Bendigo Health & Bendigo Community Health Services Inc.

Transcription

1 Bendigo Health & Bendigo Community Health Services Inc. Nurse Practitioner Service Plan Collaborative Health Education and Research Centre - Bendigo Health

2 Table of contents Executive Summary Introduction Aim Methodology Literature review Governance Group Working parties Learning Sessions Consultation with clinical units and consumers Liaison with other DHS Nurse Practitioner projects Results...5 Bendigo Health & Bendigo Community Health Services Inc. Nurse Practitioner Service Plan...7 Introduction... 7 Vision... 7 Mission... 7 Our goals are:... 7 Goal 1: Governance...9 Objective Objective Goal 2: Policy framework...10 Objective Objective Objective Goal 3: Communication and marketing strategy...11 Objective Objective Goal 4 Education and mentoring framework...11 Objective Objective Goal 5 Integration of the Nurse Practitioner role into existing services...13 Objective Objective Objective Goal 6 Spread and sustainability...14 Objective Objective Objective Objective Goal 7: Identification of Nurse Practitioner roles...15 Objective Objective Goal 8: Research...16 Objective Objective Goal 9 Credentialing...17 Goal 10 Leadership...18 Objective Objective Objective Suggested areas for implementation of the Nurse Practitioner role Appendix 1. Nurse Practitioner Governance Group Terms of Reference...20 Appendix 2. Communication strategy...22 Appendix 3: Generic Nurse Practitioner Candidate Position Description...25 Appendix 4: Appointment process...29 Appendix 5: Expression of interest template...30 Appendix 6: Full submission template...36 Appendix 7: Credentialing policy...56 Appendix 8: GP referral policy & procedure...57 Appendix 9: Chronic care coordinator referral policy & procedure...59 Appendix 10: HITH referral policy & procedure...61 Appendix 11: Outpatients clinic referral policy & procedure

3 Appendix 12: Specialist referral policy & procedure...66 Appendix 13: Admission to hospital procedure...69 Appendix 14: Discharge from hospital procedure...71 Appendix 15: Medication prescribing policy & procedure...74 Appendix 16: Ordering pathology procedure...78 Appendix 17: Ordering radiology procedure...80 Appendix 18: Terms of reference CPG working party...82 Appendix 19: CPG authorisation tree...84 Appendix 20: Terms of reference education working party...85 Appendix 21: Case review process

4 Executive Summary 1. Introduction Careful planning prior to implementation of the Nurse Practitioner role is a critical step towards successful and seamless integration of this new role into existing health services. This project enabled Bendigo Health (BH) and Bendigo Community Health Services Inc. to develop a readily transferable plan to enable implementation of the Nurse Practitioner role within a large regional health service, smaller outreach services and in a community health setting. The implementation plan will be sustainable after completion of the project and will form the foundation for operationalising the Nurse Practitioner role within the two organisations and sustaining and extending Nurse Practitioner roles in BCHS. The Service Plan was designed to be readily transferable to other organisations in the rural and regional settings. BH and BCHS collaborated to develop a service plan that enables both organisations to implement and sustain the role of the Nurse Practitioner into existing health services. BH was the lead agency for this project and BH s Collaborative Health Education and Research Centre (CHERC) managed the project. CHERC is a business unit of BH. Collaboration between these key health service providers in Bendigo was seen as critical to the development of a service plan that supports implementation of the Nurse Practitioner role. The development of a service plan that embraces both acute and community health providers will enhance provision of seamless care across the continuum. Recruitment and retention of nurses in rural and regional areas is widely recognised as an ongoing challenge and one that is compounded by rural issues such as geographic isolation. Similar challenges face recruitment and retention of rural general practitioners leading to limited access for to a broad range of health services. BHCG and BCHS support the idea that development and implementation of the Nurse Practitioner role is an innovative strategy that will provide an incentive for nurses to move to rural and regional locations for employment opportunities and remain there. This will assist in alleviating some of our workforce issues. 2. Aim The aim of this project was to develop a service plan to implement and sustain the Nurse Practitioner role within Bendigo Health Care Group and Bendigo Community Health Services Inc. that will assist in strengthening the capacity of the health system and be readily transferable to other health services. 3. Methodology Action research was used as the theoretical framework for this project. Action research was selected as it is designed specifically to bridge the gap between theory, research and practice and involves collaboration between researcher and practitioner in finding a solution to a practical problem. To compliment and assist in achieving optimal outcomes change management principles were adopted throughout this project. 3.1 Literature review Current literature was reviewed in relation to Nurse Practitioners and health service planning to identify models of best practice in the development, sustainability and 4

