CREATING A VOICE FOR NURSES
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1 CREATING A VOICE FOR NURSES Erik van Muilekom MANP, OCN, RN Clinical nurse specialist Netherlands Cancer institute- Antoni van Leeuwenhoek hospital Amsterdam President EONS
2 European Oncology Nursing Society 2014 Charity established 1984 UK 30 European countries represented cancer nurses Affiliated NGO s Non Governmental Organizations other cancer organisations ECCO, ESO, ONS, ISNCC, UICC MASCC, IPOS, EAUN
3 Austria Belgium(2) Bulgaria Czech Republic Croatia Cyprus Denmark Estonia Finland France Germany Greece Hungry Iceland Ireland EONS countries and 26 languages EONS = English Israel Italy Lithuania Malta Norway The Netherlands Poland Portugal Serbia Sweden Switzerland Slovenia Spain Turkey UK(2)
4 Vision That all people affected by cancer across Europe will benefit from the care of well educated, well informed and highly competent cancer nurses, who will play a central role in providing support, promoting health and improving clinical outcomes
5 Mission Working in partnership to develop and promote excellence in cancer nursing practice through education, research, leadership and support to cancer nurses across Europe
6 Values To be an inclusive and credible organisation, which aims to provide effective and practical support to all members across Europe. Work in co-operation with a range of multidisciplinary organizations to optimise the nursing contribution to cancer care in Europe.
7 CREATING A VOICE FOR NURSES Proud to be a nurse Cancer in Europe Nursing workforse Let s hear your voice Organisation Education Advanced nursing practise Patient s voice
8 Nursing staffing cuts to save money, effects patients, increase bachelor education for nurses could reduce hospital deaths
9 Nursing staffing and education and hospital mortality in EU Increase workload-increased mortality > 6 patients per nurse higher mortality More bachelor s degree nurses decrease mortality Cutting nurse staffing to same money affects patients outcomes Increase education prevent hospital deaths (Aiken et al, (2014), Lancet)
10
11 What is happening in Europe with cancer care Aging populations and professionals Fast changing treatments Change in how we deliver cancer services Many survivors patients with voices
12 Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012 Total population 733 mlj (Ferlay et al (2013) EJC, 49, 6, ) Cancer patients 3.45 miljoen Cancer deaths 1.75 miljoen
13 Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012 (Ferlay et al (2013) EJC, 49, 6, )
14 Europe and Ageing population (United Nations New York, World Population Ageing 2013)
15 (United Nations New York, World Population Ageing 2013) EU countries
16 Facts Ageing population Increasing demand for healthcare Elderly people multiple chronic conditions (IMF.org )
17 (Gatta G et al, 2014 Lancet Oncol) Improved survival but differences between countries, accesibility to good care, variation different reasons
18 Health workforce Also Aging Insufficient new recruits to replace those retiring Patients > 65 years Doctors Nurses 87 million 152,7 million 30% > 55 years Age years (EU: Action plan EU health workforce )
19 The average age of the nurse in many countries > 40 year Canada Denmark Iceland - 44 Ireland Germany Japan New Zealand - 44 Singapore - 35 Thailand - 41 United Kingdom - 42 United States * (ICN, 2007, An Ageing Nursing Workforce)
20 Health workforse Also Growing feminization healthcare workforce 13.1 million Women 2010=75% of the workforce Medical schools 50% women
21 Health workforse Also Increasing turnover health professions Due to Low pay Long working hours Stress Difficult work life balance
22 Balance is the key for life
23 Estimated shortage in EU 2020 Undersupply of health professionals rural, poor populated areas Unequel distribution of health professionals Estimated shortage 2020 Estimated % care not covered Physicians ,5% Dentist, pharmacists and physiotherapists ,5% Nurses % Total ,8%
24 EU action plan Forcasting workforce needs Anticipating future skills needed in health professions Share good practice Effective recruitment What can we do as Nursing professionals
25 Policy: EU Green paper Progress on improving the health status of the population and providing better provision of, and access to, healthcare for all across Europe cannot be realised without a workforce of sufficient capacity and with the right skills. Promoting a sustainable workforce for health in Europe 2012
26 Caring in Crisis Nurses in EU work harder than before, asked to provide more for less Nurses (female) are unequally and hardest hit Lack of equipment, reduced supplies, inadequate staffing, placing patients lives in danger (European Federation of Nurses Associations, Caring in Crisis, 2012)
27
28 Current Challenges Increasing public awareness of oncology nurses potential in Europe Shortage of oncology nursing workforce Diversity of roles, titles and qualifications* Mobility Rapidly changing healthcare systems Personalized care *Schneider & Faithfull (2008) EONSNewsletter2011springPage28.pdf
29 We have to build our own future
30 Let your voice hear
31
32 What is your way to get attention
33 Let your voice hear Who has the power What is realistic to reach Where are my friends Who are my enemies Can I make small steps When to go for it
34 Building a society
35 Dutch Oncology Nursing Society 2600 members, oncology nurses 25 years Active membership Depending on individuals Invite new members and leaders
36 Education of nurses is a major key to quality care and better outcomes for patients (Aikan et al, 2014, Lancet)
