MALLEE TRACK HEALTH AND COMMUNITY SERVICE

Transcription

1 MALLEE TRACK HEALTH AND COMMUNITY SERVICE DEPARTMENT OF HUMAN SERVICES VICTORIAN NURSE PRACTITIONER PROJECT PHASE 4 ROUND 4.1 PROJECT REPORT AND SERVICE PLAN SEPTEMBER

2 Panic plays no part in the training of a nurse Elizabeth Kenny Nurses One of the blessings of being ill Sara Moss-Wolfe RN means Real Nice Anonymous 2

3 The information contained within this report is based on sources believed to be reliable. However, no warranty is given that the said sources are correct, and Kayjay Projects Bendigo Pty Ltd accepts no responsibility for any resultant errors contained herein and damage or loss, howsoever caused or suffered by any individual or corporation. Kayjay Projects Bendigo Pty Ltd 3

4 TABLE OF CONTENTS TABLE OF CONTENTS... 4 EXECUTIVE ENDORSEMENT... 6 ACKNOWLEDGEMENTS... 7 EXECUTIVE SUMMARY... 8 SECTION 1 BACKGROUND TO THE MTH&CS NURSE PRACTITIONER PROJECT mth&cs EXPRESSION OF INTEREST IN THE PHASE 4 PROJECT NURSE PRACTITIONERS AND NURSE PRACTITIONER CANDIDATES NURSE PRACTITIONER EDUCATION LEVEL COUNCIL OF REMOTE AREA NURSES OF AUSTRALIA DETERMINING WHETHER A HEALTH SERVICE REQUIRES A NURSE PRACTITIONER SECTION 2 PROFILE OF MTH&CS CATCHMENT AREA SERVICES AND PROGRAMS DELIVERED BY MTH&CS SERVICE AND BUSINESS PLANNING STRATEGIES RELATIONSHIP TO NURSE PRACTITIONER POSITIONS...24 SECTION 3 COMPETENCY STANDARDS FOR NURSE PRACTITIONERS AND ADVANCED NURSING PRACTICE AUSTRALIAN NURSING AND MIDWIFERY COUNCIL S NATIONAL COMPETENCY STANDARDS ADVANCED NURSING PRACTICE COMPETENCY STANDARDS ANALYSIS OF THE LANGUAGE OF ADVANCED NURSING NURSE PRACTITIONERS VICTORIAN LEGISLATION NURSES BOARD OF VICTORIA ENDORSEMENT REQUIREMENTS FOR NURSE practitioners SECTION 4 NURSE PRACTITIONER SERVICE PLANNING PROJECT METHODOLOGY SECTION 5 PROJECT ESTABLISHMENT ACTIVITIES EXECUTIVE SPONSOR AND STEERING COMMITTEE PROJECT REPORTING ARRANGEMENTS STAKEHOLDERS AND THEIR VIEWS ISSUES IDENTIFIED BY STAKEHOLDERS PROJECT BUDGET...34 SECTION 6 UNDERSTANDING DEMAND AND OPPORTUNITIES MTH&CS SERVICE AND BUSINESS PLANNING REGIONAL AND STATEWIDE PLANS WORKFORCE DEMAND AND WORKFORCE SUPPLY WORKFORCE DEMAND AND SUPPLY environmental scanning IDENTIFIED SERVICE GAPS NURSE PRACTITIONER ROLE AND SERVICE MODEL EVOLUTION OTHER MATTERS FOR CONSIDERATION BARRIERS AND CONSTRAINTS TO NURSE PRACTITIONER MODELS OF CARE SECTION 7 SHAPING THE SERVICE MODEL FOR NURSE PRACTITIONERS NURSE PRACTITIONER MODELS OF CARE PRIORITISING AREAS FOR NURSE PRACTITIONER SERVICE DEVELOPMENT

5 7.3 IMPLEMENTATION TIMEFRAME CURRENT MODEL OF CARE IN THE PRIORITY AREAS SUPPORT FOR MEDICAL REGISTRAR TRAINING BENEFITS TO KEY STAKEHOLDERS DEFINING FUTURE NURSE PRACTITIONER ROLES GENERIC POSITION DESCRIPTIONS SUCCESSION PLANNINg for service continuity MENTORING AND SUPERVISION OF CANDIDATES EVALUATION AND MONITORING...67 SECTION 8 PRIMING THE ORGANISATION FOR NURSE PRACTITIONERS EXECUTIVE LEAD FOR NURSE PRACTITIONER ROLE DEVELOPMENT ESTABLISHMENT OF GOVERNANCE STRUCTURES COMMUNICATION STRATEGY AND ENGAGING KEY STAKEHOLDERS IDENTIFICATION OF NURSE PRACTITIONER KNOWLEDGE GAPS IN KEY STAFF INTERNAL PROCESS FOR RECEIPT AND ASSESSMENT OF EXPRESSIONS OF INTEREST ORGANISATIONAL STRUCTURE AND REPORTING LINES FOR NURSE PRACTITIONERS AND NURSE PRACTITIONER CANDIDATES BUDGET MODELLING, FUNDING REQUIREMENTS AND STRATEGIES SECTION 9 PREPARING THE NURSING WORKFORCE CURRENT EXPRESSIONS OF INTEREST CROSS MATCH WITH PRIORITY AREAS MAPPING CURRENT EDUCATIONAL PREPARATION TIMEFRAME IDENTIFICATION ESTABLISHMENT OF A NURSE PRACTITIONER CANDIDACY MODEL SECTION 10 ENCOURAGING ADVANCED NURSING PRACTICE POSTGRADUATE STUDIES POSTGRADUATE EDUCATION PLANNING FOR ADVANCED NURSING PRACTICE SECTION 11 STRATEGIC PLANNING INITIATIVES STRATEGIC INITIATIVES...85 APPENDIX 1 NURSE PRACTITIONER COMPETENCY STANDARDS APPENDIX 2 ADVANCED NURSING PRACTICE COMPETENCY STANDARDS APPENDIX 3 GENERIC POSITION DESCRIPTION APPENDIX 4 REFERENCES