5 implementation of the Nurse Practitioner role in the acute and community health settings. 3.2 Governance Group A Governance Group with representatives from key stakeholder groups was convened to provide project guidance and support. Ms Clare Turner (BH), and Ms Karen Riley (BCHS) acted as chief advisors to the project. 3.3 Working parties Two working parties were convened during the project and each had specific portfolios related to the key outcomes for the service plan. The two working parties that were convened were the Peer Review and Clinical Practice Guideline Working Parties. 3.4 Learning Sessions A series of three plan, do, study, act cycles were conducted throughout the project and each cycle was punctuated by a learning session. Learning sessions facilitated communication between key stakeholders and enabled the service plan to be developed, refined and finalised. 3.5 Consultation with clinical units and consumers Consultation with clinicians from all areas and disciplines in both BH and BCHS was ongoing throughout the project and enabled opportunities to comment on the development of the Nurse Practitioner service plan. Links were formed with consumer groups to enable provision of information in relation to Nurse Practitioner activities within the two organisations. 3.7 Liaison with other DHS Nurse Practitioner projects Links were formed with other DHS Nurse Practitioner projects and learning was shared and findings disseminated between the groups. Close links were also maintained with DHS Nurse Policy Branch to enable project information to flow. 4. Results The Governance Group meet monthly throughout the project and was responsible for providing support and direction for the project. A communication strategy was developed by the project team and aimed to engage and inform key stakeholders and enable successful and implementation and sustainable outcomes. The communication strategy was implemented by members of the Governance Group and project team to assist in dissemination of project information during the Scoping project. Two working parties were convened to assist in development of the service plan in relation to objectives outlined in the project submission. The purpose of the Clinical Practice Guideline Working Party was to facilitate the development of clinical practice guidelines for Nurse Practitioners. The Nurse Practitioner Candidate Peer Review Working Party was developed to support Nurse Practitioner Candidates working towards endorsement form the Nurses Board of Victoria. A total of eighty key stakeholders participated in the three Learning Sessions and included representatives from across BH and BCHS. Senior managers from surgical and medical services, clinicians and allied health services were represented at the workshop. 5

6 Learning Session participants identified key areas that may benefit from the implementation of the role and commenced discussions on the issues that may be barriers to implementing this role, for example clearly identifying the scope of practice for the Nurse Practitioner. A number of small work groups were assembled from the areas identified during Learning Session 1 for implementation of the Nurse Practitioner role. These sessions were facilitated the Project Manager and were conducted over an hour. A number of distinct areas were identified during Learning Session 1 as having potential to develop into a Nurse Practitioner role these are included in Section 11 of the Service Plan. Data collected during the consultation process was analysed and presented at Learning Sessions 2 and 3, the Governance Group and Working Party meetings. This data informed the development of the Service Plan. 6

7 Bendigo Health & Bendigo Community Health Services Inc. Nurse Practitioner Service Plan Introduction Although Nurse Practitioners are not new to health care systems, the concept is relatively new to Victoria. The introduction of a new role to any organisation, particularly one that requires changes to existing models of care and work practices creates a certain sense of insecurity to working teams. It is for this reason that careful planning prior to implementation of the Nurse Practitioner role is a critical step towards successful and seamless integration of the new role into existing health services. This service plan will enable Bendigo Health (BH) and Bendigo Community Health Services Inc. to implement the Nurse Practitioner role within a large regional health service, smaller outreach services and in the community health setting. The service plan will enable the Nurse Practitioner role to be implemented and sustained by using a systematic approach that is based on change management principles. The Service Plan was designed to be readily transferable to other organisations in rural and regional settings. Vision To integrate the Nurse Practitioner role into the health system to enhance services in Bendigo. Mission To design an effective strategic plan for introducing and sustaining the Nurse Practitioner role into Bendigo Health and Bendigo Community Health Services Inc.. Our goals are: 1. To develop a clinical governance structure that supports the introduction and development of the Nurse Practitioner role. 2. To develop systems that enable identification and prioritisation of areas where there is potential to develop a Nurse Practitioner role. 3. To develop a policy framework that supports the Nurse Practitioner role in BH and BCHS. 4. To develop a communication and marketing strategy. 5. To develop an education and mentoring framework that supports the Nurse Practitioner role. 6. To support the integration of the Nurse Practitioner role into existing health services and to align the role with the business plan of the clinical unit and the strategic plan of the organisation. 7. To enable development of a sustainable Nurse Practitioner program that can spread across different aspects of the health services. 8. To develop a Nurse Practitioner research agenda. 9. To recognise the importance of formal and regular credentialing of Nurse Practitioners to ensure that all Nurse Practitioners practice within 7

8 a framework of competence and safety. 10. To support Nurse Practitioners to develop leadership skills that are in line with the practice area in which they are applying for endorsement and will meet the requirements of the Nurses Board of Victoria. 8

