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Goulburn Valley Health

Service Plan Development Nurse Practitioner Project

Final report October 2006

Prepared by Carole Maddison RN, MN, FRCNA Coordinator Nurse Practitioner Projects

Goulburn Valley Health Service Plan Development Nurse Practitioner Project – Final Report

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Table of Contents 1. Executive Summary ............................................................................................ 3

2. Introduction....................................................................................................... 4

3. Background/history to Nurse Practitioner roles in the health service, opportunities

for role development ........................................................................................... 5

4. Policy framework to support the role at the local level including: ............................... 6

5. Process for the development of the NP role in the organisation including time

frames. ............................................................................................................. 7

6. Priority areas for establishing the NP role and method for determining those areas

including: .......................................................................................................... 9

7. A plan for education/mentoring candidates ........................................................... 10

8. Development of clinical practice guidelines, including process for organisational

approval.......................................................................................................... 11

9. Expected benefits to the organisation, community and clients of the

establishment of the role. .................................................................................. 12

10. Example of a generic position description for Nurse Practitioner............................... 13

11. A description of the barriers/constraints to implementation of the role and

possible solutions. ............................................................................................ 14

12. A budget for the implementation of the role including possible funding options .......... 15

13. A plan for the evaluation of the role..................................................................... 16

14. Process to ensure sustainability of the NP role in the organisation............................ 17

Appendices: ............................................................................................................ 18


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1. Executive Summary

Nurse Practitioner roles within Goulburn Valley Health have commenced in two clinical areas with different models of practice that have been developed to meet specific service needs. The understanding of how to make these roles sustainable, effective and an attractive career choice for nurses in regional areas has underpinned the efforts undertaken during this project. Specific processes for identification and application to develop a nurse practitioner role have been identified for the future. Within the processes are embedded the need to ensure the best outcomes for the service and patient care. Evaluation strategies for each nurse practitioner program are an integral part of the development processes and will address both qualitative and quantitative elements to gain understanding of the progress. There has been development of standardised documentation, project requirements and processes for these programs. The establishment of a Nurse Practitioner Steering committee ensures key stakeholders have an opportunity for dialogue and explore how the roles fit with existing services and planned developments. There are significant barriers and constraints to ensuring these models of care are ongoing, proactive and meeting health care needs. Where champions and supporters of the roles exist, it has become clear that they have greater chance success. Simplification and streamlining of the endorsement process with the Nurse’s Board of Victoria will encourage other rural nurses to contemplate taking on Nurse Practitioner roles and make them an exciting career choice at the apex of the clinical nursing career pathway. Together the initiatives undertaken during this project have combined to enhance the capacity of Goulburn Valley health to sustain the current nurse practitioner roles and create new initiatives in the future.


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2. Introduction

Goulburn Valley Health (GV Health) is a multi-campus facility providing a broad range of hospital and community services to communities across the West Hume and Campaspe districts of northern Victoria and into southern New South Wales. Specifically the organization serves a culturally diverse, growing and ageing population of more than 180,000. Goulburn Valley Health is the major health service provider in the Goulburn Valley proving a referral centre for the surrounding ‘C, D & E’ sized hospitals and is well placed to play a pivotal role in future health care delivery for its catchment. Goulburn Valley Health adopts a Regional Integrated Service Delivery model to ensure that our diverse organisation can operate in a changing health care and community environment. The main campus is in Shepparton which lies

• 180 kms north of Melbourne (about 2hours drive) • 122 kms north east of Bendigo (90 minutes drive) and • 107 kms west of Wangaratta (75 minutes drive)

Shepparton is the closest major centre to a number of NSW towns such as Tocumwal, Finley and Deniliquin. Historically, people from these centres have travelled south for health services to GV Health. The Local Government Area population grows significantly between December and May each year with an estimated increase of 10,000 at the peak of the picking season and the related food and dairy processing seasons. Seasonal, itinerate workers see this population expand and the Emergency Department activity data when reviewed on a month-by-month basis reflects this trend each year. In the 2004/2005 financial year a total of 24,470 inpatients were treated, showing an increase of 7.7% from the previous year. The Number of emergency department presentations increased by 6% to 30,658.

The Department of Infrastructure reports a strong and continuing growth in regional Victoria’s irrigated areas. Growth is not confined to agriculture, and is also noted in the manufacturing sector. This has been one of the population growth drivers over the past five years, and will continue to be so. It has also been noted that the Goulburn Valley has a wider diversity of income per household than many regional areas, with 5% to 10% being in the high-income group (more than $1500 per week per household) but 25% in the lower income group (less than $300 per week per household). This is associated with the high indigenous and migrant population within the catchment. The delivery of health care by Goulburn Valley Health continues to respond to the growth, diversity and changing needs of the community. Nurse Practitioner roles are seen to be part of the response to identified needs in the region.


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3. Background/history to Nurse Practitioner roles in the health service, opportunities for role development

Goulburn Valley Health has been proactive in its involvement with the Nurse Practitioner model through the formation of preliminary management pathways with the expectation that Nurse Practitioner models will become a reality in rural communities. It is well acknowledged that the best outcome for the patient can only be achieved through a collaborative approach within a multidisciplinary team. At GV Health there is support for the role where the Nurse Practitioner and Nurse Practitioner Candidates are not working in isolation from other caregivers. This collaborative model has been the underpinning principle for projects considered by the organisation and is reflective of the stated aims of these roles as expressed by the Nurses Board of Victoria and the Department of Human Services. Two Nurse Practitioner models have been operating at GV Health and this has provided valuable insight into the requirements of the organisation to sustain them in the long term. These have been in the areas of

• Diabetes - A model of enhanced triage of referrals for physician management of patients with diabetes

• Emergency – Fast track care for Australian Triage Scale category 4 and 5 patients who present to emergency department and limited category 3 patients

Nurse Practitioner Candidates have been operating in these roles for two years in diabetes and twelve months for emergency. Both Nurse Practitioner models have evolved from an increasing demand for service. The emergency department has seen an ongoing growth in presentations in ATS category 4 and 5 patients. This is driven by multiple factors but a significant influence is the limited access to bulk billing general practitioners in the region, particularly after hours. The Rural Emergency Department Nurse Practitioner Project was funded around the same time as this Service Plan Development project. It has utilised and resourced materials from other metropolitan Emergency Nurse Practitioner Projects and been able to take a consciously collaborative approach with them and other Rural Emergency Nurse Practitioner projects. The rising incidence and prevalence of diabetes in the community is well documented. The Goulburn Valley region is affected similarly with some notable distinctions: an increase in women with gestational diabetes. While there have been other strategies implemented to address these needs such as the Diabetes Resource Worker program and the Integrated Diabetes Strategy, the introduction of the Nurse Practitioner in diabetes is a vital adjunct. The Diabetes Nurse Practitioner Candidate moved to Goulburn Valley Health from a city tertiary hospital where a funded pilot project had been undertaken and been evaluated by The University of Melbourne. The model used at the Royal Melbourne Hospital was implemented at Goulburn Valley Health with minor contextual adjustments made. Implementation occurred prior to allocation of funding for this Service Plan Development project and has informed and assisted in some of the decisions made. Given the regional need for integration of diabetes care, this has provided an additional strategy in achieving improved access to specialist care. During the establishment of these Nurse Practitioner roles it has been necessary to ensure opportunities for collaboration, discussion and debate amongst stakeholders. The establishment of relationships with various divisions and services of Goulburn Valley Health in the Steering Committee has provided a formal structure for exploring the nuances of the new roles. Opportunistic encounters have added to the development of an understanding of the scope and limitations of Nurse Practitioners.


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4. Policy framework to support the role at the local level including:

i. Prescriptive and diagnostic authority

ii. Referral process

iii. Admission and discharge protocols

The need to have a policy and governance structure to support the Nurse Practitioner roles is considered vital to ensure the sustainability, support, monitoring and development of the new practice models. At Goulburn Valley Health we have a strong quality and governance structure into which Nurse Practitioner Projects are required to feed. The Nurse Practitioner steering committee is part of that quality and governance structure, reporting to the continuum of care structure and senior nursing management. The members of the Nurse Practitioner Steering Committee include: • Associate Director of Nursing – Centre for Nursing Practice Education and Research (Chair) • Chief Nursing Officer • Chief Medical Officer • Chief Medical Imaging Technologist • Chief Physiotherapist • Manager – Application Systems, Clinical Business Unit • NUM x 2 • Medical Director of ED • Pathology Laboratory Manager • Director of Pharmacy • Physician – Diabetes Service • Diabetes Nurse Practitioner Candidate • Nurse Practitioner Project Officer(s) • Quality Manager Having a wide range of members means that there is an opportunity for dialogue on a regular basis to identify and clarify functions and processes. Additionally more informal contacts occur outside this structure. Clinical guideline development requires extensive consultation with many of the Steering Committee members and other key stakeholders outside the meeting structure. The Terms of Reference for the NP Steering Committee are attached in Appendix 1. An umbrella organisation wide policy outlines the requirements of all Nurse Practitioner Projects in relation to documenting and describing each model of care. It is a requirement of key stakeholders and the organisational executive members to approve the proposed prescriptive and diagnostic formularies, referral processes and admission and discharge protocols as outlined in the Submission to Establish a Nurse Practitioner Role document A copy of the Nurse Practitioner diagnostic and medication formulary is held by pharmacy and pathology and are compiled as the by-product of clinical guideline development and approval process. Similarly the referral pathways and admission and discharge protocols are embedded in the guidelines. The Goulburn Valley Health Nurse Practitioner Policy statement is attached in Appendix 2. Lines of accountability are clearly identified for each model of Nurse Practitioner care to ensure there is an overall knowledge of the scope of practice by the Chief Nursing Officer and other organisational executive members.