6 EXECUTIVE ENDORSEMENT DOCUMENT TITLE NURSE PRACTITIONER PROJECT SERVICE PLAN AND REPORT CONTACT PERSON MS PAM VALLANCE POSITION TITLE DIRECTOR OF NURSING TELEPHONE NUMBER (03) ADDRESS ENDORSED BY: SIGNATURE OF AUTHORISED EXECUTIVE OFFICER AUTHORISED EXECUTIVE OFFICER S NAME POSITION TITLE DATE OF ENDORSEMENT MS PAM VALLANCE DIRECTOR OF NURSING 6

7 ACKNOWLEDGEMENTS Funding for the Nurse Practitioner Service Planning project was made available to Mallee Track Health and Community Service (MTH&CS) by the Department of Human Services through its Nurse Policy Branch and this financial support is gratefully acknowledged. In addition, the level of support given by Officers of the Nurse Policy Branch and especially Ms Katy Fielding, Manager, Nurse Workforce Policy and Programs and, until the end of June 2008, Ms Mara Manfrin, Project Officer, was invaluable. Their assistance and efforts in arranging various forums at which subjects relevant to the project were discussed, and the conduct of monthly teleconferences between the various agencies undertaking the project, was invaluable and was greatly appreciated. Similarly, the co-operation and mutual assistance of the Rural Nurse Practitioner Collaborative members who participated in the teleconferences was extremely valuable and contributed greatly to the co-operative environment within which the project was undertaken The assistance received from representatives of the various stakeholder organisations was much appreciated and special mention should be made of Dr John Russell, Director of the Monash University s Mildura Regional Clinical School, Ms Lee Vause, Chief Executive Officer of Rural North West Health and Mr Craig Stanbridge, Chief Executive Officer of Sunraysia Community Health Services who strongly support the nurse practitioner concept and have indicated a willingness to work closely with MTH&CS in its implementation. Finally, the assistance and input to the project provided by other key stakeholders was also greatly appreciated as were the efforts of Kayjay Projects Bendigo Pty Ltd which undertook the role of project officer. 7

8 EXECUTIVE SUMMARY Mallee Track Health and Community Service (MTH&CS) submitted an Expression of Interest in relation to the Victorian Nurse practitioner Project Phase 4 Round 4.1 and subsequently received funding for the preparation of a Nurse Practitioner Service Plan. In seeking funding for this project, MTH&CS advised that the organisation had recently completed an aged care capacity project and had undertaken the development of a new service plan for the three year period from January 2007 to December It was considered that the implementation of a nurse practitioner model of care would integrate effectively with the service plan and would provide an additional service option for the community. Establishment of one or more nurse practitioner positions and models of care were considered to be consistent with the service delivery strategies and objectives contained in the Service and Business Plans which the Agency will pursue during the stated three year term and, in some cases, well beyond. These strategies and objectives are outlined in Section 2.3 of this service plan. Implementation of a nurse practitioner model of care would be new to MTH&CS as the agency has not previously had positions of that nature. Nurse practitioners are registered nurses with advanced educational preparation and experience who are authorised to practice in an expanded nursing role. They can work in a diverse spectrum of clinical settings from acute hospitals to aged care and community placements. In addition to further education and advanced clinical practice, nurse practitioners have developed the skills and knowledge to expand their role to include aspects of care, such as prescribing medicines and ordering and interpreting investigations and tests, that have traditionally been performed by doctors and other health professionals. The progression from beginning a nursing career to endorsement as a nurse practitioner occurs over a number of years although it should be noted that holding a nursing registration for a number of years, or gaining a relatively wide range of clinical experience does not automatically lead to nurse practitioner endorsement. It is generally accepted that a Masters Degree level of education is appropriate for entry to practise as a nurse practitioner in order that the specific skills and scholarly development required to meet the demands of safe nurse practitioner practice can be acquired. Whilst this level of tertiary education is seen as desirable by the authorities, it has been made abundantly clear in discussions with various stakeholders and staff members that undertaking a Masters Degree is regarded as a major disincentive to pursuing this particular career path, especially in a rural area such as the Mallee Track which is remote from universities offering this degree course and, secondly, where family incomes and environments have been adversely affected by prolonged drought conditions. A number of other barriers and constraints were identified during the course of this project and these are outlined in greater detail in Section 6.9. It was considered, however, that the current educational requirements are the most significant deterrent to pursuit of nurse practitioner status. Priority Service Areas for Nurse Practitioner Models of Care When addressing the need for nurse practitioner models of care in the MTH&CS catchment area, four priority clinical service areas were identified Emergency nursing Aged care nursing Rural community health nursing Oncology and palliative care nursing 8

