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ANP Oncology Masterclass presentation - Dr J Richmond

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  • 1. Letterkenny General Hospital,Letterkenny General Hospital, Co.DonegalCo.Donegal The development of anThe development of an Advanced NurseAdvanced Nurse Practitioner Post OncologyPractitioner Post Oncology Dr Janice RichmondDr Janice Richmond
  • 2. JaniceP.Richmond@mailb.hse.ieJaniceP.Richmond@mailb.hse.ie m.murray@st-vincents.iem.murray@st-vincents.ie
  • 3. StructureStructure 1.1. Local context and pre-site facilitation workLocal context and pre-site facilitation work 2.2. Site preparation-working to site accreditationSite preparation-working to site accreditation • Working as an ANP site-facilitatorWorking as an ANP site-facilitator 3.3. Job componentsJob components 4.4. ANP accreditation working to submit portfolioANP accreditation working to submit portfolio • Working as an ANP candidateWorking as an ANP candidate 5.5. ConclusionConclusion
  • 4. Local context and pre-siteLocal context and pre-site facilitation workfacilitation work
  • 5. LGH context 2006LGH context 2006 • Regional GeneralRegional General • 300 nurses300 nurses • 300 beds300 beds • 1 Haem/Onc DSU1 Haem/Onc DSU • 1 Haem/Onc ward1 Haem/Onc ward • 1 Cons Onc1 Cons Onc • 1 Cons Haem1 Cons Haem
  • 6. Service history up to 2006Service history up to 2006 • 1990s-Staff nurses in oncology commenced service1990s-Staff nurses in oncology commenced service • 2001/2002-Consultant Oncologist and Haematologist2001/2002-Consultant Oncologist and Haematologist appointedappointed • 2002 CNM2 Haem/Onc DSU appointed2002 CNM2 Haem/Onc DSU appointed • 2002 CNS Haematology appointed2002 CNS Haematology appointed • 2002 CNS Oncology appointed2002 CNS Oncology appointed • 2002 OPD clinics commenced2002 OPD clinics commenced • 2003 CNS Oncology Liaison appointed2003 CNS Oncology Liaison appointed • 2005 ANP Site-facilitator Oncology appointed2005 ANP Site-facilitator Oncology appointed • 2005 CNM1 Oncology DSU appointed2005 CNM1 Oncology DSU appointed • 2005 CNM2 Haem/Onc In-patient ward appointed2005 CNM2 Haem/Onc In-patient ward appointed • 2006 ANP appointed and nurse-led clinics commenced2006 ANP appointed and nurse-led clinics commenced
  • 7. Oncology/Haematology ServiceOncology/Haematology Service up to 2006up to 2006 • 1 Day services Unit1 Day services Unit • I In-patient ward (11 beds) opened 03/2006I In-patient ward (11 beds) opened 03/2006 • 1 OPD Oncology Clinic Monday pm1 OPD Oncology Clinic Monday pm • 1 OPD Haematology Clinic Monday am1 OPD Haematology Clinic Monday am • 3 satellite St Luke's clinics/month3 satellite St Luke's clinics/month – Visiting radiation oncologistVisiting radiation oncologist • 2 nurse-led Oncology Clinics/week & 1 walk-in2 nurse-led Oncology Clinics/week & 1 walk-in clinic per weekclinic per week
  • 8. Pre-site facilitation workPre-site facilitation work • DoN had a vision for ANP Oncology inDoN had a vision for ANP Oncology in 20022002 • ANP posts must be service-ledANP posts must be service-led – Behind in review clinicsBehind in review clinics – Psychological support at clinics minimalPsychological support at clinics minimal – Delay in reviewing consultsDelay in reviewing consults – Delays in Haem/Onc Day Services for reviewDelays in Haem/Onc Day Services for review patientspatients
  • 9. The route takenThe route taken • CNS Oncology given the job of leading outCNS Oncology given the job of leading out on development of ANP job descriptionon development of ANP job description • Key stakeholders group set up toKey stakeholders group set up to lead/develop this rolelead/develop this role – CNS oncology, CNS haematology, CNM2CNS oncology, CNS haematology, CNM2 oncology, DoN, A/DoN, CNM3, PD person.oncology, DoN, A/DoN, CNM3, PD person. – Medical staff & NCNM not included at thisMedical staff & NCNM not included at this stagestage