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5. Process for the development of the NP role in the organisation including time frames.

The Nurse Practitioner role has become more readily understood by staff within Goulburn Valley Health in the past year. This has been achieved through a number of strategies that have combined to create a positive and supportive environment in which Nurse Practitioner roles can develop. Over a number of years, the Senior Nursing Management group have considered the role of the Nurse Practitioner and how best it could be used in our rural setting. Whilst unsuccessful in early applications for funding, the later successful development of a submission for the Rural Emergency Nurse Practitioner project and the employment at Goulburn Valley Health of the Diabetes Nurse Practitioner Candidate who had undertaken a pilot project at the Royal Melbourne Hospital, gave us a more extensive insight to the potential and use of Nurse Practitioners. The Rural Emergency Nurse Practitioner Pilot project has challenged us to establish governance models, processes and structures to support, monitor and evaluate the roles. This understanding has also informed our incorporation of the Diabetes Nurse Practitioner role and how to ensure sustainability. The process of enhancing the corporate and individual health staff knowledge of Nurse Practitioner roles during the life of the project have included, but are not restricted to the following activities. Establishing Governance structures Establishment of the Nurse Practitioner Steering Committee November 2005 Development of organisational policy October 2006 Raising awareness of NP roles Annual Nursing Presentation Ceremony – Anna Green December 2005 Local press coverage of NP at GVHealth December 2005, January 2006 NP Newsletter April 2006 NP in a rural setting forum June 2006 Development and Launch of June 2006

• Expression of interest document • Submission document • Flow chart

Time frames for each stage and completion of journey for NPCs to NP It is understood that the time frames for completion of the journey from Nurse Practitioner Candidate to Nurse Practitioner will vary depending on the prior preparation of the candidate. This could be influenced by factors such as prior academic preparation, individual education needs, the existence of clinical guidelines in the area of practice for the Nurse Practitioner role and the hours of work allocated to the Nurse Practitioner role. Not only are there variations between individual candidates but the administrative processes of the Nurses Board of Victoria can exert significant influence on the timeliness of processing applications to the endorsement stage. Having considered these factors a broad framework for completion of preparation for endorsement is outlined below in Table 1.


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Table 1. Time frame for transition from Nurse Practitioner Candidate to Endorsed Nurse Practitioner

Appointment of Nurse Practitioner Candidate Activity Comments Maximum time to complete

from appointment as NPC Clinical Guideline development

Intensive in first 3 months prior to commencing clinical practice as NPC Review of need for new guidelines is ongoing

Core guidelines complete in 6 months Remainder complete 12-18months

Individual clinical learning Intensive in first 3 months prior to commencing clinical practice as NPC Ongoing updates required

18 months

Establishing a research basis for practice

This takes time but the NPC needs to have identified at least one research project in first 3 months

Research project complete in 2 years

Completion of Therapeutic medication module

Ideally commenced in first 6 months

12 months

Development of practice portfolio

Ongoing but needs to be formatted prior to submission to NBV

2 years

Application for Endorsement submitted to NBV

2 years

Endorsement given by NBV 3 years


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6. Priority areas for establishing the NP role and method for determining those areas including:

iv. A description of the service

v. The patient group

vi. Analysis of the current service gaps and how the NP role will

address those gaps

In considering priority areas for establishing the Nurse Practitioner role, Goulburn Valley Health has decided to adopt a method of service needs analysis and review to inform this decision. A two phase development process was adapted to the Goulburn Valley Health context from that developed by Bayside Health and includes

• Stage 1 - Expression of Interest in establishing a NP role • Stage 2 - Submission to Establish a NP role

Utilising the two stage process for developing Nurse Practitioner roles requires the proposal to be developed from the service need perspective. A flow chart was developed to provide an overview of how to approach the development of NP roles. Stage one requires an initial description of the service, the identification of need within the service and how a Nurse Practitioner role would assist in addressing it. Once the document is completed, it is reviewed by the Senior Nursing Management Group or a Divisional Director. If approved then the recommendation to proceed to stage two requires a more complex submission, developing the business case as well as a clinical rationale for the role. These documents are attached in Appendix 3. A forum titled ‘Establishing Nurse Practitioner Roles in a Rural Setting’ was held in June 2006 and the documents were launched at this time. The forum presented an opportunity for nurses, management and interested parties from the region to learn more about how to identify and plan for establishing Nurse Practitioner roles. We have also worked hard to inform and elicit new areas of Nurse Practitioner practice in the organisation and regional health care providers by way of newsletters and invitations to meetings. As Goulburn Valley Health currently has two different models of Nurse Practitioner being established to meet the differing needs of speciality clinical areas and practice contexts, there has been no particular push to embark upon further projects at this stage. There is an imperative to consolidate the two current projects and refine our processes to ensure sustainability. Preliminary discussions have taken place within the Goulburn Valley Health Paediatric unit about a Nurse Practitioner role. This is being encouraged to progress to the submission of the expression of interest stage in 2007. As a result of attendance at our forum in June 2006, Shepparton Hospice Care Service is now also considering the development of a Nurse Practitioner role, linking with other Palliative care Nurse Practitioners across the state. The opportunities that Nurse Practitioner roles present for enhancing patient care and outcomes needs to be brought to the forefront of consideration by Department heads and Nurse Unit Managers. This will be an ongoing and important function of the Centre for Nursing Practice, Education and Research which will continue to provide ongoing support the implementation, and support of Nurse Practitioner roles.


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7. A plan for education/mentoring candidates

The Nurse Practitioner’s application for extensions to the current scope of practice will reflect the speciality area, the model of care and context in which the nurse will practice. It is important that the education plan for each candidate will be modelled according to these considerations as well as the individuals’ identified learning needs. Where similar Nurse Practitioner roles have been established within Victoria and other states, reference to the experience of these nurses is recommended to guide educational requirements. It is suggested that the education plan incorporate the following:

• Self assessed learning needs for extension to scope of practice • Key stake holder suggestions for learning needs of the role/ individual • Internal education opportunities – utilising medical, nursing and allied health resources • Tertiary education opportunities • Local / regional / state-wide and national education opportunities • Prescribing processes and requirements in relation to the context of practice • Diagnostic investigation ordering processes and requirements in relation to the context

of practice

Completion of an appropriate Masters program is not dictated by the organisation. A range of options are identified and it is left to the Candidate to decide which program best suits their particular needs and delivery options. Mentoring of Nurse Practitioner Candidates, endorsed Nurse Practitioners or nurses considering a Nurse Practitioner role will enable a more streamlined approach to endorsement and the sustainability of the role. The experience of others can inform candidates of the pitfalls and successful initiatives on the journey. Goulburn Valley Health is fortunate to have three candidates at various stages along this journey and this is proving beneficial in their preparation. The support occurs on an informal basis but works best when combined with structured meetings. A plan for regional Nurse Practitioner networking meetings is being explored to make this a worthwhile opportunity. Goulburn Valley Health has been working to provide support for Nurse Practitioner Candidates and organisations across the region who are considering establishment of Nurse Practitioner roles. Where possible we have shared our resources for adaptation to each setting. Ongoing liaison to support these Nurse Practitioners and their organisations in Seymour, Benalla and Cobram will be mutually beneficial, enhancing patient care within the region.


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8. Development of clinical practice guidelines, including process for organisational approval

The current organisational system for approval of clinical practice guidelines is utilised for all Nurse Practitioner Clinical Guidelines. A chart that explains this process is attached in Appendix 4. The development of Nurse Practitioner guidelines incorporates processes of seeking existing guidelines to form a basis, reviewing the evidence and contextualising the guideline to the practice setting at GV Health. To ensure consistency, the emergency Nurse Practitioner guidelines have followed the formatting of other Nurse Practitioner projects established across Victoria. Key stakeholder input is always part of the development processes and the draft guidelines are reviewed by a range of appropriate staff prior to submission to the appropriate Continuum of Care subcommittee. Once approved by the subcommittee they are forwarded to the main Continuum of Care committee for endorsement. Diabetes clinical guidelines were developed external to the organisation through a Project Team of expert diabetes clinicians and endorsed by the Australian Diabetes Educators Association and Australian Diabetes Society. These have subsequently been reviewed by a team of clinicians at GV Health and followed the normal endorsement processes. All Nurse Practitioner guidelines are formatted to the GV Health standard and are available on the intranet site marked specifically for use by Nurse Practitioner or Nurse Practitioner Candidates in that speciality area.