37 Improve cancer nursing care New Core Curriculum is based eight modules and focuses on the adult with cancer Can be used for curricula development for all nursing education programs Nurses working in cancer centers or in general practice/hospital settings
38 Did cancer nursing in EU change due to EONS existence Cancer nursing as a specialty Advanced nursing practice Nursing research Differences in Europe Making progress
39 EONS member survey 2013 Countries cancer nursing recognized as a specialist area of nursing Belgium Practice Croatia Cyprus Denmark Estonia Finland Iceland Ireland Hungary Lithuania Norway Sweden Poland The Netherlands Turkey UK Countries cancer nursing NOT recognized as a specialist area of nursing Practice Austria Czech Republic France Greece Malta Serbia Switzerland Slovenia Portugal Spain Total: 16 10
40 Recognition of cancer nursing Working on a European level EONS & ESMO
41 Development advanced nursing practice globally (Sheer, B. 2008, Journal of Nursing Scholarship, 40,3, )
42 Development advanced nursing practice globally Advanced practice nursing rol expanded last decade Education programs but sometimes no jobs Requires a healthcare environment of multidisciplinarity (Sheer, B. 2008, Journal of Nursing Scholarship, 40,3, )
43 Advanced practic nurse A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Masters degree is recommended for entry level. (International council of Nurses (ICN) 2009)
44 Advanced practice nurse Educational preparation Recognition education programs Fromal system licensure, registration, certification etc.. Nature of practice Intergrates research Autonomy Consultant services etc. Regulatory mechanisms Right to diagnose Prescribe medication, treatment Recognized titles etc.. (International council of Nurses (ICN) 2009)
45 Best of both worlds Physicians domain Joint domain Nursing domain
46 (Lewis R., 2009, Journal of Advanced Nursing)
47 Results/conclusion: 4 trials No difference in survival, recurrence, psychological morbidity Patients more satisfied with nurse follow up Telephone follow-up good alternative Costs less than of physician led follow up No statistical comparison More well conducted research is needed (Lewis R., 2009, Journal of Advanced Nursing)
48 (Faithfull, 2001, BJC)
49 Results/conclusion: No difference symptom scores over time nurse-led vs physician-led Patients received nurse-led care more satisfied Significant cost benefits (31% reduction) Evidence nurse-led follow up safe (coping symptoms, telephone support) (Faithfull, 2001, BJC)
50 Results/conclusion: Nurse-led symptom management clinic reduces hospitalization Toxicities controlled, costs reduce Results/conclusion: Nurse-led symptom management toxicity/side effects is possible (Mason H, 2013 ONF) (Zwinkels H, 2009, ONF)
51 Best of both worlds Evolution of nursing power (VBOC, 2006, Verpleegkundige toekomst in goede banen)
52 Be visible as a nurse Card Titles Speak openly Media newspapers/tv/internet Politics Are you a nurse or a doctor
53 Evidence besed practice Translate research findings in practise Use guidelines Stimulate education Work togheter with other care providers
54 Be visable in the public domain
55
56 Proud to be a nurse
57 Patients voice
58 Patients with voices Listen to them Collaborate with them Policy statements together Advocate for them Allliance facing Politicians Other stakeholders Organisations
59 Patients are the best promotion In order to be successfull Important for nurses to work together, Across employment settings and roles, To advocate on behalf of colleagues and the profession. Nurses comprise the largest professional group within healthcare and have been recognized by the public as the most trusted profession (Tomajan, 2012, OJIN "Advocating for Nurses and Nursing )
60 Patients are the best promotion In order to be successfull Despite nursing s strengths inherent in its size, diversity, and unique relationship with the public, the full potential for influence by the nursing profession has yet to be realized (Tomajan, 2012, OJIN "Advocating for Nurses and Nursing )
61 THE TURKISH EONS STORY
62 Participation Fatigue Workshop in1996 Milan All Spring Conventions, first in Leuven 1998 First strategic planning meeting for in Brussels Masterclass Programs The study of Complementary and alternative medicine in cancer patients in Europe with 13 other countries in 2005 Online course
63 Grants and Awards Recieved 1000 from Novartis Pharmaceutical Company Novice Research Award and Best Poster Award EONS Grant for ECCO15 Clinical Travel Grant Life Time Achievement Award
64 Translation Many articles from the EONS Newsletter Post Basic Core Curriculum Extravasation Guidelines 2007 TITAN TARGET
65 Our contribution to EONS Had an advisory board member in EONS Served for the 4th Spring Convention in Edinburgh 2004 Sultan Kav EONS Board Member and President from 2005 to 2013 Hosting the 9th EONS Congress in Istanbul
66 Results and Impact 13 TITAN Courses 3 TARGETcourses The extravasation guidelines EONS provides a role model Courses, workshops, masterclasses,conventions Chemotherapy Certification Course
67 ASK for help use Opinion leaders Stakeholders
68 The first Masters in Advanced Nursing Practise (2009 Ministerie Volksgezondheid Welzijn, Sport)
69 Grow up
70 Use opinion leaders
71 To be visable
72 Take home message
73 Look at the donut not at the hole
74 Take away message Proud to be a nurse Quality care prevents mortality Let your voice hear Advanced practise Ask for help Make our own future
41 T Korea, Rep. 52.3. 42 T Netherlands 51.4. 43 T Japan 51.1. 44 E Bulgaria 51.1. 45 T Argentina 50.8. 46 T Czech Republic 50.4. 47 T Greece 50.
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