  • 10. The route taken-4 meetingsThe route taken-4 meetings • Brainstorming sessions surrounding jobBrainstorming sessions surrounding job components of ANP rolecomponents of ANP role • Analyse National Council requirements for ANPAnalyse National Council requirements for ANP • Analyse existing ANP roles/job descriptions andAnalyse existing ANP roles/job descriptions and other job descriptionsother job descriptions • Analyse job components documented by nursingAnalyse job components documented by nursing literatureliterature • Advantages/disadvantages of ANP roleAdvantages/disadvantages of ANP role • Vision for ANP role within LGHVision for ANP role within LGH • Developed complex job descriptionDeveloped complex job description – Needed reduced and redefinedNeeded reduced and redefined
  • 11. 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
  • 12. Taking this forwardTaking this forward • Consult wider group (medical board)Consult wider group (medical board) • NCNM involvedNCNM involved • Funding sought (? NCNM, ? Health board)Funding sought (? NCNM, ? Health board) • Funding obtainedFunding obtained (NCNM)(NCNM) • Job advertised Summer 2004Job advertised Summer 2004 • Interviews 16.07.04Interviews 16.07.04 • Successful applicant informed 23.07.04Successful applicant informed 23.07.04 • Site-prep commenced 21.02.05Site-prep commenced 21.02.05
  • 13. Site preparation-working toSite preparation-working to site accreditationsite accreditation Working as an ANP site-Working as an ANP site- facilitatorfacilitator
  • 14. Successful applicantSuccessful applicant • RN, BSc(Hons) 1996RN, BSc(Hons) 1996 • PGDip AdvancedPGDip Advanced Nursing-1998Nursing-1998 • Doctorate in NursingDoctorate in Nursing Science-2002Science-2002 • N.IrelandN.Ireland • KenyaKenya • IrelandIreland
  • 15. Successful applicantSuccessful applicant Oncology experienceOncology experience • Radiation-inpatients andRadiation-inpatients and hostel settinghostel setting • Chemotherapy-in-patientChemotherapy-in-patient and day services careand day services care • Palliative carePalliative care • Teaching at QUB/UUCTeaching at QUB/UUC • Research-clinical trialsResearch-clinical trials and nursing researchand nursing research Oncology mainly sinceOncology mainly since 19971997 • Staff NurseStaff Nurse • Nurse ManagerNurse Manager • Practice DevelopmentPractice Development NurseNurse • Clinical NurseClinical Nurse SpecialistSpecialist
  • 16. Site preparation stageSite preparation stage • Site documentSite document preparedprepared Also undertook:Also undertook: 1.1. PhysicalPhysical examination moduleexamination module (UCD)(UCD) 2.2. Psycho-OncologyPsycho-Oncology Module (DCU)Module (DCU)
  • 17. Site-preparationSite-preparation • Job description already writtenJob description already written • Site-preparation had unofficially beenSite-preparation had unofficially been ongoing in ideas and conversations onlyongoing in ideas and conversations only • Nothing had been documentedNothing had been documented • Released full-time for site prepReleased full-time for site prep
  • 18. The site-preparation fileThe site-preparation file 1.1. Part 1: Application form (download)Part 1: Application form (download) 2.2. Part 2: Job descriptionPart 2: Job description 3.3. Part 3: ANP preparationPart 3: ANP preparation 4.4. Part 4: Financial approval form (download)Part 4: Financial approval form (download) 5.5. AppendicesAppendices 6.6. Reference listReference list
  • 19. The site-preparation fileThe site-preparation file Part 2:Part 2: • Job description (pg 30 NCNM 2004)Job description (pg 30 NCNM 2004) • Job titleJob title • GradeGrade • WTE hoursWTE hours • Reporting relationshipsReporting relationships • LocationLocation • Background to postBackground to post • Includes historical documentsIncludes historical documents • Oncology Department informationOncology Department information • National DevelopmentsNational Developments • Service NeedService Need • Purpose of the postPurpose of the post