9 The Service Plan identified these areas as high priorities in terms of ongoing service development in view of the catchment area s demographic profile, the community s health status and current and future service needs. Consequently, planning for the implementation of nurse practitioner models of care has concentrated on these particular service areas and on the clinical and other skills which would be provided. Framework for Implementation of Nurse Practitioner Models of Care MTH&CS has never had a nurse practitioner position or model of care and it is unlikely that this situation will change in a short to medium term period in view of the fact that the number of nurse practitioners in Victoria is quite small and, secondly, upon completion of this project no applications to commence nurse practitioner candidacy had been received by MTH&CS. Consequently, apart from identifying the service areas in which models of care should be established as priorities, the project has concentrated on establishing a suitable framework which will support implementation of a nurse practitioner model of care in the future. This framework s principal elements include Role and function development in relation to each priority clinical service area; Business planning in support of a nurse practitioner position; Education planning and support for nurse practitioner candidates and other nurses who wish to undertake post-graduate studies; Governance arrangements and structures; Development of clinical practice guidelines for nurse practitioner models of care; Strategies which encourage advanced nursing practice through post-graduate studies; Implementation of strategies to support implementation of nurse practitioner models of care. Nurse Practitioner Role Definition The principal elements of nurse practitioner roles in each of the priority service areas have been identified and these are contained in Section 7. However, as the various models of care do not currently exist and are unlikely to be implemented in the short to medium term, the role definition has been identified and developed on generic lines and would be reviewed by a steering committee when a nurse practitioner candidate or a nurse practitioner position is established. Despite their generic nature, the various role components have been designed to reflect the community s service needs and are an accurate reflection of the Agency s service and business planning objectives. Business Planning and Budget Modelling Because a nurse practitioner position has not previously been established and as there are, currently, no nurse practitioner candidates, detailed budget modelling has not been undertaken by MTH&CS. However, work of this nature would form part of a business plan which would be developed in support of the establishment of a nurse practitioner model of care. In view of the costs of establishing a nurse practitioner position, DHS has indicated that it would support any initiatives which would provide for nurse practitioner models of care within a collaborative framework established between two or more agencies. Opportunities exist for MTH&CS in this regard and both Rural North West Health which is based in Warracknabeal and Robinvale District Health Services have expressed interest in pursuing that course of action. Both these agencies deliver services to parts of the MTH&CS catchment area and this initiative will be pursued in relation to a nurse practitioner position and, as an alternative, encouraging advanced nursing practice models which would benefit each agency. 9

10 Encouraging Advanced Nursing Practice As indicated elsewhere, MTH&CS is no different to many other rural and regional health services in that it is confronted by difficulties in recruitment and retention of health professionals including nurses. For that reason, it is possible that efforts to attract nurse practitioners may not initially be successful and, consequently, the service delivery initiatives and outcomes that would be achieved if a model of this nature was introduced will not be achieved for some time. One practical alternative which does exist is to encourage ongoing development of advanced nursing practice which is described in Section 3.2. It is important, however, to clearly define the advanced practice role, as there is a distinct need to differentiate between the two and, secondly, to note that well developed competency does not necessarily constitute advanced practice. Advanced nursing practice would, in many respects, provide considerable opportunities for service delivery enhancement with favourable outcomes for patients, clients and the catchment community at large, depending on the areas of speciality and service delivery areas in which nurses with the appropriate post-graduate qualifications and experience were practising. An integral element of advanced nursing practice is the achievement of post graduate qualifications which contribute to a nurse s ability to fulfil the various criteria and meet the national competency standards which are shown in Appendix 2 of this report. The Project Report and Service Plan as a Resource Document In completing the project and in developing this report and nurse practitioner service plan, it is intended that it will serve as a resource document for MTH&CS and its nursing staff. For that reason, information which was not specifically required as part of the DHS methodology, but which is relevant to nurse practitioner models of care and also to encouragement of advanced nursing practice, has been included. 10

11 SECTION 1 BACKGROUND TO THE MTH&CS NURSE PRACTITIONER PROJECT The Victorian Nurse Practitioner Project (VNPP) was established by the Victorian Government to provide a policy focus for development and implementation of nurse practitioner roles and to assist health services to initially pilot, and then establish nurse practitioner roles in public health services. The objectives of the VNPP are to Assist rural health services to develop service plans for nurse practitioner services that are strategic, sustainable and integrated with broader health service direction; Ensure plans for nurse practitioner services are aligned with relevant organisational, local/regional and state-wide service plans and/or workforce plans; Facilitate collaboration between health services in the development and implementation of nurse practitioner models; and Build engagement, collaboration and consultation with local stakeholders to support the nurse practitioner role. The VNPP has supported the development of nurse practitioners through a variety of mechanisms including Providing a focal point for development of nurse practitioner policy; Funding of health services to initially pilot and then establish nurse practitioner roles; Support for potential nurse practitioners through scholarships; and Development of service plans for nurse practitioner integration. The VNPP provides funding for postgraduate scholarships to nurses to assist with educational preparation of potential nurse practitioners and provides project funds to health services to implement nurse practitioner models. 1.1 mth&cs EXPRESSION OF INTEREST IN THE PHASE 4 PROJECT MTH&CS submitted an Expression of Interest in relation to the Victorian Nurse practitioner Project Phase 4 Round 4.1 and subsequently received funding for the preparation of a Nurse Practitioner Service Plan. In approving the allocation of funding for the project, DHS advised that...the key deliverable for this project is the development of a comprehensive service plan for the strategic and sustainable deployment of nurse practitioners (5-8 year horizon) at your health service. The project methodology your organisation applies to undertake this work will need to address the following areas: Analysis of key health workforce drivers and opportunities for nurse practitioner roles and models of care in the organisation that is informed by local workforce planning data and aligned with local, regional and/or relevant state service plans. Identification of priority service gaps for nurse practitioner services in the organisation and the role of the nurse practitioner in the revised service model. Development of the organisation s policy framework to support nurse practitioner roles including processes for documentation, prescriptive and diagnostic authority and referral to and from other health care professionals and including transition arrangements to support nurse practitioner candidates. A local implementation plan for the role including organisational/corporate and clinical governance structures, identification and engagement of key stakeholders, communication and marketing strategies, processes relating to internal EOI/submissions for nurse practitioner positions. 11

