses following an 18 month disease free period.
      • Caseload management of all patients with a testicular cancer diagnosis not on active treatment.
      • Shared caseload management of review patients attending the multi-disciplinary oncology clinics.
      • Initial assessment and examination of ‘new’ patients referred to the Oncology team.
      • Shared caseload management of in-patients where the skills of ANP specifically requested
    • Clinical job components
      • Advanced holistic psychosocial and physical assessment
        • To include family members/significant others
      • Plan Oncology care and communicate this to patient/family
        • Education
        • Advocate
      • Initiate care/work-up/investigations and treatment modalities
    • Clinical job components
      • Identify and implement health promotion strategies
      • Refer to to other health professionals
      • Plan for and state when discharge appropriate
        • Initiate follow-up
      • Provide contact details
    •   In-patient work Outpatient work Geographic location In-patient wards Outpatient multidisciplinary team clinics ANP-led clinics ‘ New’ referrals to the Oncology team     All patients with a breast cancer diagnosis following an 18-month disease free period.   All patients with a colorectal cancer diagnosis following an 18-month disease free period.   All patients with a testicular cancer diagnosis not on cancer treatment.   ‘ Review’ of patients attending for follow-up     ‘ Review’ of in-patients   Key: Yellow : Anticipated main clinical work of ANP Oncology Red: Weekly clinic for the ANP Oncology Green: Input from ANP Oncology is dependent on patient needs and other workload (i.e. ‘red’ areas)
    • Education
      • LYIT Undergraduate programme
      • LYIT Postgraduate Oncology Diploma
      • UUC Undergraduate programme
      • CNME Study days & short courses
      • CNME Foundations in Oncology & Haematology Nursing
      • LGH workshops
      • LGH study days
      • 1 annual Haem/Onc study day
      • 2 Conferences per annum
      • 2 publications per annum
    • Research and Audit
      • Neutropenia research
      • ? Study on Port-a-Caths in 2007
      • Continually record/audit ANP workload
    • Other work
      • Initiate and lead Haem/Onc nurses meetings
      • Haem/Onc Board member
      • Policy Review committee member
      • Chairperson for accreditation process
      • Support group
    • Other work contd…
      • Senior nurse-pulled into management
      • Mid-line catheters
      • Clinical Trial
      • PICC service
    • External to LGH
      • Cancer Nursing Practice Editorial Board
      • IANO committee member
      • NW IANO chairperson
      • NCI All-Ireland Nurses Working Group
      • External reviewer to RCN publishing
      • External reviewer to UCF
      • Editorial board member
    • ANP Oncology Overview Research time Office Friday Senior nurses meeting Nursing clinic Office Wards Thursday Haem/Onc Board Teaching Team meeting Radiology Conference Walk-in clinic Wednesday Accreditation Nursing clinic Office Wards Tuesday OPD clinic Office Monday Afternoon Morning
    • ANP audits (per annum)
        • ANP clinics (n=251)
        • Walk-in clinics (commenced July 2006, n=23)
        • OPD clinics (n=319 or 46% of review workload)
        • RIP letters (n=50 approx)
        • Thank you’s (n=52)
        • Education (53.5 hours and 94.5 hours mentor)
        • Staff support (Commenced July 2006, n=10.5 hours)
        • Consults (n=50)
        • Ward work (n=42)
        • Mid-line catheters (Commenced June 2006, n=15)
    • ANP accreditation Re-accredited every 5 years
    • Portfolio. Page 37, NCNM 2004
      • Application form (download)
      • Job description (as per site-prep document)
      • Detailed Portfolio
      • Competencies required and attained
      • Evidence and certificates
      • References
    • Portfolio, part 3
      • Personal details
      • General Education
      • Professional education
          • Registerable qualifications
          • Other professional qualifications
          • Meaningful achievements
      • Professional nursing posts held
    • Portfolio, part 3
      • 5. CPD
          • Study activities (small courses)
          • Research audit and project work
          • Documents produced/developed
          • Publications (list)
          • Professional awards obtained (list & date)
          • Lectures &seminars presented
          • Courses organised
          • Study days organised
          • Papers presented
          • Posters presented
          • Clinical supervision involvement
          • In service training obtained
    • Portfolio, part 3
          • Conferences and seminars attended
          • Study days attended
          • Professional and work-based activities
    • Portfolio
      • Part 4: competencies required and obtained
      • Table format
      3.3 3.4 See …. LGH site-prep document None Formal education (list) CPD (list) ANP guidelines Experience Supervised practice Accept responsibility for clinical decision making at advanced practice level Reference to evidence that competency achieved How achieved Specific competency as per part 1
    • Portfolio
      • Reference list
      • Evidence in order as to which it was referred to in the list of competencies
    • Conclusion
    • Value of ANP Oncology
      • Initial assessment by ANP provides patient/family with immediate plan for Oncology Tx and/or palliative care
        • Reduces patient/family anxieties
        • Can have graded approach to breaking bad news
        • Ensures faster & appropriate work-up
        • Improved referral mechanisms
        • Enables speedier and more seamless discharge for in-patients
        • Reduces in-patient bed requirements
    • Value of ANP Oncology
      • Continuous link in patient’s care (at diagnosis, as in-patient, review clinics etc)
      • Available by telephone and have admission rights
      • Have referral mechanisms in place for community staff to have ANP review patients
    • Value of ANP Oncology
      • ANP-led clincs e nable s more time to be spent with patients
        • Focus on quality of life issues & health promotion
      • ANP clinics reduce pressure on multi-disciplinary clinic times
        • Can bring sicker patients back to this clinic
      • ANP at OPD clinics increases numbers of patients reviewed
        • Zeroed waiting times for review patients
    • Achievements to date
      • Reduced review patient waiting times to be scheduled for review-now on target
      • Release consultant time to deal with complex cases at clinic-no additional ‘new patient clinics’ have been needed prior to commencing service
      • All consults reviewed within 24 hours
      • Senior nurses meeting
      • No complaints to date
      • Better able to lead/develop service
      • Launch patient support group November 2006
    • Improvements required
      • Prescribing rights
      • Radiology rights
      • Need good nursing leader
      • Hand over clinical trial
      • Set up but then hand over PICC placement
    • Lessons to be learnt
      • Get site-prep done ASAP!
      • Go to all meetings relevant to the job. Don’t let others describe it for you
      • Don’t be too ambitious
      • Consider impact on porters, secretaries, medical records, phlebotomy etc
      • Contact cards
      • Am I doing it right?
      • Am I doing enough?
      • Encouragement:
      • New South Wales
      • UK
      • MSKCC-USA
    • Value of ANP Oncology
      • Specialised team member
      • Professional and clinical leader
      • Initiates/leads/participates in educational programmes (internal/external to hospital)
      • Researcher
      • Participates in audit and uses results to change practice
      • Have national/international links
      • Promotes hospital/nursing through journal publications/conference presentations
      • The ANP is a senior member of nursing staff able to function as an autonomous practitioner responsible for leading a
      • comprehensive oncology nursing service for cancer patients and their families in Letterkenny General Hospital.
      • The ANP, as an expert practitioner, is an integral member of the multidisciplinary team, linking hospital care with the community,
      • and is a recognised leader within oncology nursing practice and research .