  • 20. The site-preparation fileThe site-preparation file Part 2:Part 2: • Role responsibilities (pg 31 NCNM 2004)Role responsibilities (pg 31 NCNM 2004) • Clinical practiceClinical practice – AutonomyAutonomy – Expert clinical practiceExpert clinical practice • Pioneering professional and clinical leadershipPioneering professional and clinical leadership • Researcher (Identify priorities for nursing research)Researcher (Identify priorities for nursing research) DescriptiveDescriptive Talk through job descriptionTalk through job description
  • 21. The site-preparation fileThe site-preparation file Part 2:Part 2: • Person specification (pg 32 NCNM 2004)Person specification (pg 32 NCNM 2004) • Qualifications outlinedQualifications outlined • Experience specifiedExperience specified • CompetenciesCompetencies – Autonomy in clinical practiceAutonomy in clinical practice – Expert practitionerExpert practitioner – Professional and clinical leadershipProfessional and clinical leadership – ResearcherResearcher Make description in previous section (roleMake description in previous section (role responsibilities) into competenciesresponsibilities) into competencies
  • 22. The site-preparation fileThe site-preparation file Part 3: ANP Oncology Site Prep (pg 33Part 3: ANP Oncology Site Prep (pg 33 NCNM 2004)NCNM 2004) Took the 11 criteria and made them into 11Took the 11 criteria and made them into 11 sections & 1 conclusionsections & 1 conclusion
  • 23. The site-preparation fileThe site-preparation file Part 3:Part 3: 1.1. Health service need (pg 33)Health service need (pg 33) 1.1. Background to post (description of route taken)Background to post (description of route taken) 2.2. Results of auditsResults of audits 3.3. Service review, evaluation and case load analysisService review, evaluation and case load analysis (service plan)(service plan) 4.4. Review of relevant literature and documentsReview of relevant literature and documents 5.5. Epidemiological and demographical data (HSE andEpidemiological and demographical data (HSE and NWHB documents)NWHB documents) 6.6. National and international developmentsNational and international developments 7.7. ConclusionConclusion
  • 24. The site-preparation fileThe site-preparation file Part 3:Part 3: 2.2. Relevant legislation, rules, regulations andRelevant legislation, rules, regulations and guidelinesguidelines 1.1. Relevant documents (ABA)Relevant documents (ABA) 2.2. Areas of expansion in relation to ANP OncologyAreas of expansion in relation to ANP Oncology • Laws, rules, regulations and guidelinesLaws, rules, regulations and guidelines 3.3. ConclusionConclusion
  • 25. The site-preparation fileThe site-preparation file Part 3:Part 3: • Service insurance arrangementsService insurance arrangements – Liaise with Clinical risk managerLiaise with Clinical risk manager – Vicarious liabilityVicarious liability
  • 26. The site-preparation fileThe site-preparation file Part 3:Part 3: 4.4. Guideline developmentGuideline development • Outlined generic processOutlined generic process • Identify caseloadsIdentify caseloads • Consider scope of practiceConsider scope of practice • Write guidelines (#19)Write guidelines (#19)
  • 27. The site-preparation fileThe site-preparation file Part 3:Part 3: 5.5. Patient/client benefits (pg 34 NCNM 2004)Patient/client benefits (pg 34 NCNM 2004) 1.1. IntroductionIntroduction 2.2. Projected level of service to be providedProjected level of service to be provided 3.3. Current service provisionCurrent service provision 4.4. Identification of key projected outcomes in serviceIdentification of key projected outcomes in service 5.5. Audit of service providedAudit of service provided 6.6. Potential value of ANP to pt/clientPotential value of ANP to pt/client
  • 28. The site-preparation fileThe site-preparation file Part 3:Part 3: 6.6. Consistency with service philosophyConsistency with service philosophy 1.1. Statement of serviceStatement of service 2.2. Philosophy of carePhilosophy of care 3.3. Role of ANPRole of ANP 4.4. ANP links with philosophy of careANP links with philosophy of care