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9. Expected benefits to the organisation, community and clients of the establishment of the role.

The establishment of Nurse Practitioner roles have had a number of positive effects on the organisation. The introduction of these positions has provided enthusiasm and opportunities for development of new models of care delivery. Nursing at GV Health now has a very clear career development pathway in a clinical stream that is appropriately remunerated and recognised. In rural areas this opportunity can provide incentive to remain and enjoy the challenges and extensions to practice of a regionally based Nurse Practitioner. As the Nurse Practitioner roles are founded on multidisciplinary collaboration they have further strengthened these teams and the desired organisational approach to delivery of care. The development of evidence based clinical practice guidelines has provided direction to clinical care that is often utilised by medical staff as well as Nurse Practitioner Candidates. There has been a significant need for this kind of guidance for junior doctors and these Nurse Practitioner guidelines have been a great advantage to ensure best practice is promoted in the units where there is a Nurse Practitioner. At Goulburn Valley Health we have developed Nurse Practitioner roles in response to a review of service needs. There is a requirement that Nurse Practitioner roles work from a service need basis and this has encouraged reflection on current practices and how service could be improved to enhance patient outcomes. There is a potential and actual demonstrated benefit to both the wider community and clients. In both the Nurse Practitioner models at GV Health clients are seen in a more timely manner, the processes of care are clearly identified allowing more standardised management and adherence to evidence based best practice. Often continuity of care is also enhanced as the Nurse Practitioner Candidate is able to undertake all aspects of care (emergency Nurse Practitioner Candidate) and ensure all preliminary work up is completed prior to physician review (diabetes Nurse Practitioner Candidate). Community perception of their health service is also enhanced when it can be seen that the organisation is progressive in adapting new strategies of safe and effective health care delivery. To date there have been no complaints in regards to Nurse Practitioner roles despite a very public media campaign by the local division of general practice against the incorporation of Nurse Practitioner roles at the time of commencement of the emergency Nurse Practitioner project.


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10. Example of a generic position description for Nurse Practitioner.

In the process of establishing some standard requirements for Nurse Practitioner roles it has become clear that Nurse Practitioner Candidates have been employed under differing position descriptions. There was a need to develop both an endorsed Nurse Practitioner position description and Nurse Practitioner Candidate position description as there are subtle differences in regards to supervision that need to be established. Having developed these documents ensures a standard expectation that is specified from the outset for new Nurse Practitioner Candidates and endorsed Nurse Practitioners. The GV Health position descriptions for Nurse Practitioner Candidate and Endorsed Nurse Practitioner are attached in Appendix 5.


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11. A description of the barriers/constraints to implementation of the role and possible solutions.

In rural areas where nurses often work part time and work to supplement the income from farming or horticultural family businesses, it can be difficult to find nurses who are willing to undertake the long journey from being a nurse with advanced practice skills to endorsed Nurse Practitioner. At this time it would take a nurse who has not begun academic preparation at least three years to complete preparation and gain endorsement. Access to tertiary study options for appropriate Masters programs is often difficult in rural areas and can require time, financial support and personal dedication to attend study days or on campus requirements. There are a number of delivery options that are available for Masters programs and GV Health has chosen to inform potential Nurse Practitioner Candidates of these opportunities and allow them to decide which option best suits their personal circumstances. GV Health supports nurses undertaking post graduate study in various ways. These include but are not limited to EBA entitlements of post graduate study leave, exam leave and individualised financial support. Nurse Practitioner candidates also access these arrangements to complete their tertiary studies. Constraints to implementation of Nurse Practitioner roles potentially can be considerable if the preparation within the service for Nurse Practitioner roles has not been consultative and developmental. Attitudes of other nursing staff to Nurse Practitioner roles can be negative where they are perceived to be ‘trying to be like doctors’. This may be individual reflections but needs to be sensitively explored to identify the reasons for such statements and provide additional information about these new roles in the provision of enhanced patient care. The Board and Executive of GV Health have been supportive and accommodating of the implementation of Nurse Practitioners and are kept informed via meeting minutes, newsletters and updates from the candidates and Chief Nursing Officer. Potential for external barriers to implementation and sustainability are significant. These could develop where the Nurse Practitioner role is not understood clearly or where it is perceived that it could cross into areas of practice already adequately covered by private business concerns or other professional groups. Community based Nurse Practitioner roles face the added challenges of establishing provider numbers and processes with the Health Insurance Commission. Adequate planning and discussion about new Nurse Practitioner roles will inevitably identify and work to reduce the barriers and constraints that can occur. However the experience to date has been that whilst the position of professional group may be against Nurse Practitioner roles, individuals from that professional group are willing to embrace this change of practice. The importance of developing relationships and champions for Nurse Practitioner roles in the organisation and the community is vital to support and sustain the individual. Clear information concerning how to establish HIC processes in regards to limited prescribing rights, diagnostic investigations and Medicare are required from the Nurses Board of Victoria. Education for candidates and potential community based Nurse Practitioner roles is needed.


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12. A budget for the implementation of the role including possible funding options

Each Nurse Practitioner role submission will be required to establish a clinical rationale and a business case that clearly identifies funding and potential costs. The pay rates according to the Enterprise Bargaining Agreement for Nurse Practitioner Candidates and endorsed Nurse Practitioners will form the basis for establishing the business case. Identification of costs needs to consider the following:

• Clinical time

• Non clinical time – writing guidelines, attending education, research

• Education – own education, presentations at conferences

• Resources – access to journals, books, office area, stationery and printing

• Evaluation strategies

• Travel – attendance at study days, conference, meetings

• Corporate on costs

• Management oversight of role

Where the Nurse Practitioner role operates in an acute setting, decisions regarding their inclusion or non inclusion as part of the rostered staff for calculation of ratios need to be clearly documented. A clear understanding of the benefits and outcomes required of the role from the time of establishment will inform the budgeting process as well as the evaluation strategies required.


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13. A plan for the evaluation of the role

In general the evaluation of Nurse Practitioner roles will include the following in relation to the established project outcomes: Timeliness of treatment

Time to treatment Time to discharge

Quantity of treatment

Number of patients seen

Quality of treatment Patient satisfaction Adverse events

Cost of treatment

Cost per patient treated

Where possible data already collected within the service should be utilised and manipulated to provide information. In the emergency Nurse Practitioner project we have utilised the VITAL system, LABTRAK systems. Cost benefit analysis comparing Nurse Practitioner Candidates and non Nurse Practitioner Candidate management of patients in the emergency departments has been designed and undertaken with the Clinical Business Unit. This has provided a robust way to continue to evaluate and compare the time and costs of this Nurse Practitioner model. Future models will be directed to use this approach. Each new Nurse Practitioner model will be required to have completed the Stage 2 – Submission for Nurse Practitioner Role and have organisational authority to proceed. Evaluation strategies will be identified within this document, though these may need to be modified as the role becomes established. A template for evaluating Nurse Practitioner roles to be modified for each model is provided in the table attached in Appendix 6. Data sources may vary depending on the context of practice as different systems are used to collect data in community and acute sectors. Information will be collated in a report that summarises clinical statistics and costs, nurse practitioner reflections on barriers and facilitators to practice, and results of document analysis. The report should be accompanied by relevant supporting documentation.


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14. Process to ensure sustainability of the NP role in the organisation.

The priority in building sustainability for Nurse Practitioner roles at Goulburn Valley Health is to ensure the governance structures to support their operation are established and maintained. This includes appropriate policy, transparent processes and the operation of a steering committee that incorporates key stakeholders for all Nurse Practitioner roles in the organisation.

A process of regular evaluation (12 monthly) is vital to ensure the Nurse Practitioner model is appropriate and to identify if it could be enhanced by further modification. This is an essential element in early stages of the Nurse Practitioner establishment to justify and fine tune models of care. It is important that this process is not too burdensome and support and guidance to candidates is provided. At Goulburn Valley Health this will be provided from the Quality Unit and the Centre for Nursing Practice Education and Research. Long term, this should become a part of a broader service review and evaluation process to embed Nurse Practitioner roles and ensure they are meeting service needs. Nurse Practitioners are senior nursing clinicians who need to be recognised as being at the highest level. It is important, however that they have working relationships with appropriate personnel to provide operational support and guidance. This will include both nursing and medical staff of the service and Division. As the Nurse Practitioner role incorporates more than that of an advanced clinician, the organisation must ensure time for non clinical activity is embedded in costing. To be able to function as a leader, researcher and educator in their speciality, appropriate allocation of time away from the clinical interface is required. The benefits of the Nurse Practitioner being able to network on best practice issues in a broader context will ensure the organisation is well represented and informed of changes in practice. Building sustainability of Nurse Practitioner roles in the rural setting requires a mentor system to be developed with considerable thought as to the needs of the individuals and regional health care services. It may be that this encompasses a range of practice models and incorporates a regional, intra and inter state strategy. The advantages of the Nurse Practitioner model of care can truly enhance health care delivery and patient choice in the rural setting. Goulburn Valley Health is excited by the prospects it can see for these roles as our first Nurse Practitioner Candidate is nearing the final stages prior to endorsement.


