Stakeholder Engagement and Insight for Education, Employment and Practice. CASN Nursing Research Conference 2012

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1 Stakeholder Engagement and Insight for Education, Employment and Practice CASN Nursing Research Conference 2012 Irene Koren, Oxana Mian, Ellen Rukholm

2

3 Stakeholder Engagement Key points: A continuous process of engaging in partnerships Benefit from expertise within the partnerships Research with potential for impact Moving evidence to practice Range of activities and approaches

4 NP Research Program Tracking study of NP students and graduates Continuing education needs assessment 2002 Continuing education evaluation 2004 NP workforce survey Tracking study of NP workforce Phase I: Phase II: Key Stakeholders COUPN NPAO MOHLTC, Nursing Secretariat NPs, NP employers & other khld stakeholders

5 NP Supply Trend Ontario Canada (excluding Ont.) Totals Source: Nursing Database, CIHI

6 NP Specialties Ontario, 2011 NP Specialty # % NP Adult NP Paediatrics NP Primary Health Care Total 1811* 100 * Members with 2 Specialties = 11

7 NP Tracking Study Purpose To provide information on trends in NP demographics, work environments and client characteristics To provide information about topics of interest Preferences for continuing education Consultation and referral with collaborating physicians Incentives to work with underserved populations Retirement plans Practice barriers Certification and future plans

8 Study population CNO registration NP Tracking Study Willingness to be contacted t for research purposes Method Data collection questionnaires for PHC & Acute * (2006, 2007, 2008, 2010) modified Dillman 3 mailings focus group + key informant interviews + NP questionnaire (2012; 2013)

9 Response Rates Year PHC Acute Surveys Suitable for Surveys Suitable for sent analysis sent analysis (60%) (50%) (67%) (52%) (49%) (52%) (56%) (38%) (46%)

10 Age (2010) Demographics PHC averageage 47years; 40% were46 55 years Acute averageage 48years; 45% were46 55 years Years of experience (2010) PHC average 17.5 years as RN; 6.8 years as RN[EC] Acute average 16 years as RN; 9.0 years as APN Education (2010) PHC 26% had earned a Master s in Nursing Acute 30% had earned a post Master s credential

11 100 Geographic Distribution Ontario, % General population, NPs in PHC, survey NPs in Acute Care, 2010 survey Southern Ontario Northern Ontario

12 Urban Rural Distribution, Ontario, % General population, 2011 NPs in PHC, 2010 survey NPs in Acute Care, 2010 survey Large cities Small cities & Rural & Remote Towns

13 p=0.00 p=0.00 Rural Urban, NP PHC, 2010 p= Rural Urban Total 10 0 % NPs with more than % NPs who provide % NPs saying they 300 clients home visits practice to full scope to large extent

14 What NPs said... We re definitely fiitl increasing i access to primary care for people who don t have a primary care provider... I think each of us must have at least three hundred on our caseload, and we continue to accept new people every day.... We re definitely getting people in who haven t been seen for a long, long time... We get people... Who are older and have chronic health issues that haven t been addressed, there s a lot of work upfront to get those people stabilized and assessed properly, and referred to all the specialists they need to see. (NP8)

15 What NPs said... Poor education, low economic, high h smoking, high h drinking, low employment, so that s my community... Most of my practice is made up of working poor, or on social assistance. And I do prenatal to palliative care. (NP5) We certainly see lower educational levels, lower, far lower employment levels l and salary levels. l (NP3)

16 Client population, PHC, 2010 HIV/AIDS clients Homeless Transient, seasonal Aborignal people Recent immigrants Permanent physical disability Cultural minority Substance/drug user Unemployed Low income earner Typical family practice 10% 15% 21% 24% 27% 30% 36% 43% 50% 61% 73%

17 Mi Main Practice Employer Main Practice Employer PHC % Acute care % n=252 n=379 n=151 n=190 CommunityHealth Centre Family Health Team Physician s Office Public Health Unit Other Community Facility Long term Care < 3.3 < 2.5 Acute Care Hospital Community Hospital Paediatric i Teaching Hospital

18 Work kprofile Percentage of work time spent on various activities, 2010 Work Activities (per month, 2010) PHC* % Time Spent Acute * % Time Spent n % Mean Median Min Max n % % Time Spent Mean Median Min Max Direct patient care Teaching Research/Scholarly Administration * Column represents number who reported participating in each activity

19 PHC NP Practice Profile by, Practice Setting (2008) Physician NP led CHC Office Hospital Other FHT Clinic All P value (n=121) (n=87) (n=47) (n=55) (n=56) (n=12) (n=378) Direct care Research/scholarly Nursing admin. Non nursing Estimated percentage of time spent on activities ** 71.4** ** ** Estimated percentage of time spent on activities ** <0.05** <0.05** <0.05** HP/DP 24.4** ** ** <0.05** Treatment Chronic disease mgt. Palliative care Counselling ** ** ** ** 3.1** <0.05** <0.05** <0.05** Advocacy * Koren, I., O. Mian and E. Rukholm (2010). Integration of Nurse Practitioners into Ontario s primary health care system: variations across practice settings. Canadian Journal of Nursing Research, 42(2),

20 Premise: Nurse Practitioner Integration Successful integration requires development of collaborative relationships with other healthcare professionals Indicator of collaborative relationships = referral patterns Referral is a written or verbal communication from the primary provider to a second provider that requests that the second provider assess, give information, advice or share in the decision making for a patient s care. A referral requires a separate patient appointment with the second provider

21 Nurse Practitioner Integration 100 Referrals between NPs and physicians: 2005 and % NPs that % NPs that received % NPs that referred to FPs referrals from FPs referred to specialist physicians

22 What NPs said... The greatest thing has just been working with the same physicians, specialists because what I ve seen is much more comfort with the NP role and understanding. And that isn t any change in any legislation has really done, it s just the familiarity of working with these same people over and over again. (NP3)

23 What NPs said... One thing that would support our practice is to be able to refer to specialists directly... Changes to OHIP billing system are needed to make that happen. Right now specialists receive a higher payment if a client is referred by a physician than a nurse practitioner, so it makes sense for them to require a physician s referral otherwise they get paid less for doing the same job, which h really isn t fair to them. (NP8)

24 Nurse Practitioner NP < > Social k 38 Integration Rf Referral pattern variation i across practice settings, NP < > Allied health k NP < > Mental h l h worker worker worker health FP > NP NP > FP CHC FHT FP office Mian, O., I Koren., and E. Rukholm (2012). Nurse practitioners in Ontario primary healthcare: Referral patterns and collaboration with other healthcare professionals. Journal of Interprofessional Care (Online): 1 8.

25 What NPs said... We have multidisciplinary meetings every week... We meet with the social worker, dietician, all the nursing staff, NPs and the physician, and we just discuss cases, discuss problems that we had that week and try to come up with solutions as a team. Anybody can bring forward any issue or question, or something that they ve learned, we just share information very openly, every week, which is important. (NP8)

26 Integration Trends Some trends from NP TS Better public awareness of the NP role Legislative barriers to NP autonomous practice identified in earlier surveys some have been eliminated but others persist Patterns of referrals between NPs in PHC and other health care providers in various settings indicate increased acceptance ce of the role eand collaborative at relationships Limited time for research an other leadership activities challenge NPs in practice

27 Acknowledgements Stakeholders College of Nurses of Ontario Ministry of Health and Long Term Care

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