  • 29. The site-preparation fileThe site-preparation file Part 3:Part 3: 7.7. Facilitation of service planFacilitation of service plan Described how ANP would complementDescribed how ANP would complement and expand current service provisionand expand current service provision
  • 30. The site-preparation fileThe site-preparation file Part 3:Part 3: 88. Location of service. Location of service 1 paragraph outlining where the ANP1 paragraph outlining where the ANP should functionshould function
  • 31. The site-preparation fileThe site-preparation file Part 3:Part 3: 9.9. Integration of the role to the MDTIntegration of the role to the MDT 1.1. Identified key stakeholders and methods ofIdentified key stakeholders and methods of communicationcommunication 2.2. Relationship of the role to other MDT membersRelationship of the role to other MDT members 3.3. Areas of role development that required negotiationAreas of role development that required negotiation 4.4. Effect of the role upon other health professionalsEffect of the role upon other health professionals
  • 32. The site-preparation fileThe site-preparation file Part 3:Part 3: 10.10. Role context within nursing frameworkRole context within nursing framework 1.1. Areas of responsibilityAreas of responsibility 2.2. Levels of authorityLevels of authority 3.3. Channels of accountabilityChannels of accountability
  • 33. The site-preparation fileThe site-preparation file Part 3:Part 3: 11.11. Resource implicationsResource implications 1.1. RosteringRostering 2.2. StaffStaff 3.3. Equipment and facilitiesEquipment and facilities 4.4. Research facilitiesResearch facilities 5.5. CPDCPD 6.6. Audit facilitiesAudit facilities 7.7. Liaison arrangement with 3Liaison arrangement with 3rdrd level institutionslevel institutions
  • 34. The site-preparation fileThe site-preparation file Part 3:Part 3: 12.12. ConclusionConclusion Reiterated job purposeReiterated job purpose
  • 35. The site-preparation fileThe site-preparation file Part 4:Part 4: Financial approval form (download)Financial approval form (download)
  • 36. The site-preparation fileThe site-preparation file AppendicesAppendices • Audit tables/diagramsAudit tables/diagrams • Guidelines #19Guidelines #19 • Audit form(s) & documentsAudit form(s) & documents ReferencesReferences
  • 37. Site preparationSite preparation • Commenced 21.02.05 to 04.04.05Commenced 21.02.05 to 04.04.05 • Site visit by NCNM June 2006Site visit by NCNM June 2006 • Site accredited August 2006 by NCNMSite accredited August 2006 by NCNM • ANP candidate job advertised Feb 2006ANP candidate job advertised Feb 2006 • ANP candidate appointed May 2006ANP candidate appointed May 2006 – Only when achieved ‘candidate’ status canOnly when achieved ‘candidate’ status can ANP portfolio be submittedANP portfolio be submitted
  • 38. ANP job componentsANP job components
  • 39. Clinical work of ANP OncologyClinical work of ANP Oncology • Caseload management of all patients with a breastCaseload management of all patients with a breast cancer and colorectal diagnoses following an 18cancer and colorectal diagnoses following an 18 month disease free period.month disease free period. • Caseload management of all patients with aCaseload management of all patients with a testicular cancer diagnosis not on active treatment.testicular cancer diagnosis not on active treatment. • Shared caseload management of review patientsShared caseload management of review patients attending the multi-disciplinary oncology clinics.attending the multi-disciplinary oncology clinics. • Initial assessment and examination of ‘new’Initial assessment and examination of ‘new’ patients referred to the Oncology team.patients referred to the Oncology team. • Shared caseload management of in-patients whereShared caseload management of in-patients where the skills of ANP specifically requestedthe skills of ANP specifically requested
