VNPP Nurse Practitioner Candidate Support Package Guidelines

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1 VNPP Nurse Practitioner Candidate Support Package Guidelines Overview A barrier to Nurse practitioner (NP) implementation can be the time and resources to prepare an advanced nurse to be endorsed as a NP. Supporting supervised clinical practice and professional supervision is a significant up-front training cost for employers that cannot be offset by productivity in the short term. A NP Candidacy program is a structured and supported workplace-based program of clinical and professional supervision that is individualised and aligned with the academic program (where candidates are completing studies) - refer to attachment 1. NP Candidate Support Packages are an initiative of Nursing and Midwifery Workforce as part of the Victorian Nurse Practitioner Project (VNPP). Public health services have been able to access NP Candidate Support Packages (NPCSPs) since April NPCSPs provide a flexible pool of funding as a contribution towards the costs of providing clinical and professional supervision and support for a NP candidate in targeted clinical areas of service delivery. The cost of the clinical supervision component of current NP master degrees is estimated to be in the range of $15-25,000 per individual however total costs are dependent on factors such as base grade of the nurse/np candidate, the service setting, model of supervision, number of nurses or NPCs being supported within a given health service, ability to access other relevant advanced clinical training programs (for example, registrar training) and base level of competence, preparation and education of the nurse when appointed as a candidate. 1. Amount and purpose Nursing and Midwifery Workforce is funding up to $10,000 to eligible health services as a contribution towards the costs of providing clinical and professional supervision and support for each NP candidate. Public health services may apply for a NPCSP for a nurse in their employment, who they are supporting to prepare for NP endorsement. Funding: is provided to health services as a one off, capped unit price is tagged to a specific individual NPC is a one-off payment to support the period of candidacy (typically about 2 years) may be pro rata depending on the intensity and length of support required for the individual at the time of application. Since single/sole practitioner models are highly vulnerable and cannot offer a sustainable service, an incentive is offered to encourage services to plan for and appoint more than one full time equivalent (FTE) of NPC in an area. Accordingly, NPCSP funding is: $8,000 for first NPC in the area $10,000 for second and subsequent NPCs appointed to the same area or clinical service. The NPCSP is not intended to cover the full costs associated with providing supported preparation and it is recognised that a significant up-front contribution is made by employers that cannot be readily offset by productivity gains in the short to medium term. Health services who receive funding for a NPCSP are required to establish a support program that bridges the clinical requirements of the academic program as well as any specific skills and competencies that will be required in the service model in which the nurse will be employed as a NP.

2 The NPCSP will support the: clinical supervision for activities that are extensions to nursing practice specific skills acquisition identified as a requirement for the NP service model professional supervision/mentoring while a NPC. A comprehensive and individualised package will include: description of the skills/competencies to be achieved and assessment requirements learning objectives and specific performance expectations expectations regarding timeframes to achieve the agreed skills/competencies. The VNPP does not provide separate funding for NP positions/salaries. The decision to appoint a NP or NPC is within the scope of individual health services. No Department of Health approvals are needed. Funding for NPs and NPCs must be found from existing organisational funding streams. The provision of an NPC support package by the Department is not linked to, or does not constitute an undertaking to provide additional salary support in the future. Health services need to undertake an analysis of the internal budget options for supporting NPs as part of the NP model development. The funding approach for NPCSP also assumes the full use of each nurse s EBA entitlements (for example study leave) and recognises that smaller/rural health services may have to pay general practitioners, whilst larger organisations will have a greater capacity to access salaried staff for supervision. A pro-rata funding package may be negotiated for NPCs who are well advanced or midway to endorsement at the time of this funding round. 2. Eligibility Health service providers funded under VNPP can apply for NPCSPs for nurses that are: 1. Eligible for endorsement as an NP by the Nursing and Midwifery Board of Australia (NMBA) 2. Employed in a public health service, public residential aged care service or health care provider specifically approved as part of a VNPP funding round (such as the NGOs approved as part of the Palliative Care Consortia models in Round 4.4 or Primary and Community providers included in Round 4.13) 3. Appointed by the employer as a NP Candidate (NPC) 1 4. Have an agreed structured program of clinical and professional supervision in place designed to assist in meeting NMBA and course requirements, and 5. Practising in an area/service that is aligned with the organisation s service and/or strategic plan. NPCs may be enrolled in courses of study (Masters and pharmacology units) that lead to endorsement as an NP or they may have already undertaken and completed their studies. 3. How to apply Eligible health services/employers can apply for NPCSP on behalf of appointed NPCs. NPCSP are offered as part of a VNPP NP implementation funding round in a targeted area of the service system. Rounds are generally offered annually and are advertised directly to Directors of Nursing through the monthly Nursing and Midwifery Communique and are also on the Nursing in Victoria website: From time to time, open NPCSPs (that is, not linked to a targeted area/round) are offered. These NPCSP are announced through the same channels as above. 1 An NPC is a Registered Nurse engaged to undertake a course of study and undertake clinical experience leading to endorsement as a nurse practitioner. A registered nurse engaged as a nurse practitioner candidate (as defined) shall be classified and paid their substantive salary (Australian Industrial Relations Commission 2006).