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Appendices:

Appendix 1: GV Health Terms of Reference – Nurse Practitioner Steering Committee (draft awaiting approval) Appendix 2: GV Health Executive Policy – EXPOL1.032 – Nurse Practitioner/Nurse Practitioner Candidate. Oct. 2006. Appendix 3: Flowchart - Nurse Practitioner Role Submission

Expression of Interest – Nurse Practitioner Role Submission for a Nurse Practitioner Role

Appendix 4: GV Health Committees and How Policies, Procedures and Guidelines are Approved. Appendix 5: GV Health Position Description – Nurse Practitioner

GV Health Position Description – Nurse Practitioner Candidate Appendix 6: Nurse Practitioner Role Evaluation Template

Terms of Reference

Goulburn VTerms of Refer

1

TERMS OF REFERENCE

NURSE PRACTITIONER STEERING COMMITTEE 1. PURPOSE:

The purpose of the committee is to provide information and guidance fPractitioner (NP) / Nurse Practitioner Candidate (NPC) and the service ipractice.

2. OBJECTIVES: 2.1. Ensure the Nurse Practitioner role considers the requirements o

stakeholders; 2.2. Provide a forum for discussion of key issues 2.3. Provide guidance to the NP/NPC through input to clinical guideli

development of operational systems and data management; 2.4. Review the progress of the NP/ NPC role 2.5. Promote the NP role within the organization and community

3. ORGANISATIONAL RELATIONSHIPS:

The NP Steering Committee provides a nexus for the monitoring and suprograms throughout GV Health. The membership links Nurse PractitionPractitioner Candidates with multidisciplinary Service and Management ensure optimal patient care.

4. REPORTING:

Minutes of meetings will be forwarded to the Nursing Services Senior MGroup and main Continuum of Care Committee.

5. MEMBERSHIP: - Associate Director of Nursing – CNPER - Chief Nursing Officer - Chief Medical Officer - Chief Medical Imaging Technologist - Chief Physiotherapist - Manager – Application Systems - NUM x 2 - Director of Services where NP roles operate - Pathology Laboratory Manager - Director of Pharmacy - Physician of Services where NP roles operate - Nurse Practitioner Candidate (s) - Nurse Practitioner Project Officer(s) – when appointed - Quality Manager 6. COMMITTEE PROTOCOLS:

6.1. Documentation Minutes will be taken at each meeting and distributed to all memattending by invitation.

Appendix

1

alley Healthence Manual

or the Nurse n which they

f key

ne development,

pport of NP ers and Nurse personnel to

anagement

bers and those

Terms of Reference 2

Goulburn Valley HealthTerms of Reference Manual

6.2. Chairperson

ADON – Centre for Nursing Practice, Education & Research

6.3. Secretary Secretary CNPER

6.4. Co-opting Powers

The Committee may co-opt additional members on a sessional or short term basis to address specific issues.

6.5. Quorum

5 members

6.6. Frequency of Meetings Bi-Monthly, second Wednesday with the option to change.

6.7. Decision Making

Decisions will be made by consensus

6.8. Apologies Apologies are to be forwarded to the project officer prior to the meeting.

6.9. Review of Terms of Reference

Annually

7. PERFORMANCE INDICATORS: 7.1. Receipt of reports from NPCs four times per year and NP twice yearly 7.2. Reporting requirements for DHS funded projects are met 7.3. A minimum of 4 meetings per year

AUTHOR: Associate Director of Nursing, Centre for Nursing Practice, Education and Research VALIDATED BY: APPROVAL: AUTHORISED: APPROVAL DATE: REVIEW DATE: RESPONSIBILITY FOR REVIEW:

Appendix 2

EXPOL1.032 1

Goulburn Valley HealthExecutive Policy Manual

FUNCTION: CONTINUUM OF CARE TITLE: NURSE PRACTITIONER / NURSE PRACTITIONER

CANDIDATE POLICY CODE: EXPOL1.032 POLICY STATEMENT: Nurse Practitioner / Nurse Practitioner Candidate roles are established within Goulburn Valley Health as part of a Service development approach directed by identified needs within that Service. The extended scope of practice of the Nurse Practitioner for each model is specific to that Service and is described, documented, evaluated and supported by the Service area and wider organisation. PRINCIPLES: The safety and appropriateness of patient care by staff of GV Health is maintained in a collaborative model of care delivery. OBJECTIVES: All Nurse Practitioner Roles are documented in the GV Health Nurse Practitioner Expression of Interest and Submission guidelines and approved by the key stakeholders in the organisation. All legal requirements of Nurse Practitioners and Nurse Practitioner Candidates extended scope of practice are met by the compilation and maintenance of records of:

o Model of care description o Medication formulary o Diagnostic formulary o Clinical practice guidelines o Evaluation strategy o Professional indemnity

to ensure it’s ongoing sustainability and viability. Data collection is congruent with that established for the Nurse Practitioner Workforce Planning Minimum Data Set. REFERENCES: Victorian Nurses Act 1993 section 8b Department of Human Services (2000) Victorian Nurse Practitioner Project: Final Report of the Taskforce, Melbourne www.nbv.org.au www.nnnet.gov.au GV Health Nurse Practitioner Steering Committee Terms of Reference GV Health Nurse Practitioner – Expression of Interest Guidelines

http://www.nbv.org.au/

http://www.nnnet.gov.au/

EXPOL1.032 2

Goulburn Valley HealthExecutive Policy Manual

AUTHOR: ADON CNPER VALIDATED BY: GV Health Nurse Practitioner Steering Committee APPROVAL: Quality & Risk Management Committee AUTHORISED: APPROVAL DATE: October 2006 REVIEW DATE: October 2009 RESPONSIBILITY FOR REVIEW: GV Health Nurse Practitioner Steering Committee

Adapted from document and process of Bayside Health January 2006

FLOWCHART

NURSE PRACTITIONER ROLE SUBMISSION

Expression of interest for Nurse Practitioner Role is advertised Initially – As part of a broad communication strategy regarding the Nurse Practitioneclinical areas wanting to develop a Nurse Practitioner model will be invited to compleExpression of Interest. Ongoing – Website contact details, templates, guidelines etc will be available to supapplication.

Prior to application

Discussion about the proposed role by a representative from the clinical area with Nurse Unit Manager or Associate Director of Nursing or Service Director and Chief Nursing Officer, GV Health Consideration of the criteria that will need to be addressed if invited to proceed to Information accessed from the Nurses Board of Victoria Website.

Stage 1. Expression of Interest

Brief submission to give an idea of proposed model Submitted to: Chief Nursing Officer GV Health Reviewed by: Steering Committee Feedback through: Chair of the Committee

If approved

Stage 2. Invitation to complete a formal submission for a Nurse Practition

This is a detailed document addressing all identified criteria for a Nurse PractitioSignatures of all key players required to ensure submission is supported, fits within

plan and is financially viable. It is an expectation that all key players will be consulted, and agreement reach

the proposed model, during the development phase. Submitted to: Chief Nursing Officer, GV Health Reviewed by: Smaller working group, with representation from the Steering Commirelevant clinical areas Feedback through: A nominated member of the working group

If approved

3

Work begins on developing a model Supported: at a local department / service level Overseen: by the Steering Committee

Appendix

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er Role ner Model. the strategic

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3

EXPRESSION OF INTEREST NURSE PRACTITIONER ROLE

The nurse practitioner role “. . . extends current clinical nursing practice, is advanced, with a stknowledge, skills and competencies1” In Victoria their practice extends the nursing role outsidescope of practice for a registered nurse in limited prescribing and at least one other of the follo

initiation of diagnostics referral to medical specialists admitting and discharging privileges approval of absence of work certificates2

The nurse practitioner role is therefore the apex of clinical nursing practice. The role requires aexperienced registered nurse with a clinically relevant Masters degree, to work autonomously collaboratively in an expanded clinical role that continues to have a nursing focus. There is an the Nurse Practitioner is also actively contributing to research, publication, teaching, quality imother activities that indicate a high level of leadership capacity and clinical expertise. In order for the GV Health Chief Nursing Officer and Nurse Practitioner Steering Committee toprioritise areas for the development of Nurse Practitioner roles across GV Health, a two stage developed. The first step is to complete an expression of interest using the following guideline.followed by a more detailed submission at the invitation of the Chief Nursing Officer and NurseSteering Committee. References 1. Department of Human Services (2000) Victorian Nurse Practitioner Project: Final Report

Melbourne 2. www.nbv.org.au

Page 1 of 5

Nurse Practitioner – Expression Of Interest Guidelines GV Health, Centre for Nursing Practice, Education and Research,


Appendix

rong foundation in of the current

wing areas:

highly and expectation that provement and

identify and process has been This may be Practitioner

of the Taskforce,


Stage 1: Expression of interest

It is important that prior to completing the Expression of Interest form, due consideration is given to the criteria for Stage 2 (attached). This will ensure that you will be able to adequately address these criteria if you are invited by the Chief Nursing Officer / Steering Committee to complete the more detailed submission.