  • 40. Clinical job componentsClinical job components • Advanced holistic psychosocial and physicalAdvanced holistic psychosocial and physical assessmentassessment – To include family members/significant othersTo include family members/significant others • Plan Oncology care and communicate this toPlan Oncology care and communicate this to patient/familypatient/family – EducationEducation – AdvocateAdvocate • Initiate care/work-up/investigations andInitiate care/work-up/investigations and treatment modalitiestreatment modalities
  • 41. Clinical job componentsClinical job components • Identify and implement health promotionIdentify and implement health promotion strategiesstrategies • Refer to to other health professionalsRefer to to other health professionals • Plan for and state when dischargePlan for and state when discharge appropriateappropriate – Initiate follow-upInitiate follow-up • Provide contact detailsProvide contact details
  • 42.   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)
  • 43. EducationEducation • LYIT Undergraduate programmeLYIT Undergraduate programme • LYIT Postgraduate Oncology DiplomaLYIT Postgraduate Oncology Diploma • UUC Undergraduate programmeUUC Undergraduate programme • CNME Study days & short coursesCNME Study days & short courses • CNME Foundations in Oncology & HaematologyCNME Foundations in Oncology & Haematology NursingNursing • LGH workshopsLGH workshops • LGH study daysLGH study days • 1 annual Haem/Onc study day1 annual Haem/Onc study day • 2 Conferences per annum2 Conferences per annum • 2 publications per annum2 publications per annum
  • 44. Research and AuditResearch and Audit • Neutropenia researchNeutropenia research • ? Study on Port-a-Caths in 2007? Study on Port-a-Caths in 2007 • Continually record/audit ANP workloadContinually record/audit ANP workload
  • 45. Other workOther work • Initiate and lead Haem/Onc nursesInitiate and lead Haem/Onc nurses meetingsmeetings • Haem/Onc Board memberHaem/Onc Board member • Policy Review committee memberPolicy Review committee member • Chairperson for accreditation processChairperson for accreditation process • Support groupSupport group
  • 46. Other work contd…Other work contd… • Senior nurse-pulled into managementSenior nurse-pulled into management • Mid-line cathetersMid-line catheters • Clinical TrialClinical Trial • PICC servicePICC service
  • 47. External to LGHExternal to LGH • Cancer Nursing Practice Editorial BoardCancer Nursing Practice Editorial Board • IANO committee memberIANO committee member • NW IANO chairpersonNW IANO chairperson • NCI All-Ireland Nurses Working GroupNCI All-Ireland Nurses Working Group • External reviewer to RCN publishingExternal reviewer to RCN publishing • External reviewer to UCFExternal reviewer to UCF • Editorial board memberEditorial board member
  • 48. ANP Oncology OverviewANP Oncology Overview MorningMorning AfternoonAfternoon MondayMonday OfficeOffice OPD clinicOPD clinic TuesdayTuesday OfficeOffice WardsWards Nursing clinicNursing clinic AccreditationAccreditation WednesdayWednesday RadiologyRadiology ConferenceConference Walk-in clinicWalk-in clinic TeachingTeaching Team meetingTeam meeting Haem/OncHaem/Onc BoardBoard ThursdayThursday OfficeOffice WardsWards Nursing clinicNursing clinic Senior nursesSenior nurses meetingmeeting FridayFriday OfficeOffice Research timeResearch time
  • 49. ANP audits (per annum)ANP audits (per annum) – ANP clinics (n=251)ANP clinics (n=251) – Walk-in clinics (commenced July 2006, n=23)Walk-in clinics (commenced July 2006, n=23) – OPD clinics (n=319 or 46% of review workload)OPD clinics (n=319 or 46% of review workload) – RIP letters (n=50 approx)RIP letters (n=50 approx) – Thank you’s (n=52)Thank you’s (n=52) – Education (53.5 hours and 94.5 hours mentor)Education (53.5 hours and 94.5 hours mentor) – Staff support (Commenced July 2006, n=10.5 hours)Staff support (Commenced July 2006, n=10.5 hours) – Consults (n=50)Consults (n=50) – Ward work (n=42)Ward work (n=42) – Mid-line catheters (Commenced June 2006, n=15)Mid-line catheters (Commenced June 2006, n=15)
  • 50. ANP accreditationANP accreditation Re-accredited every 5 yearsRe-accredited every 5 years