9 Goal 1: Governance To develop a Clinical governance structure that supports the introduction of the Nurse Practitioner role. Objective 1.1 Establish a Nurse Practitioner Governance Group with representation from key stakeholder groups to provide guidance to Nurse Practitioners across the organisation. Strategies Convene a Nurse Practitioner Governance Group as a sub-set of Senior Nurse Council with the following membership: Executive Director of Nursing (Chair) Nursing Director Surgical Services Nursing Director Medical Services Nursing Director Residential Services General Manager of Primary Health Bendigo Community Health Services Inc. Head of School (Nursing & Midwifery) LaTrobe University Bendigo Area Organiser, ANF Operations Manager, CHERC Project Coordinator Develop Terms of Reference for the Governance Group that include details such as frequency of meetings and quorum. See Appendix 1 for Governance Group Terms of Reference Provide governance for all Nurse Practitioner functions including review and approval of: Expressions of interest to implement a Nurse Practitioner role; Full submission to implement a Nurse Practitioner role (including areas of expanded practice); Policies and procedures developed or modified to incorporate the Nurse Practitioner role; Clinical practice guidelines developed for the Nurse Practitioner role; Conference Presentations relating to the Nurse Practitioner role; Education and mentoring activities; Support structures; Research activities and Publications relating to the Nurse Practitioner role. Objective 1.2 To ensure evolving Nurse Practitioner roles link to the Nurse Practitioner Service Plan and the Organisation Wide Strategic Plan. Strategies The Governance Group will oversee the development of expanded practice activities for Nurse Practitioner roles within the organisation to ensure these link with the Nurse Practitioner Service Plan and 9

10 Organisation Wide Strategic Plan The Governance Group will determine the time frame for completion of all aspects of Nurse Practitioner candidate activities that contribute to endorsement as a Nurse Practitioner by the Nurses Board of Victoria The Governance Group will develop a generic position description for a Nurse Practitioner role. (See Appendix 3). Goal 2: Policy framework To develop a policy framework that supports the introduction of the Nurse Practitioner role in BH and BCHS. Objective 2.1 To drive the development of policies, guidelines and processes which support Nurse Practitioner clinical practices so that integration into existing work practices and necessary changes to models of care are undertaken in a way which supports safe and efficient practice. Strategies To undertake an analysis of those areas where policy development and change is required to support the introduction and sustain the Nurse Practitioner role in BH and BCHS Identify those areas where policy development is required to support the introduction of the Nurse Practitioner role (for example admission and discharge of patients, ordering, medications and pathology and radiological tests). See Appendices 5 to 14 for policies developed to date Identify existing policies that require change to support Nurse Practitioner practice Monitor policy development across BH and BCHS to ensure new or modified policies articulate with, and take into consideration the Nurse Practitioner role. Objective 2.2 To utilise the literature and findings from the BH and BCHS Nurse Practitioner projects to inform the development of policies associated with the Nurse Practitioner role. Strategies Analyse the literature and past and present Nurse Practitioner projects for policy implications. Where appropriate, develop policy in response to the information analysed Develop a periodic review system for policies relating to the Nurse Practitioner role. Objective 2.3 Inform and engage key stakeholders in policies relating to the Nurse Practitioner role. 10

11 Strategies Disseminate policy document to key stakeholder's regarding the Nurse Practitioner role Develop a system that includes all key stakeholders in the development and authorisation of policies relating to the Nurse Practitioner role Engage Clinical Effectiveness Unit in the development process for policies relating to the Nurse Practitioner role Disseminate new policy information widely once authorized. Goal 3: Communication and marketing strategy To develop a communication and marketing strategy that informs key stakeholders and enables successful implementation of the Nurse Practitioner role. Objective 3.1 To identify key stakeholders including acute and community health services, health professionals and consumers of health services. Strategies Develop a communication strategy that takes into account different opinions and perspectives enables information to be disseminated to key stakeholders in a systematic and comprehensive way Scope service area for key stakeholder groups including other health service providers (medical, nursing and allied health), consumer groups and Nurse Practitioner special interest groups Review Communication Plan annually (or as required) and update contents so that they are consistent with current activities. Objective 3.2 Provide all key stakeholders with current information regarding the role of the Nurse Practitioner. Strategies Develop presentations and information packages (including posters, brochures, and oral presentations) that explain the role of the Nurse Practitioner and Nurse Practitioner candidate for different audiences (for example health professionals, consumers and media organisations) Form links with community advisory committees and community groups and present to these groups on a regular basis Identify appropriate forums in which to present information about the Nurse Practitioner role to colleagues Respond to invitations to address forums in a timely manner. Goal 4 Education and mentoring framework To develop an education and clinical mentoring framework to support the Nurse Practitioner role that is based on evidenced based best practice. 11