There is also an expectation that the following will have occurred:

a. Discussion regarding the proposed role with: • Nurse Unit Manager • Associate Director of Nursing / Service Director

and • Chief Nursing Officer, GV Health

b. Information from the Nurses Board of Victoria website is accessed and understood.

(Follow the links to Nurse Practitioner information under “Frequently asked Questions”.)

Expression of Interest (EOI)

Name of Service

Name of Person Completing

Position/Title

Phone/Fax

Email address

For the proposed Nurse Practitioner Model please describe (in no more than 2 pages):

a) The role of the Nurse Practitioner in the clinical setting, including the extensions to practice that will be utilised.

b) How existing health services will be enhanced or new services will be provided to meet the needs of a

patient group or the organisation.

c) What support there is from key stakeholders for the introduction of this role at this stage. This will need to include an indication of in principle support from the:

- Divisional Director (where not CNO) - Associate Director of Nursing

Or - Chief Nursing Officer

d) Strategies that will allow for funding the Nurse Practitioner model within the existing unit budget,

including brief consideration of additional costs associated with the development of the model, education and mentoring, which may require up to one day per week of non-clinical time for the initial 12 months.

Please direct any further queries and forward your response to:

Coordinator Nurse Practitioner Projects – Goulburn Valley Health Telephone: 5832 2435

Page 2 of 5



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Stage 2. GV Health Nurse Practitioner

Submission Criteria The following criteria are to be considered when developing an Expression Of Interest and form the basis of the more detailed submission that may be requested by the GV Health Chief Nursing Officer and Nurse Practitioner Steering Committee following the approval of an Expression of Interest. 1. THERE IS A DEMONSTRABLE NEED.

1.1 Describe how existing health care services could be enhanced or new services provided to meet the needs of a patient group, or an organisational need?

1.2 What data/information is there to support the requirement for this change to the health care service?

1.3 In what ways is a Nurse Practitioner the most appropriate health professional to provide this service? 1.4 How would patient/organisational outcomes of the new/expanded service and Nurse Practitioner role be evaluated?

2. THERE IS A CLEARLY DEFINABLE SCOPE OF PRACTICE.

2.1 What would be the role of the Nurse Practitioner in the clinical setting? Your response needs to address:

a) the scope of practice b) the patient presentations to be seen/target patient population c) the extensions to practice that would be required/utilised

- prescribing - initiation of diagnostics - referral to medical specialists - admitting and discharging privileges - approval of absence of work certificates

d) the proposed reporting structure

2.2 How would the Nurse Practitioner’s scope of practice be linked to clinical practice guidelines? 2.3 How would the Nurse Practitioner function within a multidisciplinary team? In your response, consider what opportunities there would be for both autonomy and collaboration. 2.4 What changes to the current model of care would be required to implement this Nurse Practitioner role? 2.5 Are there any other Nurse Practitioner Models in an equivalent clinical area? If so, please provide details, and comment on useful learnings, that are applicable to your proposed model?

3. THERE IS DEMONSTRATED SUPPORT FOR THE ROLE FROM KEY STAKEHOLDERS

3.1 What evidence is there of: Medical Nursing Multidisciplinary Executive Consumer

support for the introduction of this Nurse Practitioner role?

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3.2 What specific multidisciplinary input is available to collaborate in the development of the Nurse Practitioner role, within the revised model of care?

4. THE ROLE CAN BE FUNDED WITHIN THE EXISTING UNIT BUDGET.

4.1 What strategies would allow for funding the Nurse Practitioner within the existing budget? In addition to ongoing funding for the role, there needs to be consideration of the requirement for: The 12 month candidature for the Nurse Practitioner The need for non-clinical time for education/training and the development of clinical practice

guidelines 5. THE REQUIREMENTS FOR AN EDUCATION PROGRAM AND OTHER REQUIRED RESOURCES HAVE BEEN IDENTIFIED.

5.1 What would be the educational requirements of the Nurse Practitioner Candidate that would enable/support extensions to current practice? Please give consideration to: Health Assessment Diagnostic Testing Prescribing Documentation

5.2 What would be the relevant multidisciplinary input into the required education? What indication is there that this will be available? 5.3 Are you aware of any existing relevant educational programs (internal and/or external) that could be accessed by the Nurse Practitioner Candidate?

5.4 Is there a team of medical consultants to take on the role of clinical mentorship? If possible, please specify consultants who have indicated their willingness. Describe how the mentorship team will operate to ensure the appropriate level of support and

clinical supervision.

6. THERE IS POTENTIAL FOR A SUITABLE NURSE PRACTITIONER CANDIDATE

6.1 Is there a potential Nurse Practitioner Candidate who has: 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 An 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 and insightful An understanding and sensitivity to the political dimension of developing the Nurse Practitioner role

and an ability to promote the role in a positive manner

6.2 If there is no suitable internal candidate, what potential is there to externally recruit a suitable candidate?

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7. OTHER CONSIDERATIONS

7.1 Are there any other ways (not already described) in which the Nurse Practitioner role may impact upon: Patients The Nurse Practitioner Candidate Nursing Staff Other disciplines Your clinical area Other departments/clinical areas?

Describe what you anticipate some of the implications may be. 7.2 Any additional comments or information;

8. SIGNATURES

8.1 Signatures indicating support and financial feasibility of the model are required from: Department/Unit Manager Associate Director of Nursing Chief Nursing Officer

8.2 Further signatures of support for the model are required from: Chief Medical Officer Head of Pathology Head of Pharmacy Head of Radiology

Resources Competency Standards for the Advanced Nurse. Melbourne: ANF, 1997 Gardner G, Carryer, J, Dunn S, Gardner A. The Nurse Practitioner Standards Project: Report to the Australian Nursing & Midwifery Council. Dickson: Australian Nursing and Midwifery Council (ANMC), 2004 www.health.vic.gov.au/nursing/furthering/practitioner.htm www.nbv.org.au The Nurses Board of Victoria also offers regular information workshops for potential candidates. Details can be found on their website. www.latrobe.edu.au/nursing/Nurse%20Prac.htm

http://www.health.vic.gov.au/nursing/furthering/practitioner.htm


http://www.latrobe.edu.au/nursing/Nurse Prac.htm

Appendix 3

SUBMISSION FOR A NURSE PRACTITIONER ROLE

The work of the endorsed Victorian Nurse Practitioners, in conjunction with demonstration projects and the literature on Nurse Practitioner roles, have helped identify criteria that can influence the degree of success when developing and implementing the new role. The framework for this submission has therefore been developed around these criteria to assess the suitability of a clinical area for the development of a Nurse Practitioner role. It will also give an indication as to any issues or areas that need further exploration or refinement prior to implementation. The information provided will assist the Bayside Health Nurse Practitioner Steering Committee in developing an organisational wide strategy for the implementation of Nurse Practitioner Roles. Process: Stage 1. Expression of interest - To be provided to CNO/ADON or Divisional Director prior to completion of this document. Stage 2. Submission for a Nurse Practitioner Role - This detailed submission should only be completed at the invitation of the Goulburn Valley Health Chief Nursing Officer. Please fill out the submission framework, providing as much information/data as is available; including letters or statements of support as appropriate. Please note that all criteria are mandatory. (Useful references and resources are listed within the Expression of Interest Form) Direct any queries, and forward completed submissions to: Coordinator of Nurse Practitioner Projects Telephone 5832 2435 Graham St, Shepparton Name of Service

Name of Person Completing the Submission

Position/Title

Phone/Fax

Email address

1

CRITERIA

RESPONSE Add additional lines to each section as needed.

Attach additional documents as required 1. THERE IS A DEMONSTRABLE NEED.

1.1 Describe how existing health care services could be enhanced or new services provided to meet the needs of a patient group, or an organisational need?

1.2 What data/information is there to support the requirement for this change to the health care service?

1.3 In what ways is a Nurse Practitioner the most appropriate health professional to provide this service?

2

CRITERIA

RESPONSE

Add additional lines to each section as needed. Attach additional documents as required

1.4 How would patient and organisational outcomes of the new/expanded service and Nurse Practitioner role be evaluated?

2. THERE IS A CLEARLY DEFINABLE SCOPE OF PRACTICE.

2.1 What would be the role of the Nurse Practitioner in the clinical setting? Your response needs to address:

a) the scope of practice b) the patient presentations to be

seen/target patient population c) the extensions to practice that

would be required/utilised - prescribing - initiation of diagnostics - referral to medical

specialists - admitting and

discharging privileges - approval of absence of

work certificates d) the proposed reporting

structure

3

CRITERIA

RESPONSE


2.2 How would the Nurse Practitioner’s scope of practice be linked to clinical practice guidelines?

2.3 How would the Nurse Practitioner function within a multidisciplinary team? In your response, consider what opportunities there would be for both autonomy and collaboration.