  • 51. Portfolio. Page 37, NCNM 2004Portfolio. Page 37, NCNM 2004 1.1. Application form (download)Application form (download) 2.2. Job description (as per site-prepJob description (as per site-prep document)document) 3.3. Detailed PortfolioDetailed Portfolio 4.4. Competencies required and attainedCompetencies required and attained 5.5. Evidence and certificatesEvidence and certificates ReferencesReferences
  • 52. Portfolio, part 3Portfolio, part 3 1.1. Personal detailsPersonal details 2.2. General EducationGeneral Education 3.3. Professional educationProfessional education • Registerable qualificationsRegisterable qualifications • Other professional qualificationsOther professional qualifications • Meaningful achievementsMeaningful achievements 4.4. Professional nursing posts heldProfessional nursing posts held
  • 53. Portfolio, part 3Portfolio, part 3 5. CPD5. CPD • Study activities (small courses)Study activities (small courses) • Research audit and project workResearch audit and project work • Documents produced/developedDocuments produced/developed • Publications (list)Publications (list) • Professional awards obtained (list & date)Professional awards obtained (list & date) • Lectures &seminars presentedLectures &seminars presented • Courses organisedCourses organised • Study days organisedStudy days organised • Papers presentedPapers presented • Posters presentedPosters presented • Clinical supervision involvementClinical supervision involvement • In service training obtainedIn service training obtained
  • 54. Portfolio, part 3Portfolio, part 3 • Conferences and seminars attendedConferences and seminars attended • Study days attendedStudy days attended • Professional and work-based activitiesProfessional and work-based activities
  • 55. PortfolioPortfolio Part 4: competencies required and obtainedPart 4: competencies required and obtained • Table formatTable format Specific competencySpecific competency as per part 1as per part 1 How achievedHow achieved Reference to evidenceReference to evidence that competency achievedthat competency achieved Accept responsibilityAccept responsibility for clinical decisionfor clinical decision making at advancedmaking at advanced practice levelpractice level Formal education (list)Formal education (list) CPD (list)CPD (list) ANP guidelinesANP guidelines ExperienceExperience Supervised practiceSupervised practice 3.33.3 3.43.4 See ….See …. LGH site-prep documentLGH site-prep document NoneNone
  • 56. PortfolioPortfolio • Reference listReference list • Evidence in order as to which it wasEvidence in order as to which it was referred to in the list of competenciesreferred to in the list of competencies
  • 57. ConclusionConclusion
  • 58. Value of ANP OncologyValue of ANP Oncology • Initial assessment by ANP providesInitial assessment by ANP provides patient/family with immediate plan for Oncologypatient/family with immediate plan for Oncology Tx and/or palliative careTx and/or palliative care – Reduces patient/family anxietiesReduces patient/family anxieties – Can have graded approach to breaking bad newsCan have graded approach to breaking bad news – Ensures faster & appropriate work-upEnsures faster & appropriate work-up – Improved referral mechanismsImproved referral mechanisms – Enables speedier and more seamless discharge forEnables speedier and more seamless discharge for in-patientsin-patients – Reduces in-patient bed requirementsReduces in-patient bed requirements
  • 59. Value of ANP OncologyValue of ANP Oncology • Continuous link in patient’s care (atContinuous link in patient’s care (at diagnosis, as in-patient, review clinics etc)diagnosis, as in-patient, review clinics etc) • Available by telephone and haveAvailable by telephone and have admission rightsadmission rights • Have referral mechanisms in place forHave referral mechanisms in place for community staff to have ANP reviewcommunity staff to have ANP review patientspatients