12 Objective 4.1 Develop and implement multidisciplinary Clinical Practice Guideline Working Parties in the service stream where the Nurse Practitioner role is being developed. The working parties will assist in the development and verification of Clinical Practice Guidelines for Nurse Practitioners (See Appendix 19 for Terms of Reference for the Clinical Practice Guideline Working Party). The working parties will report to the Nurse Practitioner Governance Group. Strategies Convene a Clinical Practice Guideline Working Parties that comprises of the following members: Nursing Director (from applicable service stream) Nurse Unit Manager (from applicable Department) Department Clinical Director Department Specialist (Fellow of the applicable Specialist College) Nurse Practitioner/Nurse Practitioner Candidates Director of Pharmacy Director of Pathology Manager of Medical Imaging The working parties will review Clinical Practice Guidelines and protocols and ensure they are developed using evidence based best practice and integrate with other organisational policies, procedures and clinical practice guidelines The Clinical Practice Guideline Working Parties will facilitate multidisciplinary communication through monthly meetings and enable the Nurse Practitioner to have access to a multidisciplinary team of experts Identify and engage clinical mentors (senior clinicians) to work with Nurse Practitioners Develop a Clinical Practice Guideline Authorisation Tree that enables all key stakeholders to review and have input into Nurse Practitioner clinical practice guidelines prior to implementation (See Appendix 20 for Clinical Practice Guideline Authorisation Tree) Review Clinical Practice Guidelines and progress in line with Clinical Practice Guideline Authorisation Tree. Objective 4.2 Develop and implement an Education and Mentoring Working Party that reports to the Nurse Practitioner Governance Group and aims to support the education components of the Nurse Practitioner role and enable the Nurse Practitioners to develop new skills and have access to senior nurses for advice and assistance. Strategies The Education and Mentoring Working Party will comprise of senior nurses and nurse education experts with the aims of supporting Nurse Practitioner s /Nurse Practitioner Candidates by: Linking with current education programs; Identifying appropriate scholarship opportunities; Establishing networks of Nurse Practitioners to act as mentors for Nurse Practitioner Candidates as they commence in the organisation; Establishing a case review process that focuses on reflective practice (See Appendix 22 Case Review Process); Providing education mentors to support the Nurse Practitioner Master level education; 12

13 Developing an forum group to enable access to opinions from external agencies members of the Working party and Governance Group between scheduled meetings and Providing education to Nurse Practitioners/Nurse Practitioner Candidates in clinical and management systems. For example many nurses who are clinical experts have not had exposure to management systems (including funding structures, policy development or committees) Develop Terms of Reference that reflect the aims and objectives of the working party (See Appendix 21 for Terms of Reference for the Education and Mentoring Working Party) Develop a Nurse Practitioner Candidate Case Review Group with the aim of providing professional support to Nurse Practitioners and Nurse Practitioner Candidates in the clinical areas and to expand the clinical inquiry and skills of nurses working in sites external to the main campus Develop a clinical education program that addresses the learning needs of the Nurse Practitioner Candidates in collaboration with senior medical and nursing staff Develop an forum to enable access to opinions from external agencies members of the Working Party and Governance Group between scheduled meetings Identification and development of cadre of nurses who are eligible to enter Nurse Practitioner Candidate training, who practice at an advanced level and focus on clinical excellence, and have a demonstrated interest in Nurse Practitioner status. Goal 5 Integration of the Nurse Practitioner role into existing services To support the integration of the Nurse Practitioner role into existing health services and to align the role with the business plan of the clinical unit and the strategic plan of the organisation. Objective 5.1 To provide timely communication with all key stakeholder groups regarding the Nurse Practitioner role prior to its introduction in specific clinical units. Strategies Utilise the communication strategy (developed as strategy under Goal 3 See Appendix 2) as a guide to the distribution and depth of material presented to the various stakeholders Evaluate the effectiveness of the information presented Review information in light of the evaluation process and continue to maintain open communication processes. Objective 5.2 To use a multidisciplinary "implementation team" approach to identify and implement the Nurse Practitioner role into the clinical unit. Strategies Convene a multidisciplinary team with representatives from nursing, medicine and allied health disciplines and management representatives Appoint a team leader to "champion" implementation of the new role 13

14 into existing services Develop shared goals between the "implementation team", unit managers and staff working on the unit Align shared goals of the implementation team with the business plan of the clinical unit and the strategic plan of the organisation Review implementation planning process and goals to ensure alignment with the units' business plan and strategic plan of the organisation. Objective 5.3 Develop an Expression of Interest (EOI) and Full Submission (FS) process to submit to Group Executive that identifies potential Nurse Practitioner roles. The EOI will identify clearly the new Nurse Practitioner role and outline the benefits of implementing the role. A costing model that includes identification of funding to support the position will be completed as part of the FS document. Strategies Develop Expression of Interest (EOI) and Full Submission (FS) templates for development of a Nurse Practitioner role (See Appendices 19 & 20) for EOI and FS templates) Develop a system for the Nurse Practitioner Governance Group to review EOI and FS for development of a Nurse Practitioner position Develop an education package that accompanies the process Provide education to clinical units who express an interest in developing, or have identified a potential Nurse Practitioner role Develop an infrastructure within the organisation to manage the EOI and FS processes for the Nurse Practitioner role. For example, the Nurse Practitioner Governance Group will act as a filter for EOl's and FS prior to linking in with standard operational processes within the organisation for implementation of new roles within the health service. See Appendix 4 Appointment Process for Nurse Practitioners Nurse Practitioner Governance Group will provide written feedback to units considering the development of a Nurse Practitioner role Monitor and review the EOI and FS templates and processes to ensure currency and timely response to proposals submitted to the Nurse Practitioner Governance Group for consideration. Goal 6 Spread and sustainability To enable development of a sustainable Nurse Practitioner program that can spread across different aspects of the health service. Objective 6.1 To develop and maintain effective and sustainable Nurse Practitioner roles within BH and BCHS. Strategies Build a clinical unit level financial review process into the EOI proforma and FS document Complete a full costing for a Nurse Practitioner position to the organisation (including clinical education provided to candidates) Conduct a cost benefit analysis for the Nurse Practitioner role Develop a system for monitoring the costs associated with implementing a Nurse Practitioner role. 14