3 4. Disbursement and Conditions NPCSP are paid as a single payment to health services on confirmation to Nursing and Midwifery Workforce of the appointment of an individual(s) as NPCs. By accepting the package, NPCs agree to complete the NPC logbook supplied by Nursing and Midwifery Workforce. NPCs submit de-identified aggregate data six monthly to Nursing and Midwifery Workforce. This data will inform the Department of Health s understanding of the training and supervision inputs for NPCs and form the basis of future funding bids for NP development state wide. 4.1 Eligible costs NPC preparation involves clinical supervision by expert practitioners. Given the neophyte nature of the NP role, this clinical supervisor role will necessarily need to be undertaken by senior clinicians from other disciplines (radiographers, pharmacists, surgeons or physicians depending on the clinical specialty) until there are sufficient numbers of NPs who can take on the supervisor role. The NPCSP may be used for reasonable costs associated with the clinical and professional supervision provided by health services to nominated NPCs, such as: undertaking a candidate needs assessment against the specific anticipated job and service requirements accessing supervision when the supervisor is not employed by the health service (such as payment of GPs, community pharmacist, payment of sessional rates for supervisors). Note: there is an expectation that salaried staff will provide supervisory services as part of their commitment to training and development contribution to backfill for NPCs whilst having supervision reasonable cost of teleconferencing or travelling to access supervisors participation in Department of Health NP collaborative activities accessing professional supervision/mentoring by a senior nurse (for NPCs in services that do not have formal professional nursing structures such as some community health, drug and alcohol services, this may have to be accessed outside the organisation). In particular, providing supervision for NPCs in rural areas and/or smaller services may necessitate travel to larger centres or sites to ensure candidates have access to the range of clinical services and supervisors needed. The NPCSP funds are not to be used for course fees associated with undertaking postgraduate studies (either Masters or pharmacology units), for the fees associated with applying to NMBA for endorsement as a NP, or any costs directly associated with preparation of documents for assessment by NMBA. 4.2 Transition Planning The NPCSP should also be used to develop a suitable strategy to manage the transition from NPC to endorsed NP including re-negotiation of conditions of employment (if required) to meet service need. Planning for employment as an NP also needs to recognise that although a primarily clinical role, there is a requirement that NPs continue to undertake those elements of their practice that are essential (and a requirement of ongoing endorsement) such as clinical leadership, audit and research, and these activities need to be accommodated within the NP role and workload. 4.3 Reporting Health services receiving funding for NPCSP are required to provide a six monthly log (summary level, de-identified data) of the supervision provided to each candidate, supervisors and the focus of the supervision. To ensure standardised data is received, a template log book page will be provided by Nursing and Midwifery Workforce for all candidates receiving a package.

4 The data supplied through the logbooks will provide the Department with information about the cost of supporting NP candidates and assist in identifying the actual costs associated with role implementation. 4.4 Withdrawal of candidature If a NPC with a NPCSP ceases employment with the health service (or takes leave of longer than six months), Nursing and Midwifery Workforce must be notified as soon as practicable to discuss the funding. NPCSP funding is not transferable to another NPC without agreement of Nursing and Midwifery Workforce. If a NPC transfers to another public health service into a candidate position, pro rata transfer of funds may be required. A case-by-case assessment (including consideration of the costs incurred to date and time to presentation to the NMBA) will be made by Nursing and Midwifery Workforce in consultation with the sites/services involved. 4.5 Evaluation of NP Candidacy programs NPCSP provided by health services will evolve in response to formal and informal evaluation as well as the emerging organisational and NPC needs and experiences. Local evaluations should be structured to elicit information about aspects including: satisfaction of candidates, clinical and professional supervisors with program completion of specific clinical competencies changes to care delivery, clinical outcomes or process measures indicating the uptake of the model and/or impact of the NP role, and time to endorsement. Nursing and Midwifery Workforce may from time to time request health services collect and provide information about the packages and the types of programs offered to assist the Department in informing the policy framework and funding allocation for this initiative. 5. Contact/Further information For more information about the process and requirements for endorsement as a NP, go to: For information about the VNPP, go to:

5 Attachment 1: About NP Candidacy Programs The preparation to become an NP includes formal educational preparation as well as workplace training and coaching. Whilst nurses undertaking preparation to become a NP will have well developed advanced practice skills in their given area of practice, a period of supervision and clinical training is generally needed to support the transition to practice as an endorsed NP. Nursing is a practice-based discipline and the NP role is at the peak of clinical practice. The preparation of a NP requires the integration of academic theory with clinical practice as well as mastery and application of advanced clinical assessment and diagnostic skills and knowledge and competence in pharmacotherapy and other treatment options. In addition to these competencies 2, NPs need to develop strong research abilities and demonstrate advanced clinical leadership ability. Academic programs for NPs often require students to undertake periods of supervised clinical practice. In addition, employers may identify specific clinical competencies that they will require NPs to have in order to meet service demands that need to be developed in the nurse practitioner candidate (NPC). One approach is for employers to provide a candidacy program for NPs. Candidacy programs are structured and supported programs of clinical and professional supervision that are individualised and aligned with the academic program (where candidates are completing studies). Having a formal and structured approach is in the interest of both employers and the nurse as it contributes to the overall likelihood that an individual will successfully complete their academic program and progress to endorsement in a timely manner. It also ensures that the specific requirements of the NP service model are developed and met before endorsement. Structure of Candidacy programs Candidacy programs developed by health services need to recognise and accommodate that: each NPC will start at different levels, progress at different rates and respond differently to learning experiences therefore the learning needs of a NPC will vary from NPC to NPC as well as across the period of candidacy the program may be required to extend over one- two years the NPC may be accessing study leave to undertake formal education requirements supervision of a NPC may be provided by a range of people over the course of the candidacy including but not limited to, the disciplines of nursing, medical, pathology, and pharmacy, radiology and physiotherapy. This model of interdisciplinary supervision is particularly needed where there are no endorsed NPs practising who can supervise the NPC the NPC will access existing training opportunities where the competency/skill development is shared (for example, registrar/specialist training sessions, teaching rounds, clinical audit) clinical exposure and supervision may need to be provided outside the nurse s current work setting or even outside the employing organisation both structured and unstructured learning opportunities and support are necessary and time may be dedicated to a range of activities such as seminars, group discussion, observation, reflective practice techniques, journaling, research and investigation, peer support and personal supervision or mentoring 2 The ANMC National Competency Standards for the Nurse Practitioner have been accepted by the Nursing and Midwifery Board of Australia as the standards by which NPs are assessed to obtain and retain their license to practice as a NP in Australia. The standards build on the core competency standards for registered nurses and midwives, and the advanced nursing practice competency standards.

6 as NPCs develop their capacity to practise with increasing autonomy, they can assume responsibility for a more complex and diverse clinical workload NPCs generally begin a candidacy as advanced practice nurses and as such supervision should focus on new practice capability a range of assessment methods and tools are applied throughout the program to ensure the learning objectives of the NPC are met and competence is demonstrated. Resources for Candidacy programs In addition to access to supervisors and expert clinicians, NPCs will need the support of educational expertise to develop an agreed program of learning as well as appropriate assessment and supervision frameworks. NPCs should also be provided with appropriate resources including: time to undertake the program and maintain manageable workloads access to suitable supervisors (clinical and professional) and mentors that understand the role and objectives of the supervision flexible rostering to allow them to meet study requirements and work with/spend time with supervisors access to library facilities (including on-line), office equipment and clinical skills development equipment/simulators etc. Evaluation of program It is anticipated that NP Candidate Support Programs provided by health services will evolve in response to evaluation and the organisational and candidate needs and experiences. Local evaluations should be structured to elicit information about: satisfaction of candidates, clinical and professional supervisors with program completion of specific clinical competencies changes to care delivery, clinical outcomes or process measures indicating the uptake of the model and/or impact of the NP role time to endorsement. Nursing and Midwifery Workforce will request health services collect and provide information about the packages and the types of programs offered to assist the Department in informing the policy framework and funding allocation for this initiative. Definitions Clinical Supervision A formal, structured process of professional support (DHS, 2005) that enables reflection and review of clinical situations (DoH WA, 2004) and is focused on progressing clinical practice. (Mills et al., 2005) Also sometimes referred to as a Clinical Internship. A NPC may need academic, clinical and/or professional supervision. Mentoring Academic Supervision Mentoring is a process in which the mentor is able to support and help the mentees to develop their knowledge, skills, thinking and behaviours and thus problem solving and performance in a current role as well as longer term career development planning. (Mason 2005,p1 referencing, Negovan, V 2006, p3.) An intensive form of teaching that goes beyond knowledge acquisition (James & Baldwin, 2006). Academic supervision is commonly used to describe the relationship between academics and students completing a postgraduate research degree but the principles of research supervision can be applied to other academic contexts.

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