2.4 What changes to the current model of care would be required to implement this Nurse Practitioner role?

4

CRITERIA

RESPONSE


2.5 Are there any other Nurse Practitioner Models in an equivalent clinical area? If so, please provide details, and make comment on useful learnings that are applicable to your proposed model.

3. THERE IS DEMONSTRATED SUPPORT FOR THE ROLE FROM KEY STAKEHOLDERS

3.1What evidence is there of: Medical Nursing Multidisciplinary Executive Consumer

support for the introduction of this Nurse Practitioner role?

3.2 What specific multidisciplinary input is available to collaborate in the development of the Nurse Practitioner role, within the revised model of care?

5

CRITERIA

RESPONSE


4. THE ROLE CAN BE FUNDED WITHIN THE EXISTING UNIT BUDGET.

4.1 What strategies would allow for funding the Nurse Practitioner within the existing budget? In addition to ongoing funding for the role, there needs to be consideration of the requirement for:

The 12 month candidature for the Nurse Practitioner

The need for non-clinical time for education/training and the development of clinical practice guidelines

5. THE REQUIREMENTS FOR AN EDUCATION PROGRAM AND OTHER REQUIRED RESOURCES HAVE BEEN IDENTIFIED.

5.1 What would be the educational requirements of the Nurse Practitioner Candidate that would enable/support extensions to current practice? Please give consideration to:

Health Assessment Diagnostic Testing Prescribing Documentation

6

CRITERIA

RESPONSE


5.2 What would be the relevant multidisciplinary input into the required education? What indication is there that this will be available?

5.3 Are you aware of any existing relevant educational programs (internal and/or external) that could be accessed by the Nurse Practitioner Candidate?

5.4 Is there a team of medical consultants to take on the role of clinical mentorship?

If possible, please specify consultants who have indicated their willingness.

Describe how the mentorship team will operate to ensure the appropriate level of support and clinical supervision.

7

CRITERIA

RESPONSE


6. THERE IS POTENTIAL FOR A SUITABLE NURSE PRACTITIONER CANDIDATE.

6.1 Is there a potential Nurse Practitioner Candidate who has: - 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

- An 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

8

centred and within a nursing model of practice

- The capacity to be critically reflective and insightful

- An understanding and sensitivity to the political dimension of developing the Nurse Practitioner role and an ability to promote the role in a positive manner

6.2 If there is no suitable internal candidate, what potential is there to externally recruit a suitable candidate?

7. OTHER CONSIDERATIONS

7.1 Are there any other ways (not already described) in which the Nurse Practitioner role may impact upon:

Patients The Nurse Practitioner

Candidate Nursing Staff Other disciplines Your clinical area Other departments/clinical

areas? Describe what you anticipate some of the implications may be.

7.2 Any additional comments or information;

9

I have read the above submission for the Nurse Practitioner role and support the proposed model. I am able to confirm that the development of the role will occur within the existing unit budget. Signature DateDepartment/Unit Manager

Associate Director of Nursing / Service Director

Chief Nursing Officer

I have read the above submission for the Nurse Practitioner role and support the proposed model. Signature DateChief Medical Officer

Head of Pathology

Head of Pharmacy

Head of Radiology



10

Appendix 4

COMMITTEES AND HOW POLICIES, PROCEDURES AND GUIDELINES ARE APPROVED This diagram of the GV Health committee system explains the hierarchy of committees. All policies/procedures/guidelines are approved at sub-committee level prior to submission to the next level, eg. Clinical Practice Guidelines (CPG) must be submitted and endorsed at a Continuum of Care sub committee (eg Medical Continuum of Care) prior to submission and final approval at the main Continuum of Care Committee. The approved CPG is then tabled at Quality & Risk Management Committee for information. This process assists GV Health to meet its Clinical Governance responsibilities.

Information Management(Core func tion com mittee)

Continuum of CareComm ittee (CoC)

(Core function com mittee)

Safe P rac tice &Environment

(Core function com mittee)

Human ResourcesManagem ent

(Core func tion comm ittee)

Quality & Risk Managem entCom mittee

Board of Directors(Patient Care Review Com mittee) Clinical Audit

Executive

MedicalCoC

Surgical SubCoC

Women's HealthSub CoC

Energy & WasteManagem ent

Chem ical &Product

Evaluation

OH & Safety

Library

ClinicalInformation

Advisory

Clinical Bus inessInform ation Group

ResidentialQuality Care

CoC

CommunityServices CoC

Mental HealthCoC

Neonatal &Paediatric CoC

Sub Acute CoC

Emergency CoC

Infection Control

ConsumerConsultativeCom mittee

Issued: October 2006 Review Date: ----/----/----

5

Goulburn Valley Health Position Description

Title: Nurse Practitioner (insert speciality) Department: Division: Nursing Cost Centre: Code & Classification: Grade 6 Employment Conditions: Responsible To: Divisional Director Responsible For: Establishing the delivery of patient care in

scope of practice Performance Review: Upon completion of 6 months probationar

annually or as requested thereafter Prerequisites and Key Selection Criteria:

Required • Current registration with Nurses Board

certified to practice as a Division 1 nurendorsement as Nurse Practitioner (ins

• Master of Nursing (including a mandatTherapeutic Medication Management mdemonstrated capacity and commitmeif not already completed

• Evidence of high-level written and verbcommunication skills.

• The ability to maintain open dialogue wclinicians and management personnel

• Evidence of participation in the collectireport writing

• Medium to high level IT skills in Office Word and Excel

• Satisfactory Police Check Desirable • Graduate Diploma (or equivalent) in Nu

speciality

ROLE: The Nurse Practitioner is a registered nurse who has acquired the expertbase, complex decision-making skills and clinical competencies forpractice.1The Nurse Practitioner role includes assessment and manaclients using nursing knowledge and skills and may include, but is not limdirect referral of patients to other health care professionals, prescribing mand ordering diagnostic investigations. The Nurse Practitioner role is grounursing profession’s values, knowledge, theories and practice aninnovative and flexible health care delivery that complements other providers. The scope of practice of the Nurse Practitioner is determicontext in which the Nurse Practitioner is authorised to practice.2

1 International Council of Nurses, http://icn-apnetwork.org/ 2 Australian Nursing and Midwifery Council (2003), Report to Australian Nursing and Midwifery CouncPractitioner Standards Project, Queensland University of Technology

Appendix

Page 1 of 5

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KEY ACTIVITIES / PERFORMANCE INDICATORS: Leadership & Management • Act as a positive role model and provides expert nursing knowledge to the

multidisciplinary team and be accountable and responsible for advanced levels of decision-making.

• Establish effective, collaborative and professional relationships with patients, members of the multidisciplinary team and other stakeholders to ensure an integrated approach to patient care across the continuum of care.

• Works with all staff of the Service to promote understanding and role of Nurse Practitioner in enhancing patient care and flow.

• Demonstrates effective communication and promotes collaborative practice with other health care professionals.

• Continues to develop and expand the role of Nurse Practitioner in the clinical area of expertise.

• Assume a team leadership role when required. • Assists in preparation of reports as required. • Apply conflict resolution skills when dealing with problems involving all levels of

staff, patients and their significant others and the public. • Build partnerships with other health services developing similar roles. Continuum of Care Perform comprehensive patient assessments and demonstrate skill in the diagnosis and treatment of acute and chronic illness within the specified scope of practice and in collaboration with other members of the multidisciplinary team. • Document clinical case management. • Demonstrate comprehensive understanding of specific pharmaceuticals and

diagnostic tests related to the specified area of practice. • Prescribe medications and other treatments within the specified scope of

practice. • Initiate and interpret diagnostic and radiological tests specific to the scope of

practice. • From within the specified scope of practice refer patients to other health

professionals as necessary. • Evaluate the effectiveness of the client’s response to the clinical case

management and take appropriate action. • Practice within a clinical framework that is evidence based, relevant and current,

and is in accordance with the standards prescribed by the Australian Nursing and Midwifery Council, Nurses Board of Victoria Guidelines, Goulburn Valley Health and departmental policies and procedures.

• Recognise limits to own practice and consult appropriately, facilitating the patient’s access to appropriate interventions or therapies.

• Completion of competencies appropriate to clinical practice. Provide education services in the specified clinical discipline: • Identify, design and provide education programs as required specific to the

individual learning needs of patients, their significant others, nursing, and allied health staff and students, community organisations and the wider public.

• Coordinate, develop and maintain appropriate learning tools to facilitate learning. • Provide equipment in-services in consultation with product representatives and

the Centre for Nursing Practice Education and Research (CNPER) and new product evaluation committee as appropriate.