15 Objective 6.2 Review opportunities to provide input into funding decision making. Strategies Maintain links with DHS on a regional level (LMR) and in metropolitan Melbourne via Nurse Policy Branch and Workforce Planning Branch. Objective 6.3 Develop and maintain strategic alliances with DHS and other potential funding bodies. Strategies Attend DHS meetings as required Examine funding opportunities for research and development for the Nurse Practitioner role including State and Federal sources and including workforce planning and quality improvement grants Examine potential joint submissions with LaTrobe University Respond to funding rounds as appropriate. Objective 6.4 Develop a generic evaluation framework for the Nurse Practitioner role that indicates the general efficacy of the role. Strategies Develop a template to collect relevant data that will support the efficacy of the Nurse Practitioner role and includes items such as: Timeliness of treatment (reduced time to treatment and discharge); Quantity of treatment (increasing number of patients seen); Quality of treatment (no increase in adverse events, no decrease in patient satisfaction) and Cost of treatment (decreased cost per treatment) Analyse data to monitor performance of role and compared to alternative treatment models Collect and analyse variance data associated with Clinical Practice Guidelines and Nurse Practitioner policies and procedures Modify systems in collaboration with key stakeholder groups in response to variance reporting. Goal 7: Identification of Nurse Practitioner roles To develop systems that enable identification and prioritisation of clinical areas where there is potential to develop the Nurse Practitioner role. Objective 7.1 Identify clinical areas suitable for the implementation of the Nurse Practitioner role. Strategies Prioritise the roles through examination of: Data (including clinical and patient outcome data); 15

16 Process mapping on the clinical unit; Potential to streamline service; Potential cost benefits and Potential to improve patient satisfaction Convene a multidisciplinary implementation team as described in Section Identify areas where the role of a Nurse Practitioner may be clinically beneficial through consultation with key stakeholders at the clinical unit level. Objective 7.2 To utilise the EOI and FS templates to initiate the process of implementing the Nurse Practitioner role. Strategies Goal 8: Research Utilise EOI template as a guide to assist prioritisation of potential Nurse Practitioner role and submit completed template to the Nurse Practitioner Governance Group for comment and recommendation to complete and FS Utilise Full Submission template to refine further the potential Nurse Practitioner role identified by the clinical unit and submit to the Nurse Practitioner Governance Group for recommendation to complete HR 1 (See Appendix 4 Nurse Practitioner Appointment process). To develop a Nurse Practitioner research agenda that supports the development of a Nurse Practitioner portfolio suitable for submission to the Nurses Board of Victoria. According to the Nurses Board of Victoria, research activities include, but are not limited to, journal reading and journal club, membership of research committees, program evaluation, quality improvement activities and future and current plans for research. Objective 8.1 Integrate evidence based best practice into Nurse Practitioner clinical practice guidelines. Strategies Review literature to collect evidence that supports Nurse Practitioner Clinical Practice Guidelines Liaise with clinical experts via Clinical Practice Guideline Working Party to seek verification of best practice Utilise Clinical Practice Guideline Authorisation Tree to gain authorisation of all Clinical Practice Guidelines. Objective 8.2 Develop a Nurse Practitioner research strategy by facilitating independent Nurse Practitioner research agendas that are in line with the operational and strategic directions of BH and BCHS and the clinical area in which the Nurse Practitioner is working. 16

17 Strategies Nurse Practitioners to develop and review the Nurse Practitioner Research agenda annually in collaboration with the Nurse Practitioner Governance Group and members of sub-committees of that group the Clinical Practice Guideline and Education and Mentoring Working Parties Provide support for Nurse Practitioners to develop a research agenda that includes links to the LaTrobe University Clinical School and other research faculties within BH for example CHERC and the Centre for Rural Mental Health Enable Nurse Practitioners to hold joint appointments between BH and LaTrobe University. Subject to organisational approval Identify potential research ideas, develop research proposals and identify potential partners and funders in collaboration with members of the Nurse Practitioner Governance Group Develop submissions for funding Nurse Practitioner research proposals Publish Nurse Practitioner research and development activities in relevant peer reviewed journals in collaboration with LaTrobe University School of Nursing and present at relevant conferences and scientific meetings. Goal 9 Credentialing To recognise the importance of formal and regular credentialing of Nurse Practitioners to ensure that all Nurse Practitioners practice within a framework of competence and safety Objective To develop a policy and procedure for credentialing Nurse Practitioners within the organisation that supports organisational processes by reducing clinical risk. Strategies Develop a credentialing policy that ensures all Nurse Practitioners practice within a framework of competence and safety (See Appendix 7 for Draft Nurse Practitioner Credentialing Policy) Develop a credentialing policy to set out the way credentialing and an approved scope of clinical practice are determined for an individual Nurse Practitioner undertaking independent practice Develop a credentialing policy to provide for an approved scope of practice Develop a credentialing process that supports the Nurse Practitioner credentialing policy Amend relevant organisational policies to incorporate the Nurse Practitioner credentialing process as outlined in the organisation s Credentials Committee Terms of Reference to include relevant sections of the Nurses Act (1993) and the Drugs, Poisons and Controlled Substances Act (1991) The Organisation s Credentials Committee advises the Chief Executive of the outcome of the credentialing process for all Nurse Practitioner staff Qualifications of the candidate seeking credentialing must be verified by the Credentials Committee before any offer of a position is made. 17