12 Strategies for the identification, employment, education/supervision and preparation of nurse practitioner candidates. Budget development to ensure ongoing employment of candidates as nurse practitioners post endorsement. In submitting its expression of interest, MTH&CS advised that the organisation had recently completed an aged care capacity project and had undertaken the development of a new service plan for the three year period from January 2007 to December It was considered that the implementation of a nurse practitioner model of care would integrate effectively with the service plan s objectives and would provide additional clinical service options and service enhancement for the community. 1.2 NURSE PRACTITIONERS AND NURSE PRACTITIONER CANDIDATES The DHS Nurse Policy Branch s list of Acronyms and Glossary includes the following definition of a nurse practitioner A nurse practitioner is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include, but is not limited to the direct referral of patients to other health care professionals, prescribing medications, and ordering diagnostic investigations. A nurse practitioner is a Registered Nurse registered under division 1, 3 or 4 who has satisfactorily completed a course of study and undertaken clinical experience that in the opinion of the Nurses Board of Victoria, qualifies the nurse to use the title Nurse Practitioner. Similarly, the Branch s glossary identifies a Nurse Practitioner Candidate as A Registered Nurse registered under division1, 3 or 4 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). Information available on the Victorian Government s Health Information website indicates that Nurse practitioners are registered nurses with advanced educational preparation and experience who are authorised to practice in an expanded nursing role. They can work in a diverse range of clinical settings from acute hospitals to aged care and community placements. In addition to further education and advanced clinical practice, nurse practitioners have developed the skills and knowledge to expand their role to include aspects of care, such as prescribing medicines and ordering and interpreting investigations and tests that may have traditionally been performed by other health professionals. The progression from beginning a nursing career to endorsement as a nurse practitioner occurs over a number of years although it should be noted that holding a nursing registration for many years does not automatically lead to NP endorsement. A person in the role of a beginning nurse is one who is consolidating their knowledge and clinical skills, is often reliant upon more experienced colleagues for support with decision making regarding patient care. The experienced nurse is one who is able to make sound decisions quickly and competently answers questions regarding patient care. The advanced clinical nurse is one who has an enormous background of experience and knowledge and has generally completed further study, either at graduate certificate, diploma 12

13 or masters level. Colleagues regard this nurse as a leader who is able to provide them with advice and assistance with a range of complex patient issues. The NP has all of the skills, leadership and clinical abilities of an advanced clinical nurse, is able to work autonomously within a collaborative multidisciplinary team and has masters level education experience to support performing extensions to practice safely and competently. 1.3 NURSE PRACTITIONER EDUCATION LEVEL Across Australia, it is generally accepted that a Masters level of education is appropriate for entry to practise as a nurse practitioner. At Masters level the specific skills and scholarly development required to meet the demands of safe nurse practitioner practice are acquired. In Victoria, the Nurses Board of Victoria (NBV) accredits courses that lead to endorsement as a nurse practitioner. A number of other clinically based Masters Degrees may be accepted although additional studies in Pharmacology will usually be required to meet NBV requirements. 1.4 COUNCIL OF REMOTE AREA NURSES OF AUSTRALIA Information obtained from the Council of Remote Area Nurses of Australia (CRANA) website indicates that the council recognises the emerging and changing role of nurses in isolated and remote areas of Australia and this recognition extends to the specialist and extended role of the nurse practitioner. The website indicates that In recognising the expanded role of the nurse practitioner, CRANA understands the following regarding the role of nurse practitioners; The nurse practitioner is a registered nurse whose role of expanded nursing practice allows for advanced nursing practice and an expanded nursing role in areas of need. The nurse practitioner is a nurse practising at an advanced level or an expert nurse and one who applies for and practices as a nurse practitioner under the appropriate legislative body and as such is responsible for their own practice and outcomes. The nurse practitioner adheres to the Code of Nursing Practice and is aware of the Commonwealth and State legislation relevant to their area of nursing practice. The nurse practitioner is a registered nurse who through further study has learnt to reflect upon their own area of practice in a critical yet positive way to best meet patients needs. The nurse practitioner has also learnt to reflect upon the body of nursing knowledge relevant to their area of practice which then allows reflection upon their own practice to provide primary health care from a best nursing practice perspective. The nurse practitioner practices in a culturally safe and appropriate manner to meet the health care needs of patients whoever they might be. The nurse practitioner does not work in isolation (even if geographically isolated) but works as part of a health care team including other health care professionals to deliver safe and efficient primary health care. The nurse practitioner continues to strive to improve clinical skills and knowledge and to practice at a high level of competency. 1.5 DETERMINING WHETHER A HEALTH SERVICE REQUIRES A NURSE PRACTITIONER In its project methodology, DHS indicated that decisions to establish nurse practitioner positions should be made in the same way as any other health worker position. Investigation and planning should provide an understanding of service needs and gaps and the requisite skills and knowledge required to meet those service demands. 13

