Advancing Nursing Practice:
Improving Staff Retention
and Patient Outcomes
Wendy Wood
Deputy CEO and
Executive Director Ca...
The Peter MacCallum Cancer Centre
• Australia's only public hospital solely dedicated to cancer
• A national leader in mul...
Our mission
• Improve the outcomes for individual cancer patients and
reduce the impact of cancer on our community.
• Ensu...
Cancer statistics –
Cancer Council Australia (Feb 2011)
• 114,000 new cases of cancer were diagnosed in
Australia in 2010....
Demand drivers
• The death rate (number of deaths per 100,000 people )
has fallen by 16%.
• More than 60% of cancer patien...
The Cancer Workforce
• Workforce shortages and systemic inefficiencies are restricting
access to care across all domains o...
Career Wisdom
• Really successful people are clear about what they want
• They can tell you want they want to do with thei...
Peter Mac’s Nursing Workforce Strategy
• Investing in the training and retention of cancer care
professionals
• Redesign o...
The Development of an Advancing
Nursing Practice Framework
Advanced Practice Exemplars
(adapted from McCaffery Boyle 1996)
• Active case finding
• Chronic illness care (Griffiths & ...
The Purpose of Advanced Practice Roles
• Contribute to improved outcomes for patients and
families
• Develop and lead impr...
Purpose of the Framework:
• To guide the advancement of nursing practice in the
interest of better care and improved patie...
What’s Does The Framework Cover?
1. Principles
2. Career Structure
3. Description of specialist roles and advanced practic...
1. Principles
• The priorities, needs and experiences of people affected
by cancer are the key driver of the development o...
3. Description of Specialist & ANP Roles
• Clinical Nurse Specialist
• Practice Development Nurse
• Clinical Nurse Coordin...
Credentialing Framework for Advanced
Practice Nurses & NPs
• A clear pathway
• Identification of a perceived patient care ...
Data to indicate service gap might
include:
• Numbers of in-patient admission due to uncontrolled
symptoms;
• Numbers of p...
Retention and Advanced Practice
Peter Mac 2010-2011
• Since launching the framework in October 2010
• 8 nurses have been c...
Qualifications
2012 Number of RNs with postgraduate level qualifications
0 50 100 150 200 250 300 350 400 450
Total postgr...
Nurse Agency Spend by Financial Year
from BI
Source: Business Intelligence (BI)
Nurse Agency Spend by Financial Year
from ...
Improved Patient Outcomes
• Satisfaction with nurse-led telephone follow up for low to
intermediate risk prostate cancer p...
Outcomes cont.
• Trial: evaluate the acceptability, feasibility and safety of a
post transplant nurse-led clinic (NLC) mod...
Current Evaluation Activities
• Nurse-Led Survivorship Care Intervention for Long-term Survivors of
Hodgkin Lymphoma.
Prim...
Advancing Nursing Practice at
Peter Mac
www.petermac.org/AdvancingNursingPractice
Acknowledgements
• Associate Professor Meinir Krishnasamy, Director of
Nursing and Cancer Experienced Research, Peter
MacC...
Wendy.Wood@petermac.org
Wendy Wood, Peter MacCallum Cancer Centre - Advancing Nursing Practice: Improving Staff Retention and Patient Outcomes
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Wendy Wood, Peter MacCallum Cancer Centre - Advancing Nursing Practice: Improving Staff Retention and Patient Outcomes

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Wendy Wood, Deputy CEO and Executive Director Cancer Nursing, Peter MacCallum Cancer Centre delivered this presentation at the 2012 Clinical Training & Workforce Planning Summit.

The 2012 Clinical Training & Workforce Planning Summit discussed the future of Australia's nursing workforce, exploring ways to ensure the capacity and experience to provide high quality care for our nation's increasing healthcare needs.

For more information, please visit http://www.informa.com.au/clinicaltraining12

Published in: Healthcare, Health & Medicine
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Wendy Wood, Peter MacCallum Cancer Centre - Advancing Nursing Practice: Improving Staff Retention and Patient Outcomes

  1. 1. Advancing Nursing Practice: Improving Staff Retention and Patient Outcomes Wendy Wood Deputy CEO and Executive Director Cancer Nursing
  2. 2. 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
  3. 3. 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
  4. 4. 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.
  5. 5. 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.
  6. 6. 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).
  7. 7. 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)
  8. 8. 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.
  9. 9. The Development of an Advancing Nursing Practice Framework
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. Qualifications 2012 Number of RNs with postgraduate level qualifications 0 50 100 150 200 250 300 350 400 450 Total postgraduatequalification 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 Master PhD
  20. 20. 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
  21. 21. 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.
  22. 22. 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.
  23. 23. 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.
  24. 24. Advancing Nursing Practice at Peter Mac www.petermac.org/AdvancingNursingPractice
  25. 25. 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
  26. 26. Wendy.Wood@petermac.org

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