18 Review and monitoring of compliance Ongoing compliance for all Nurse Practitioner staff is monitored through supervision and performance review processes. Goal 10 Leadership To support Nurse Practitioners to develop leadership skills that are in line with the practice area in which they are applying for endorsement and will meet the requirements of the Nurses Board of Victoria. Clinical and health care system leadership skills will be developed. Objective 10.1 Develop mechanisms to support the development of leadership skills into the existing Nurse Practitioner infrastructure. Strategies Link leadership activities with the Nurse Practitioner Education Working Party Link leadership activities with Nurse Practitioner /Nurse Practitioner Candidates research activities Link Nurse Practitioners /Nurse Practitioner Candidates into relevant committees within the organisation and where relevant represent the organisation on external committees and boards (for example Emergency Nurses Association). Objective 10.2 Support Nurse Practitioners to develop leadership skills in the areas of education and research. Strategies Support Nurse Practitioners /Nurse Practitioner Candidates to enable presentation of their education and research activities. Presentations should be to multidisciplinary team members within their department, across the organisation and at national and international conferences where applicable Support Nurse Practitioners / Nurse Practitioner Candidates to ensure their research and education activities link with the strategic plan of the organisation and are linked to quality improvement processes across the organisation. Objective 10.3 To enable Nurse Practitioners to participate actively in the development and/or review of relevant policies. Strategies Engage Nurse Practitioners in relevant committees so that they have an opportunity to have input into the development and/or review of policies relating to the Nurse Practitioner role and other relevant policies such as those that relate to clinical practice. 18

19 11. Suggested areas for implementation of the Nurse Practitioner role. A number of potential Nurse Practitioner roles were identified and prioritised during the development of the Service Plan. Participants were invited to rank the three most important areas to implement the Nurse Practitioner role. Although this list is not conclusive it could be used as an indicator of clinical areas where the role is most needed. Table 1 Suggested areas for implementing the Nurse Practitioner role in order of priority (as described above). Clinical Unit Aged Care Psychiatric Services Oncology Outpatient Rehabilitation Clinic Diabetes Service Hospital Admission Risk Program Anaesthetics Patient Services Palliative Care Critical Care Unit Orthopaedics Inpatient rehabilitation Bendigo Community Health Inc. Home Assessment and Rehabilitation Team (HART) Inpatient rehabilitation (GEM) Continence Service Bendigo Community Health Inc. Nurse Practitioner role identified Aged Care Nurse Practitioner Mental Health Nurse Practitioner Regional Cancer Nurse Practitioner Wound Management Nurse Practitioner Diabetes Nurse Practitioner Respiratory Nurse Practitioner Cardiothoracic Nurse Practitioner Cardiac Rehabilitation Nurse Practitioner Pain Nurse Practitioner Pre-admission Nurse Practitioner Outpatient Nurse Practitioner Palliative Care Nurse Practitioner ICU Liaison Nurse Practitioner Orthopaedic Nurse Practitioner Neuroscience Nurse Practitioner (Stroke) Drug and Alcohol Nurse Practitioner Neuroscience Nurse Practitioner (Cognitive impairment) Aged Care Nurse Practitioner Continence Nurse Practitioner Primary Health Care Nurse Practitioner Youth Health Nurse Practitioner Diabetes Nurse Practitioner Total Nurse Practitioner roles identified 22 19

20 Appendix 1. Nurse Practitioner Governance Group Terms of Reference Nursing Governance Group Extended Scope of Nursing Practice Projects TERMS OF REFERENCE TITLE: Nursing Governance Group PURPOSE: To provide leadership to the BH Extended Scope of Nursing Practice RN Div 1 Projects. OBJECTIVES: To identify and agree on key priorities for the project To oversee the implementation of the projects To monitor the performance and outcomes of the project To report to the BH Group Executive and other relevant boards and committees regarding project progress and outcomes To agree on the role definitions for extended/expanded scope of practice eg Clinical Nurse Consultants and Nurse Practitioners at BH Identify and review guidelines and protocols KEY PERFORMANCE INDICATORS: Regular attendance at meetings Members have a clear understanding of the project/s Project/s in line with original plan, including budget and timeframe MEMBERSHIP: BHCG Executive Director of Nursing (Chair) Nursing Director Surgical Services Nursing Director Medical Services Nursing Director Residential Services General Manager of Primary Care, Bendigo Community Health Inc. Head of School, Latrobe University Bendigo ANF Area Organiser Operations Manager, CHERC Project Coordinators DURATION OF MEETING: 1.5 hours FREQUENCY OF MEETING: Once per month, to be reviewed after first 6 months of the project QUORUM: Half the membership plus one. TERM OF COMMITTEE / PROJECT TEAM Until project is completed REPORTING TO: BHCG Executive, via Senior Nurse Council 20