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• Provide in-service education sessions as appropriate and requested. • Coordinate and participate in learning opportunities, formal and informal, in

conjunction with the CNPER. • Assist staff in the implementation of patient education at ward level. • Promote an atmosphere conducive to learning. Improving Performance Undertake research and development and continuous improvement activities to meet specified clinical nursing needs: • Contribute to the development of professional practice, including participation in

and promotion of evidence based practice and research. • Initiate, develop and maintain clinical practice guidelines which are evidence

based and ensure a high standard of care for patients. • Actively participate in quality improvement processes through the initiation,

planning, implementation and evaluation of programs. • Evaluate current research and coordinate the liaison with key stakeholders to

implement change processes to reflect research findings. • Coordinate policy and procedure development and review in consultation with

key stakeholders. • Participate in organisational committees/working groups as required. Ensure ongoing effective clinical service provision in the specified clinical discipline: • Review current service and liaise with key stakeholders to develop a model of

service for future service needs. • Be open to innovative and flexible clinical practice models, both community and

hospital based as appropriate, with the primary focus being the patient and the continuity of their care.

• Build mutually beneficial relationships with community groups and organisations. Information Management Demonstrates capacity to ensure confidentiality and appropriate use of information to provide safe, efficient delivery of patient care. • Ensures appropriate documentation in medical records highlighting nurse

practitioner candidate status and has medical officer countersign where required. • Works collaboratively in managing data entry for use in audits and reports • Assists in communicating the progress of the project to nursing, medical and

allied health staff in the emergency department and the organisation. Human Resources Management Commit to ongoing professional development of self and learning: • Actively participate in professional development and continuing education,

conferences, seminars, committees, working parties and professional groups. • Present and publish in appropriate professional conferences and journals. • Remain informed of the current literature. • Develop strong collegial links and partnerships with other nurse practitioners. • Seek feedback from key stakeholders on your own performance. • Participate in annual performance appraisal and identify learning needs.

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Support the professional development and learning of other staff: • Provide clinical leadership in the area of specialty. • Act as an advocate, mentor, clinical teacher, resource and support person. • Share knowledge of research, education and clinical practice issues and

knowledge gained from participation in seminars and conferences. • Assist nursing colleagues in research efforts. • Encourage other staff to present and publish in appropriate professional

conferences and journals. • Facilitate special interest forums for other staff in the specified clinical discipline. • Articulate the practices of the Nurse Practitioner such that the role is known and

understood by the community within which the Nurse Practitioner practices and the wider community group.

• Participates in multidisciplinary meetings and committees as required • Ensures appropriate rostering to meet needs of service and participate in

expected organisational performance reviews Safe Practice & Environment 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 take reasonable care of his or her own health and safety and to cooperate with Goulburn Valley Health’s Safe Practice & Environment policies and procedures and to participate in appropriate safety education and evaluation activities. Each employee has a responsibility to minimise exposure to incidents of infection/cross infection of residents, staff, visitors and the general public. All staff adhering to the policies and procedures as set out in Goulburn Valley Health’s Safe Practice & Environment Manual can most effectively achieve this minimisation. • Conduct yourself in a manner that will not endanger yourself or others. • Follow Goulburn Valley Health's Occupational Health and Safety policies and

procedures. • Report any unsafe work practices, hazards, near miss incidents and accidents. • Maintain an awareness of the Occupational Health and Safety Act 2004 and the

Accident Compensation (WorkCover) Act 1992. • Contribute to safety awareness and promotion by contributing ideas and

suggestions. • Maintain knowledge and practice of infection control / hygiene precautions and

GV Health infection control policies and procedures. ___________________________________________________________________

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CORE COMPETENCIES Core competencies reflect Goulburn Valley Health’s values and behaviours.

CORE COMPETENCIES LEVEL CORE COMPETENCY STATEMENT Customer / Patient Service 3 Provide a high quality service to both internal

and external customers and patients, which meets or exceeds their needs and adds value to Goulburn Valley Health.

Taking Responsibility 3 Take responsibility for own actions and seeing tasks through to a successful end result. It involves having a real sense of urgency and not being discouraged by obstacles over the short or long term.

Continuous Improvement 3 Identify and assess opportunities to improve existing processes and procedures, implement solutions and measure their impact. This may involve: a) Challenging established processes

and procedures or bringing in ideas form elsewhere to add value to Goulburn Valley Health

b) Identifying and eliminating root causes of process deficiencies.

Health & Safety 3 Observe and promote occupational health and safety to ensure a safe working environment for employees, contractors, customers and the general public.

Supporting & Managing Change 3 To communicate an agreed vision for change and effectively implement the change by generating energy and excitement around the agreed vision.

Communication 3 Communicates effectively both in the written and spoken form in a way that delivers the desired message and the message is clearly understood and acted upon by others.

Approved by: _________________________ Supervisor ____/____/____ Accepted by: _________________________ Incumbent ____/____/____ _________________________ (Print Name)


5

Goulburn Valley Health Position Description

Title: Nurse Practitioner Candidate (insert speDepartment: Division: Nursing Cost Centre: Code & Classification: Substantive until endorsement Employment Conditions: Responsible To: Divisional Director Responsible For: Establishing the delivery of patient care i

scope of practice Performance Review: Upon completion of 6 months probationa

annually or as requested thereafter Prerequisites and Key Selection Criteria:

Required • Current registration with Nurses Boar

certified to practice as a Division 1 nu• Demonstrated advanced clinical know

skills in the chosen area of specialist • Master of Nursing (including a manda

Therapeutic Medication Managementdemonstrated capacity and commitmif not already completed

• Evidence of high-level written and vercommunication skills.

• The ability to maintain open dialogue clinicians and management personne

• Show evidence of commitment to theendorsement as a Nurse Practitioner Board of Victoria

• Medium to high level IT skills in OfficeWord and Excel

• Satisfactory Police Check Desirable • Graduate Diploma (or equivalent) in N

speciality

ROLE: The Nurse Practitioner is a registered nurse who has acquired the expebase, complex decision-making skills and clinical competencies fopractice.1The Nurse Practitioner role includes assessment and manclients using nursing knowledge and skills and may include, but is not lidirect referral of patients to other health care professionals, prescribing and ordering diagnostic investigations. The Nurse Practitioner role is gronursing profession’s values, knowledge, theories and practice ainnovative and flexible health care delivery that complements otherproviders. The scope of practice of the Nurse Practitioner is determcontext in which the Nurse Practitioner is authorised to practice.2

1 International Council of Nurses, http://icn-apnetwork.org/ 2 Australian Nursing and Midwifery Council (2003), Report to Australian Nursing and Midwifery CounPractitioner Standards Project, Queensland University of Technology

Appendix

Page 1 of 5

ciality)

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rt knowledge r expanded agement of mited to, the medications, unded in the nd provides health care ined by the

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of 5


KEY ACTIVITIES / PERFORMANCE INDICATORS: Leadership & Management • Act as a positive role model and provides expert nursing knowledge to the

multidisciplinary team and be accountable and responsible for advanced levels of decision-making.

• Establish effective, collaborative and professional relationships with patients, members of the multidisciplinary team and other stakeholders to ensure an integrated approach to patient care across the continuum of care.

• Works with all staff of the Service to promote understanding and role of NPC in enhancing patient care and flow.

• Demonstrates effective communication and promotes collaborative practice with other health care professionals.

• Continues to develop and expand the role of Nurse Practitioner Candidate / Nurse Practitioner in the clinical area of expertise.

• Assume a team leadership role when required. • Assists in preparation of reports as required. • Apply conflict resolution skills when dealing with problems involving all levels of

staff, patients and their significant others and the public. • Build partnerships with other health services developing similar roles. Continuum of Care Perform comprehensive patient assessments and demonstrate skill in the diagnosis and treatment of acute and chronic illness within the specified scope of practice and in collaboration with other members of the multidisciplinary team. • Document clinical case management. • Demonstrate comprehensive understanding of specific pharmaceuticals and

diagnostic tests related to the specified area of practice. • Prescribe medications and other treatments within the specified scope of

practice. • Initiate and interpret diagnostic and radiological tests specific to the scope of

practice. • From within the specified scope of practice refer patients to other health

professionals as necessary. • Evaluate the effectiveness of the client’s response to the clinical case

management and take appropriate action. • Practice within a clinical framework that is evidence based, relevant and current,

and is in accordance with the standards prescribed by the Australian Nursing and Midwifery Council, Nurses Board of Victoria Guidelines, Goulburn Valley Health and departmental policies and procedures.

• Recognise limits to own practice and consult appropriately, facilitating the patient’s access to appropriate interventions or therapies.

• Completion of competencies appropriate to clinical practice. Provide education services in the specified clinical discipline: • Identify, design and provide education programs as required specific to the

individual learning needs of patients, their significant others, nursing, and allied health staff and students, community organisations and the wider public.

• Coordinate, develop and maintain appropriate learning tools to facilitate learning.

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• Provide equipment in-services in consultation with product representatives and the Centre for Nursing Practice Education and Research (CNPER) and new product evaluation committee as appropriate.