14 Key criteria in assessing the need for a nurse practitioner model of care should include Consideration of priority service areas; Provision of enhanced clinical skills and achievement of the competencies defined in the national standards; How best to achieve the Agency s service planning objectives; Ensuring the long-term sustainability of a nurse practitioner model of care; and Benefits to key stakeholders. The Service Plan contained over ninety separate service delivery objectives which encompassed the entire range of services and programs delivered by MTH&CS. Those objectives which relate to the four service areas identified as priorities for nurse practitioner positions during the course of this project are identified in the following sub-sections Emergency Services The objectives contained in the Service Plan included Continue delivery of Emergency Services from the Ouyen Service Centre and ensure that these services encompass stabilisation, resuscitation, monitoring and care, and other procedures consistent with the level and quality of service delivered by a multi purpose service, and which are consistent with the requirements of the State Trauma System. Ensure the service centres at Patchewollock, Underbool and Murrayville maintain the capacity and ability to undertake acute care assessment and stabilisation for emergency presentations at those centres. Identify staff training and development needs and opportunities and continue to encourage ongoing staff participation in training relating to stabilisation, resuscitation, monitoring and procedures for transfer of seriously ill or injured patients to higher level care facilities. Ensure that staff training and development opportunities encompass emergency obstetric presentations, triage skills, acute illness and trauma management and care, and the development of a critical appreciation of health related factors in patients from differing socioeconomic, cultural and family backgrounds. The service plan identified continued availability of emergency services as a high priority for the catchment community and it was anticipated that emergency presentations would, generally, encompass conditions associated with observation, post fall, gastroenteritis, chest pain, back pain, vomiting, chest infection and asthma, snake bite, road trauma and farm accidents. Similarly, for service and business planning purposes, it was considered reasonable to assume that the number of emergency presentations and the emergency workload would not fluctuate to a significant extent from that experienced in recent years, although it was acknowledged that emergency care was unpredictable in terms of workload and complexity of presentations in many rural health services. It was also considered reasonable to expect that future delivery of emergency services would encompass stabilization, monitoring and care and procedures consistent with the level and quality of service delivered by a multi purpose service. Consequently, it was considered essential that staff have opportunities to develop and enhance their existing skills in emergency care. For that reason, priority was to be given to identification of training and development needs and opportunities and also to ongoing encouragement of participation in order that the community s expectations of the standard of care available, and also the requirements of the State Trauma System, can be met. Apart from addressing stabilization, resuscitation, and transfer criteria and procedures for seriously ill or injured patients requiring higher level treatment and care, training and development would 14

15 encompass emergency obstetric presentations, acute illness and trauma management and care and triage skills. Development of a critical appreciation of health related factors in patients from differing socioeconomic, cultural and family backgrounds would also be an essential element of emergency service delivery and should be addressed in the training and development program. Emergency midwifery presentations may occur from time to time and the emergency unit should maintain the capacity to provide appropriate care for expectant mothers. The various service delivery objectives and the issues raised in relation to ongoing service delivery support the implementation of an emergency nurse practitioner position and model of care Aged Care The Service Plan s objectives included Continue delivery of High Care (Nursing Home) aged residential services from the Ouyen Service Centre as a component of the existing complement of flexi-beds on that site. Reduce the incidence of premature entry into residential aged care from people within the 70 years and over age group through effective strategies which will include improved access to early intervention, prevention and health promotion programs. Continue to deliver Low Care (Hostel) aged residential services from the Pattinson House Hostel facility. Delivery of Aged Residential High Care services will continue, and will utilise a high percentage of the Agency s complement of flexi places. An expanded level of demand for High Care residential services is expected as the population continues to age and the number of people in the 80 years and over age group, whose needs and level of dependency cannot be met through community based packages of care, increases. Delivery of Aged Residential Low Care services will continue although this particular service would be supported by the increased emphasis on development of community and in-home services and programs to maintain people with lower levels of dependency in the community, instead of within a residential care setting. The ongoing provision and development of a comprehensive range of aged care services was identified as a high priority in view of the demographic characteristics of the catchment population and an anticipated increase in demand for residential, in-home and community based services and programs. This service area was identified as a priority for implementation of a nurse practitioner model of care and the nurse practitioner s role would, amongst other things, encompass health assessments, physical examinations, referrals to higher level care and other health service practitioners, patient management, diagnostic investigations, pharmacological approaches and health promotion and illness prevention in residential and community settings Rural Community Health Nursing The Service Plan identified a wide range of objectives in relation to rural community health nursing including Develop and implement strategies for maintaining acute inpatient admissions at a level which can be effectively managed within the existing flexi-bed complement and addressing ambulatory care sensitive conditions which include the following initiatives as priorities in future service delivery Improved health screening and individual risk assessment; 15

