Vicki Doherty, Consortium Manager Irene Murphy, Nurse Practitioner Mentor. Supporting the rural nurse practitioner candidate

Transcription

1 Vicki Doherty, Consortium Manager Irene Murphy, Nurse Practitioner Mentor Supporting the rural nurse practitioner candidate

2 Overview 1. Background to GRPCC 2. Challenges facing Gippsland 3. How we are building specialist palliative care capacity in Gippsland 4. Future directions 5. Acknowledgement

3 Regional Consortia GRPCC is one of eight regional consortia in Victoria and provides leadership to its member services by: undertaking regional planning; coordinating palliative care service provision; advising the Department of Health about future service development and funding; and managing the service delivery framework and undertaking communication, capacity building and clinical service improvement initiatives in conjunction with the Palliative Care Clinical Network

4 Strengthening palliative care: Policy and strategic directions Ensuring support from communities 1 Informing and involving clients and carers 2 Caring for Carers 6 Providing quality care supported by evidence Strategic Direction 4 Providing specialist care when and where it is needed 5 Coordinated care across settings Client and Carers 4 Providing specialist care when and where it is needed 3 Working together to ensure people die in their place of choice

5 Palliative Care Services in Gippsland Nine community palliative care services 11 palliative care beds spread across the region 4 beds at Traralgon 2 beds at Warragul and Sale 1 bed each at Bairnsdale, Wonthaggi, Leongatha

6 Location of palliative care Gippsland region: services Snapshot of where the services are Where are the inpt. beds and the number

7 Challenges in Gippsland Geographics: 2nd largest region in Victoria mountain range through the middle of the region Demographics: 65 yrs higher than state average Higher Aboriginal population than state average Health indicators: Lowest male life expectancy Highest rate of smoking Highest rate of disability Highest rate of psychological distress Highest rate of drug and alcohol

8 Challenges in Gippsland Healthcare service usage: Highest rate of patient separations lowest use of private hospitals GP attendance below average Highest rate of emergency presentations

9 So why would anyone want to live in Gippsland??

10 Palliative care workforce in Gippsland Largely generalist workforce providing specialist palliative care Very few GPs upskilled in palliative care No palliative medicine specialist Very, very few psychosocial support and other allied health services

11 Building palliative care capacity in Gippsland DH provided funding in 2009 to support development of a palliative care nurse practitioner (NP) model Model proposed 4 sub-regional NPs to provide: local specialist knowledge; build relationships with local GPs, nurses and allied health professionals to improve palliative care outcomes; a triage and referral service for complex patients throughout the sub-region; client assessment and consultation; participation and leadership in local multi-disciplinary team(mdt) meetings; advice about advance care planning; education to health professionals, clients and the community; initiation and implementation of quality improvement activities; and research

12 Sub-regional palliative care nurse practitioners In 2009, GRPCC provided funding to three lead agencies to employ NPs Bass Coast Community Health La Trobe Community Health Service Gippsland Lakes Community Health BUT NO NPs APPLIED!!!!

13 Nurse practitioner candidates Three NPCs recruited in lieu of NPs No palliative medicine specialist in Gippsland to provide medical supervision Very, very few NPs in the region to provide nursing supervision No subacute palliative care unit, so no chance for NPCs to have access to a critical mass of complex clients In 2009, the role of NPs and NPCs were not very well understood Lead agencies had no prior experience in managing an NP or NPCs Little capacity to develop steering committees, scope of practice and model of care

14 What did we do? Partnerships made with metro services to provide medical supervisors Funded and coordinated placements at metro based hospices and community palliative care services Recruited an NP mentor Developed the Palliative Care Nurse Practitioner Candidacy Program

15 Nurse Practitioner Mentor Role of the NPM is to: provide clinical leadership and expert advice to NPCs; model the way for Gippsland s PC NPCs and inspire a shared vision; and to be a trusted advisor and mentor.

16 NP Candidacy Program is a structured and supported program of clinical and professional supervision and mentorship; period of candidacy is flexible; aligns with workforce planning; aligns with the NPC s academic program; supports the NPC s transition to practice as an endorsed NP; and is individualised to ensure clinical competencies that meet service demands are developed during the candidacy

17 Current State of Play One endorsed NP; One NPC due for endorsement later this year; Three NPCs 1-2 years off being endorsed

18 Future Directions Increase understanding of the role and value of the palliative care NP in improving client outcomes; Implementing appropriate measures of NP performance indicators that demonstrate client outcomes; Putting the role of the NP on the health agenda to influence policy making; Contributing to the national/international evidence based literature

19 Acknowledgements Funding: Victorian Government Department of Health for funding; Partnerships: Calvary Healthcare Bethlehem; McCulloch House, Monash Health; Palliative Care Unit, Peninsula Health; Other placements include: St Vincent s Health; Melbourne City Mission