• Provide in-service education sessions as appropriate and requested. • Coordinate and participate in learning opportunities, formal and informal, in

conjunction with the CNPER. • Assist staff in the implementation of patient education at ward level. • Promote an atmosphere conducive to learning. Improving Performance Undertake research and development and continuous improvement activities to meet specified clinical nursing needs: • Contribute to the development of professional practice, including participation in

and promotion of evidence based practice and research. • Initiate, develop and maintain clinical practice guidelines which are evidence

based and ensure a high standard of care for patients. • Actively participate in quality improvement processes through the initiation,

planning, implementation and evaluation of programs. • Evaluate current research and coordinate the liaison with key stakeholders to

implement change processes to reflect research findings. • Coordinate policy and procedure development and review in consultation with

key stakeholders. • Participate in organisational committees/working groups as required. Ensure ongoing effective clinical service provision in the specified clinical discipline: • Review current service and liaise with key stakeholders to develop a model of

service for future service needs. • Be open to innovative and flexible clinical practice models, both community and

hospital based as appropriate, with the primary focus being the patient and the continuity of their care.

• Build mutually beneficial relationships with community groups and organisations. Information Management Demonstrates capacity to ensure confidentiality and appropriate use of information to provide safe, efficient delivery of patient care. • Ensures appropriate documentation in medical records highlighting nurse

practitioner candidate status and has medical officer countersign where required. • Works collaboratively in managing data entry for use in audits and reports • Assists in communicating the progress of the project to nursing, medical and

allied health staff in the emergency department and the organisation. Human Resources Management Commit to ongoing professional development of self and learning: • Actively participate in professional development and continuing education,

conferences, seminars, committees, working parties and professional groups. • Present and publish in appropriate professional conferences and journals. • Remain informed of the current literature. • Develop strong collegial links and partnerships with other nurse practitioners. • Seek feedback from key stakeholders on your own performance. • Participate in annual performance appraisal and identify learning needs.

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Support the professional development and learning of other staff: • Provide clinical leadership in the area of specialty. • Act as an advocate, mentor, clinical teacher, resource and support person. • Share knowledge of research, education and clinical practice issues and

knowledge gained from participation in seminars and conferences. • Assist nursing colleagues in research efforts. • Encourage other staff to present and publish in appropriate professional

conferences and journals. • Facilitate special interest forums for other staff in the specified clinical discipline. • Articulate the practices of the Nurse Practitioner such that the role is known and

understood by the community within which the Nurse Practitioner practices and the wider community group.

• Participates in multidisciplinary meetings and committees as required • Ensures appropriate rostering to meet needs of service and participate in

expected organisational performance reviews Safe Practice & Environment 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 take reasonable care of his or her own health and safety and to cooperate with Goulburn Valley Health’s Safe Practice & Environment policies and procedures and to participate in appropriate safety education and evaluation activities. Each employee has a responsibility to minimise exposure to incidents of infection/cross infection of residents, staff, visitors and the general public. All staff adhering to the policies and procedures as set out in Goulburn Valley Health’s Safe Practice & Environment Manual can most effectively achieve this minimisation. • Conduct yourself in a manner that will not endanger yourself or others. • Follow Goulburn Valley Health's Occupational Health and Safety policies and

procedures. • Report any unsafe work practices, hazards, near miss incidents and accidents. • Maintain an awareness of the Occupational Health and Safety Act 2004 and the

Accident Compensation (WorkCover) Act 1992. • Contribute to safety awareness and promotion by contributing ideas and

suggestions. • Maintain knowledge and practice of infection control / hygiene precautions and

GV Health infection control policies and procedures. ___________________________________________________________________

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CORE COMPETENCIES Core competencies reflect Goulburn Valley Health’s values and behaviours.

CORE COMPETENCIES LEVEL CORE COMPETENCY STATEMENT Customer / Patient Service 3 Provide a high quality service to both internal

and external customers and patients, which meets or exceeds their needs and adds value to Goulburn Valley Health.

Taking Responsibility 3 Take responsibility for own actions and seeing tasks through to a successful end result. It involves having a real sense of urgency and not being discouraged by obstacles over the short or long term.

Continuous Improvement 3 Identify and assess opportunities to improve existing processes and procedures, implement solutions and measure their impact. This may involve: a) Challenging established processes

and procedures or bringing in ideas form elsewhere to add value to Goulburn Valley Health

b) Identifying and eliminating root causes of process deficiencies.

Health & Safety 3 Observe and promote occupational health and safety to ensure a safe working environment for employees, contractors, customers and the general public.

Supporting & Managing Change 3 To communicate an agreed vision for change and effectively implement the change by generating energy and excitement around the agreed vision.

Communication 3 Communicates effectively both in the written and spoken form in a way that delivers the desired message and the message is clearly understood and acted upon by others.

Approved by: _________________________ Supervisor ____/____/____ Accepted by: _________________________ Incumbent ____/____/____ _________________________ (Print Name)

Nurse Practitioner Role Evaluation Template

Evaluation Component

Proposed Methodology

Data Source

Appendix 6

1. Achievement of outcomes • Reduced waiting times • Reduced length of stay / number of

return visits • Allocation of Resources to where

they are most needed • Improved time to interventions and

investigations

Baseline data prior to NPC implementation and then data for the allocated period will capture: 1.1 Quantitative data which reflects demand for service 1.2 Quantitative data which reflects length of stay or number

of return visits 1.3 Quantitative data which reflects time of contact or referral

to initiation of treatment or first consult 1.4 Quantitative data which reflects time of contact to

initiation of investigations and /or the types and numbers of investigations

1.5 Referral to other health professionals 1.6 Time of investigations to first review. 1.7 Time from contact to discharge or referral

.. systems for identifying

2. Quality of Service provided by the NPC.

• Consumer satisfaction • Medical / nursing satisfaction • Implementation of best practice

with Clinical practice guidelines

Predominantly a Qualitative approach will be required to capture this data (interview / questionnaire): 2.1 Pre and post comparison testing of patient satisfaction

surveys. 2.2 Pre and post comparison testing of medical and nursing

satisfaction surveys and interviews. 2.3 Evaluation of clinical practice guidelines against current

best practice (evidence based). 2.4 Number and range of clinical practice guidelines developed

Patient survey Patient history audit

3. Feasibility to the NPC role • Ongoing employer /

management support • Effectiveness / efficiency • Cost effectiveness

3.1 Appropriateness of pathology requests as evaluated by the supervising Physician.

3.2 Appropriateness of radiographic requests as evaluated by the Physician.

3.3 Appropriateness of pharmacological interventions as evaluated by the Physician.

3.4 Assessment of specialist referrals to both inpatient and outpatient units as evaluated by chief medical officer through the Director of the Emergency Department.

3.5 Identify and compare like processes for cost effectiveness (pre and post implementation)

Some of the data can be retrieved from the lab trak / Web 1000 systems which identify the number of requests ordered by the NP. Additionally identifies the specific tests ordered. Pre and Post comparisons can then be made. Patient history audit Use Clinical Business Unit to identify best strategy to evaluate cost effectiveness




Data Source

4. Availability of the NP • Consumer choice • Physician choice • timelines

Data specific to this component can be obtained from the Department VITAL Database: 4.1 identify the number of clients managed by the NPC 4.2 identify the types of conditions managed by NPC. 4.3 Further identifies time allocated (where appropriate)

Department VITAL Database

5. NPC satisfaction with role This data will predominantly be from the qualitative method, utilizing resources such as 5.1 Professional Practice Portfolio maintained by the NPC

which will identify health promotion, patient education and critical incidents involving client care.

5.2 Identification of barriers as identified in the Professional Practice Portfolio

NP professional practice portfolio

6. Quality of NPC role A combination of quantitative and qualitative approaches will be utilized to capture data associated with adverse outcomes and complications: 6.1 patient complaints – verbal / written 6.2 unplanned representations / unplanned admissions from clients previously managed by the NPC. 6.3 deterioration of clients condition warranting transferral of

management. 6.4 Outcomes indicative of concern. 6.5 Incident reports associated with the practice of the NPC.

Complaints Unplanned readmission / representation data in patient history

7. Collaborative practice • Professional roles and

boundaries • Referrals to and from other

health professionals • Health professionals

satisfaction with NCP

As this component is quite subjective, a qualitative approach is anticipated (interviews / questionnaire), capturing data associated with: 7.1 appropriate / inappropriate amount of collaboration between the physician and NPC. 7.2 Physician satisfaction with NPC role 7.3 Key stakeholders satisfaction with the NPC role. 7.4 NPC satisfaction with the practitioner model of care. 7.5 Pre and post comparisons of referrals made to other health

care professionals. 7.6 Examination of professional journal to review referral

processes




Data Source

8. Restrictions and Limitations to NPC practice

This data will be captured with the utilization of the professional practice portfolio / interview with Physician and feedback from main stakeholders. 8.1 Restrictions to the number of patients managed 8.2 Restrictions to medication prescribing 8.3 Cost restrictions associated with ordering of investigations.

Professional Practice Portfolio

9. Promotion of the NP role • Community promotion • Hospital promotion • Rationale for expansion of the

role

As the role progresses, an evaluation to determine the rationale for expansion of the role can be evaluate through: 9.1 pre and post evaluation of community promotion of the role through qualitative method. 9.2 pre and post evaluation of hospital promotion of the role through a qualitative method. 9.3 Examine room for role expansion.

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