  • 60. Value of ANP OncologyValue of ANP Oncology • ANP-led clincsANP-led clincs eenablenabless more time to be spentmore time to be spent with patientswith patients – Focus on quality of life issuesFocus on quality of life issues & health promotion& health promotion • ANP clinics reduce pressure on multi-ANP clinics reduce pressure on multi- disciplinary clinic timesdisciplinary clinic times – Can bring sicker patients back to this clinicCan bring sicker patients back to this clinic • ANP at OPD clinics increases numbers ofANP at OPD clinics increases numbers of patients reviewedpatients reviewed – Zeroed waiting times for review patientsZeroed waiting times for review patients
  • 61. Achievements to dateAchievements to date • Reduced review patientReduced review patient waitingwaiting times to betimes to be scheduled for review-now on targetscheduled for review-now on target • Release consultant time to deal with complexRelease consultant time to deal with complex cases at clinic-no additional ‘new patient clinics’cases at clinic-no additional ‘new patient clinics’ have been needed prior to commencing servicehave been needed prior to commencing service • All consults reviewed within 24 hoursAll consults reviewed within 24 hours • Senior nurses meetingSenior nurses meeting • No complaints to dateNo complaints to date • Better able to lead/develop serviceBetter able to lead/develop service • Launch patient support group November 2006Launch patient support group November 2006
  • 62. Improvements requiredImprovements required • Prescribing rightsPrescribing rights • Radiology rightsRadiology rights • Need good nursing leaderNeed good nursing leader • Hand over clinical trialHand over clinical trial • Set up but then hand over PICCSet up but then hand over PICC placementplacement
  • 63. Lessons to be learntLessons to be learnt • Get site-prep done ASAP!Get site-prep done ASAP! • Go to all meetingsGo to all meetings relevant to the job. Don’trelevant to the job. Don’t let others describe it forlet others describe it for youyou • Don’t be too ambitiousDon’t be too ambitious • Consider impact onConsider impact on porters, secretaries,porters, secretaries, medical records,medical records, phlebotomy etcphlebotomy etc • Contact cardsContact cards Am I doing it right?Am I doing it right? Am I doing enough?Am I doing enough? Encouragement:Encouragement: • New South WalesNew South Wales • UKUK • MSKCC-USAMSKCC-USA
  • 64. Value of ANP OncologyValue of ANP Oncology • Specialised team memberSpecialised team member • Professional and clinical leaderProfessional and clinical leader • Initiates/leads/participates in educationalInitiates/leads/participates in educational programmes (internal/external to hospital)programmes (internal/external to hospital) • ResearcherResearcher • Participates in audit and uses results to changeParticipates in audit and uses results to change practicepractice • Have national/international linksHave national/international links • Promotes hospital/nursing through journalPromotes hospital/nursing through journal publications/conference presentationspublications/conference presentations
  • 65. The ANP is a senior member of nursing staff able toThe ANP is a senior member of nursing staff able to function as an autonomous practitioner responsible forfunction as an autonomous practitioner responsible for leading aleading a comprehensive oncology nursing service for cancercomprehensive oncology nursing service for cancer patients and their families in Letterkenny Generalpatients and their families in Letterkenny General Hospital.Hospital. The ANP, as an expert practitioner, is an integralThe ANP, as an expert practitioner, is an integral member of the multidisciplinary team, linking hospitalmember of the multidisciplinary team, linking hospital care with the community,care with the community, and is a recognised leader within oncology nursingand is a recognised leader within oncology nursing practice and research .practice and research .

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