16 Social marketing and health information; Health education and skill development; Provision of supportive environments; and Improved organizational and workforce development and resource allocations capable of addressing service needs. Utilise funding flexibility to implement community based ambulatory care services which address chronic disease management through targeted strategies. Effectively direct service and program initiatives at the following priority ambulatory care sensitive conditions Diabetes complications Dental conditions Chronic obstructive pulmonary disease Dehydration and gastroenteritis Cardiac failure and angina Ear, nose and throat infections Asthma Continue to develop community based ambulatory care programs which address chronic disease management through improved service integration. Continue to develop early intervention, prevention and health promotion programs directed at particular age groups and specific priority conditions. Develop initiatives which address priority ambulatory care sensitive conditions and which encompass increased use of sub-acute, primary care, community mental health and alcohol and drug services. Identify staff training and development needs and opportunities that will support early intervention, prevention and health promotion programs. MTH&CS will utilise its funding flexibility to implement community based ambulatory care services which address chronic disease management through targeted strategies and, depending on locally identified needs, may include programs such as continence management, falls and mobility and pain management. The top ten ambulatory care sensitive conditions in the Northern Mallee Primary Care Partnership area include a number of common conditions which are prevalent throughout the MTH&CS catchment area. Elderly people are particularly susceptible to many of these conditions and programs which reduce, wherever possible, the need for acute inpatient admissions will be an integral part of the future service model. In order to address the incidence of the most prevalent ambulatory care sensitive conditions in the Northern Mallee and Wimmera Primary Care Partnership areas, MTH&CS will continue to implement a range of strategies which are consistent with State Government policies. The principal emphasis will be on early intervention, prevention and health promotion services and programs which address ambulatory care sensitive conditions. Ongoing development of effective partnerships with other service providers and agencies will be essential in implementation of strategies which will include - Improved health screening, and individual risk assessment; Social marketing and health information; Health education and skill development; Provision of supportive environments; and Improved organizational and workforce development and resource allocations. Strategies and program development to address the incidence of these conditions will include Improved service integration; 16

17 Provision of appropriate facilities and infrastructure; Workforce training and development; Increased focus on population health; Increased use of sub-acute, primary care, aged care, mental health and alcohol and drug services; and Development and enhancement of health education and health promotion programs targeted to particular age groups, such as the elderly, and directed towards specific conditions such as heart disease, diabetes and asthma. In support of the State Government s policies, service delivery will be developed in accordance with the following principles Care will be provided in community based settings where it is safe and cost-effective to do so; Services will be brought together and integrated to improve accessibility, availability and quality of care; Delivery of health care will incorporate a population health approach that recognizes the social determinants of health and prioritises health promotion and illness prevention; Care will be person and family centred and will focus on the needs of the whole person as these change over time; The workforce will be configured to deliver integrated health care; and Consolidation of service delivery in community based settings will support better working conditions, more efficient use of the workforce and enhanced quality improvement systems. It was considered that the high incidence of these conditions and the various strategies identified to address them were consistent with the implementation of a rural community health nurse practitioner model of care and would strengthen the existing service delivery framework Oncology and Palliative Care The Service Plan identified a number of objectives for development of palliative care services including Continue the formation of effective alliances with established palliative care service providers, and the Loddon Mallee Palliative Care Consortium, to facilitate ongoing development and implementation of an integrated palliative care service across the catchment area. Continue to support the establishment of a range of community based programs including Social Support, Bereavement, Grief and Loss Support, Volunteer Support, Medical and Nursing Support, Care Management and Pastoral Care which are essential elements of the comprehensive palliative care service required in the catchment area. There are specific needs across the catchment area for oncology and related services which also encompass palliative conditions other than cancer. Ongoing development of a comprehensive palliative care service was seen as a high priority in the service plan as the current availability of oncology and palliative care is limited. Bed-based palliative care can be provided within the existing flexi-bed complement when required as MTH&CS does not have a dedicated Palliative Care Unit. An Oncology nurse practitioner would play a major role in the ongoing development of a comprehensive palliative care service across the catchment area and, in addition, would also have responsibilities in relation to development of an effective service model for symptom management and minor procedures including ordering diagnostic tests including blood tests. The nurse practitioner would also have a pivotal role in provision of information and the development of strategies in relation to palliative interventions and, secondly, would provide a clinical point of reference for other nurses and health professionals. 17

18 Future development of palliative care should take account of the fact that these services are required by people of all age groups and the perception of a service for the elderly, with emphasis given to that age group, should be avoided. Oncology and palliative care was identified as a priority area in which the implementation of a nurse practitioner model of care could be utilised effectively to complement the service plan s objectives. 18