21 Department Human Services REPORTING MECHANISM: Periodic reports to BHCG Executive Reports as required by Department of Human Services to fulfil project requirements APPROVED:.. (Title) COMMENCEMENT DATE: ANNUAL REVIEW DUE: (date) 21

22 Appendix 2. Communication strategy Communication Strategy-Nurse Practitioner Aim The aim of the communication strategy for the Nurse Practitioner projects is to engage and inform key stakeholders to enable successful and sustainable implementation and outcomes from each project. Principles Identifying and engaging stakeholders Preparing appropriate type, depth, and quantity of information to provide to stakeholders Agreement on project progress and outcomes Valuing different opinions and perspectives Establishing key messages that are consistent Flexible processes that can accommodate change Understanding and use of a common language Transparency in communication and consultation Active listening Methods Informal: Face to face discussions / personal communication Telephone Patient handover Information poster Formal: 1. Print media Newsletters (i.e. Bendigo Health News, Nursing News, Division of GP s newsletter) Intranet Local newspaper (via Public Relations Manager) Professional journals 2. Organisational Committees and Work Groups: Nurse Practitioner Governance Group Sub-Acute, Ambulatory, and Community Services Change Planners Group Patient Access Committee Senior Nurse Council Consumer Reference Group Heads of Department Medical and Surgical Services Heads of Department Group Pharmaceutical Advisory Committee Group Clinical Standards Committee Information Security Committee Information Standards Committee Health Information Services 3. Organisational meetings: Group Executive Medical/Surgical Senior Management Group Psychiatric Services Senior Management Group Group Business Managers Clinical Risk Management 22

23 Quality Care Council Consumer Advisory Council Group Staff Development Quality Representatives Ambulatory Care 4. Business Unit Meetings and team meetings Collaborative Health Education and Research Centre Clinical Effectiveness Unit Emergency Department Unit 5. Professional group meetings: Senior Nurse Council SNC Nursing Education Senior Allied Health Council Union Consultative Committees Visiting Medical Officers Group Meetings Staff Specialists Group 6. Consumers Acute (Medical & Surgical Services) Consumer Reference Group Residential Consumer Reference Group Veterans Affairs Focus Group Poster in ED 7. Department of Human Services Meetings: Department of Human Services (DHS) Nurse Policy Branch and Workforce design strategy meetings project manager meetings. 23

24 Nurse Practitioner Projects Communication plan Reporting to Information required Frequency Medium By whom Achieved/ Personnel BH Group Executive BCHS inc. Executive Team Key milestones achieved, identified barriers / risks to project progress and proposed contingency plan Monthly and as required Written report and meetings & as required Governance Group members Project Manager & Officer /Date Governance Group CHERC manager Operations BH Emergency Department Clinical Managers (Director, Senior Doctors, NUM & A NUM s) Clinical Unit Managers and staff of nominated service areas Acute, Subacute, Psychiatric Services and BCHS inc. executive managers, and medical staff, SMG, Senior Nurse Council Key milestones of three projects, project and project management strategies. Including all proposed project activities. Project progress, risk management strategies, and key milestones Project progress, risk management strategies, and key milestones Project progress & outcomes Monthly & as required Weekly & as required Monthly & as required Monthly and as required Governance Group meetings, phone, , face to face meetings, intranet, meetings & . Meetings, phone, , reports Senior Doctors meetings, ACN Meetings, phone, Formal and informal meetings, SMG reports, phone, , intranet, information brochures & posters CHERC Operations Manager, Project Officer, Project Manager & Relevant members of Governance Group. Project Manager & Officer Project Officer, CNC, ED NPC Project Team Visiting Officers Medical Project progress & outcomes Twice throughout project Formal meetings Project Team and Emergency Department Physician / Director. Other interested parties Consumers, staff at BH, partnership organisation (BCHS inc) Project progress and outcomes As required at a minimum quarterly Intranet, internet, newspapers, newsletters, meetings, posters and information brochures. Project officer & Project Team (Adapted from Dwyer, Stanton, and Thiessen, Project Management in Health and Community Services, 2004 and Inpatient Rehabilitation Patient Centred Care Project Communication Strategy 2005) 24