19 SECTION 2 PROFILE OF MALLEE TRACK HEALTH AND COMMUNITY SERVICE MTH&CS was formed as a result of an amalgamation of several separate health service agencies including the Ouyen District Hospital, the Pattinson House Hostel, the Patchewollock, Underbool and Murrayville Bush Nursing Centres, the Ouyen and Murrayville Neighbourhood Houses and Ouyen Community Link. All bed-based services are located in Ouyen with Acute and High Care (Nursing Home) services being consolidated on the main service centre campus, utilising up to 34 Multi Purpose Flexi Beds, whilst the Agency s 20 Bed Low Care (Hostel) Unit is situated on a separate campus in Ouyen, approximately 1.5 kilometres from the main service centre. MTH&CS operations also extend across three satellite service centres in Patchewollock, Underbool and Murrayville, with the latter being situated approximately 110 kilometres from Ouyen. Since its establishment in 1997, the Board of Management has given a high priority to achieving a number of key service delivery objectives identified in the community consultation program undertaken in 1995 and These objectives formed part of the development of a formal community submission to the Commonwealth and State Governments, which sought approval for establishment of the new Multi Purpose Service and included Increasing the range of services available in the Mallee Track area; Improving service delivery efficiency; Improving service co-ordination; Increasing the use of regional resources; Re-allocating bed based service resources to home and community based services; and Investing in appropriate communication and data processing technology. The Board has continued to implement a program of service development and enhancement across the Mallee Track area and MTH&CS now delivers a very comprehensive range of services and programs. Its success can be measured in the range of available services and programs and the level of support the Agency enjoys from its various catchment communities. 2.1 MTH&CS CATCHMENT AREA In general, MTH&CS delivers its services across an area of North-Western Victoria that covers approximately 12,000 square kilometres. The majority of this area (including the Mallee Track ) is located within the Rural City of Mildura, but it also encompasses the Northern part of the adjoining Shire of Yarriambiack. The respective areas of each municipality are located well away from the main service and commercial centres of Mildura and Warracknabeal respectively a situation that has an adverse effect on the delivery of some programs, particularly community based aged care, by other organisations located away from the Mallee Track townships. In general terms the MTH&CS Primary Catchment Area can be described as encompassing the area outlined below. Service delivery may be required by anyone residing in the various small communities on or in areas surrounding, these highways and the population generally regards MTH&CS as its health service. South-East from Ouyen to Mittyack on the Calder Highway; East from Ouyen to Kulwin on the Mallee Highway; West from Ouyen to Murrayville and the South Australian border on the Mallee Highway; South from Ouyen to Turriff on the Sunraysia Highway; and 19

20 North from Ouyen to Hattah on the Calder Highway. A map of the catchment area is shown on page 24. Apart from Ouyen which is the largest town in the catchment area, there are a number of small communities located along the Mallee Track, although census figures indicate that none have more than 250 residents. Since its establishment, MTH&CS has delivered services to these small communities and also to Patchewollock, Tempy, Speed and Turriff in the Northern part of the Shire of Yarriambiack which adjoins part of the Rural City of Mildura s Southern boundary. Establishment of a service centre in Patchewollock, and delivery of programs and services to this area, were clearly designated objectives of the initial funding submission to the Commonwealth and State Governments, although this initiative produced the cross LGA and DHS boundary situation. Although located in the Yarriambiack Shire, the communities of Patchewollock, Tempy, Speed and Turriff are closer to Ouyen than Warracknabeal which is the largest town in the Shire. Consequently, these small communities relate to Ouyen for many commercial and other services. Similarly, Mildura has a much more developed commercial and service base than any centre in the Shire and also the City of Horsham which is located further South in the Wimmera. Consequently, people living in the MTH&CS catchment area tend to Head North or Head Further North for most commercial and other services. Continued service delivery requires a thorough understanding of the various characteristics of the Agency s catchment area and these are outlined elsewhere in this service plan. The Agency s service delivery profile will continue to evolve as health and community service needs are identified and, for that reason, any service plan should be regarded as fluid in nature and subject to ongoing review and amendment. Implementation of appropriate services and programs to address those needs and to meet the service delivery objectives identified in the Service Plan continues to be a high priority for the Board of Management MTH&CS Catchment Area Population and Characteristics Demographically, overall population numbers across the 12,000 square kilometre catchment area are not expected to change significantly during the term of the service plan and beyond, although there will be some movement of total numbers within various age groups. The 2006 Australian Bureau of Statistics (ABS) Census of Population and Housing has confirmed that the MTH&CS catchment area population is approximately 2,850 people. Although the overall number may remain relatively static, there is evidence that the most significant, and increasing, service demands will come from the 60 years and over age groups and, consequently, aged care services will be a major item of operating budget expenditure in the future. Of the MTH&CS catchment population of about 2,850, a total of 760 or 26.5% were identified as being aged 60 years and over in the 2006 census. This particular situation will have a very significant effect on future demands for aged care services and, importantly, on the Agency s capacity to address those needs through appropriate strategies and initiatives Aboriginality and Multi Cultural Population Groups The Mallee Track area does not have a large Aboriginal population group and most of the Rural City s Aboriginal people reside in the Greater Mildura area. The 2006 census collection district data indicated that the Indigenous population within the catchment area totalled 18 people. Similarly, with the exception of people born in Australia, there are no significant concentrations of people from any specific population groups, or from any country of origin other than Australia. 20