25 Appendix 3: Generic Nurse Practitioner Candidate Position Description GENERIC POSITION DESCRIPTION FOR NURSE PRACTITIONER ROLE IMPLEMENTATION DESIGNATION: REPORTS TO: DATE: NURSE PRACTITIONER CANDIDATE Nurse Manager Clinical Department XXXXXX Purpose of Position Within an action research framework to trial and define the role of Nurse Practitioner in Bendigo Health Care Group s XXXX Department. To work towards attaining Nurse Practitioner status by meeting the Nurses Board Victoria eligibility requirements. Key Activities 1. Specific Responsibilities To provide care to a select groups of patients within a framework of approved clinical practice, in collaboration with relevant medical staff, within BHCG policies and procedures and the Nurses Board of Victoria Nurse Practitioner Competency Framework. To collaborate with other like services to develop evidence based clinical practice guidelines and medication formulary to enable implementation of the extended role. To work collaboratively with the Nurse Practitioner Governance Group to: define the role of the Nurse Practitioner in the XXXX Department utilise change management strategies to integrate the extended roles of nursing practice in the XXXX Department communicate with and engage key stakeholders in the process of integrating the new nursing role participate in relevant internal and external committees and working parties assist with evaluation of the new role 2. Organisational Responsibilities To practice within the philosophies and policies of Bendigo Health Care Group Participate in team/departmental meetings and other organisational meetings as required Participate in staff development and training as required Maintain accurate records, statistics and reports as needed Participate in service development as required 25

26 Position prerequisites Current registration as a Div 1 Registered Nurse with the Nurses Board Vic. Post graduate qualifications in nursing speciality and Hold or working towards a relevant Master of Nursing, including Nurse Practitioner mandated studies Extensive clinical experience in a speciality nursing field is essential Award Nurses Victorian Health Services Multi-Employer Agreement Nurses Victorian Health Services Award Registered Nurses commencing a Nurse Practitioner Candidate role will be paid their substantive salary during their candidature. Hours A minimum of 24hrs per week Performance Appraisal After the two (2) month probationary period Annually thereafter, unless required earlier. Occupational Health & Safety Each employee has the right to a safe working environment and s/he should advise the supervisor of any risk or condition likely to result in accident or injury. Each employee has the responsibility to cooperate with the Group s OHS policies and to participate in appropriate safety education and evaluation activities. Infection Control Each employee has a responsibility to minimise exposure to incidents of infection/cross infection of residents, staff, visitors and the general public. This minimisation can be most effectively achieved by all staff adhering to the policies and procedures as set out in the Group s Infection Control Manuals. Disaster or Emergency Responsibility Bendigo Health Care Group is the principal regional health provider in the event of disaster and emergency. The occupant of this position understands and acknowledges that he/she may be required to work as assigned if requested to meet the Group s responsibilities in a disaster or emergency situation. Quality Improvement Each employee has a responsibility to participate and commit to ongoing quality improvement activities using the EQuIP (Evaluation and Quality Improvement Programme) model. Workplace Harassment & Bullying 26

27 Bendigo Health Care Group adopts and applies the Victorian State Government Code of Conduct. Each employee has the right to a work environment free from any form of workplace harassment and bullying. From an employee s orientation and throughout their employment, each employee must apply BHCG policy and participate in education and training. BHCG Policies & Procedures Bendigo Health Care Group policies and procedures are fully set out in the Group s clinical and managerial policy manuals located on the BHCG intranet and in hard copy held on all departments/units. It is the responsibility of each employee to familiarise themselves with these policies especially those in the Human Resources Handbook. Confidentiality Policy Each employee has a responsibility to comply with the Group s Confidentiality Policy, as it is a condition of employment. Any breach of the Confidentiality Policy will result in disciplinary action and/or dismissal and a possible fine under the conditions of the Health Services Act (Vic). Key Selection Criteria KSC 1 KSC 2 KSC 3 KSC 4 KSC 5 KSC 6 KSC 7 KSC 8 KSC 9 KSC 10 KSC 11 Current registration as a Registered Nurse Division 1 with the Nurses Board of Victoria. A clinically relevant Masters level of nursing qualification (or working towards) Completed the therapeutic medication management module at an approved university (or working towards) A commitment to seek endorsement by the Victorian Nurse s Board as a Nurse Practitioner A minimum of 3-5 years clinical experience post specialist qualification, and evidence of working at a level of advanced practice in the clinical area Active involvement in research, publication, teaching, quality improvement and best practice activities Clinical leadership, collaboration and professional role modelling skills A focus on best patient outcomes within a multidisciplinary team High level interpersonal and communication skills across a broad range of health professionals A conceptualisation of the Nurse Practitioner model that is patient centred and within a nursing model of practice The capacity to be critically reflective 27

28 KSC 12 An understanding of and sensitivity to the political dimension of developing the Nurse Practitioner role and an ability to promote the role in a positive manner Authorised by (Executive Director of Nursing) Date Reviewed 28

29 Appendix 4: Appointment process If accepted, organisational new position process followed Complete HR 1 form (sign off by Operations manager, Executive Director, to Group Executive for approval of position by Chief Executive) Full Submission considered by Senior Nurse Council & accepted or rejected with feedback to author Multidisciplinary team complete and submit Full Submission to Senior Nurse Council If accepted an invitation for a Full Submission is extended Expression of Interest considered at Senior Nurse Council & supported or rejected with feedback to author On positive advice from Executive Director Nursing, Director & EDON Multidisciplinary team convened (NUM, Medical, Allied health and nursing clinicians) Draft EOI to Executive Director of Stream and EDON Identification of potential Nurse Practitioner role in clinical setting 29