21 Consequently, development of programs which target particular cultural population groups is unlikely to be required as a high priority during the term of the service plan Recruitment and Retention of Health Professionals Ongoing difficulty in attracting medical practitioners and other health professionals to the area, and in retaining their services for extended periods of time, continues to be one of the most significant workforce issues confronting MTH&CS. A key principle of a multi purpose service s operations is the continued development of a flexible rural workforce that can be accurately aligned to specific service needs, but which can be effectively utilised across the whole organisation to meet the needs of the catchment community. A workforce model of this nature must include a range of full time and part time staffing positions with defined roles, but it must also possess sufficient flexibility to meet changing service demands in accordance with the inherent nature of multi purpose service delivery. Another important consideration in workforce development is that MTH&CS must possess the ability to offer permanent employment to health professionals in nursing and other disciplines, in order to recruit and retain staff with appropriate expertise. 2.2 SERVICES AND PROGRAMS DELIVERED BY MTH&CS The overall range of services and programs delivered by MTH&CS is outlined below and is classified under the headings used by the Agency in its Annual Reports Multi-Purpose Bed Based Services Acute, Emergency and Post-Natal care High Care (Nursing Home) aged residential care Respite care With regard to the provision of bed based services, MTH&CS operations are, generally, delivered utilising the following configuration - 34 Multi Purpose Flexi Beds* 20 Low Care (Hostel) Beds (Located at the Pattinson House Service Centre in Ouyen) * NOTE The 34 Flexi Beds may be used for a mix of Acute, High Care and Respite services and are not designated for a specific purpose Low Care Aged Residential Services Low Care (Hostel) aged residential care Respite care Low Care services are delivered from the Pattinson House Hostel facility and the 20 beds are routinely utilised for aged residential and respite services Residential Respite Services Residential respite services are available in the Low Care and High Care Units and are provided in conjunction with normal demands for bed based services Home Based Services Nursing and support Personal care Home modifications Allied Health support 21

22 2.2.5 Medical Clinic General Practitioner Practice Nurses Community and Independent Living Services Allied Health - Occupational Therapy - Physiotherapy - Podiatry - Allied Health Assistance Programs Land and Water Based Exercises - Planned Activity Groups - Community Nurses Community Link Programs - Social Support and Transport - Meals on Wheels (HACC funded) - Meet and Eat - Friendly Visiting, Pet and Phone Links - Carers Support/Advocacy and Volunteer Neighbourhood House Programs - Farm Safety - Youth Support - Debutante Ball - Needs based programs are also provided in relation to health, welfare, social, education, recreation and basic computer and internet training - Assistance to Self Help and Community Groups - Wide range of resources (availability of/access to) Health Promotion and Prevention Programs - Assessments, screenings, counselling, education, prevention, referral and resource information - Diabetes Management Clinic - School Link Nurse Mallee Minors Childcare Centre - Child Care - Vacation Care Program - Kindergarten Cluster Management Integrated and Collaborative Service Arrangements A range of other services delivered through partnership and collaborative arrangements with other service providers Mildura Rural City Council Mildura Community Services / Groups Bendigo Health - Community Care Options Maternal and Child Health Multicare Landcare Victorian Farmers Federation Accounting Service Centrelink Video Conferencing 22

23 Skills Net Training Better Health Channel Rural Ambulance Service Victoria Women s Health Loddon Mallee Sunraysia TAFE Online Learning Australian Country Information Service Flinders University (South Australia) Annecto Robinvale District Health Services Sunraysia Community Health Services Mallee Health Service (South Australia) Regional Health Services Social Worker Dietician Staff Development Officer Speech Pathologist Podiatrist Visiting Services Fly-in Fly-Out General Practitioner (Female) Social Worker Dietician Speech Pathologist Chiropractor Dental Psychiatric services Counsellor Aged Care Assessment Drug and Alcohol Mallee Family Care Pathology Vision Australia Podiatrist Other services which visit from time to time and are advertised locally Other Services Rural Financial Counselling SERVICE AND BUSINESS PLANNING STRATEGIES The Service and Business Plans identified over ninety separate service delivery objectives which the Agency will pursue during the stated three year term. Ongoing service delivery, based on achievement of those objectives, will extend well beyond that period. However, in addressing these objectives, service delivery and business planning actions and strategies will also focus on Managing the level of demand for High Care aged residential services and acute inpatient services; Increasing the availability of community and home-based aged care services which are directed towards maintaining elderly people in their own homes for as long as possible and minimising the incidence of premature admission to residential care; Actively pursuing development of alternatives to bed-based care through increased provision of services within community and in-home settings; Implementing strategies and programs directed towards reduction of acute inpatient admissions; 23

24 Increasing early intervention, prevention and health promotion activities which are directed towards specific ambulatory care conditions and identified health promotion and prevention priority programs; Increasing the availability of health screening programs directed at priority conditions and target groups; Addressing children s and youth health services as a high priority; and Addressing men s and women s health issues with ongoing development of health promotion and health education programs. 2.4 RELATIONSHIP TO NURSE PRACTITIONER POSITIONS Establishment of nurse practitioner positions and models of care in the four identified priority service areas would provide strong support for achievement of the service plan s objectives and directions. Nurse practitioner models of care, which would be based on those outlined in Section 7.7, would significantly enhance the level of clinical skills available within the organisation. They would also strengthen the agency s service delivery framework and increase the range of service options available to the community. 24

25 MAP OF THE RURAL CITY OF MILDURA (Source: CATCHMENT AREA (HIGHLIGHTED) (Source: Yarriambiack Shire Touring Guide) 25