Advancing Nursing Practice:

Improving Staff Retention

and Patient Outcomes Wendy Wood

Deputy CEO and

Executive Director Cancer Nursing

The Peter MacCallum Cancer Centre

• Australia's only public hospital solely dedicated to cancer

• A national leader in multi-disciplinary cancer care, and

• A national and international leader in laboratory, clinical

and translational research

Our vision

• The best in cancer care, accelerating discovery,

translating to cures

Our mission

• Improve the outcomes for individual cancer patients and

reduce the impact of cancer on our community.

• Ensure that all Victorian patients, regardless of where

they live, have access to the expert care they require

• Ensure that discoveries translate to the development of

improved cancer treatments

• Provide the best in educational opportunities resulting in

the training of high-quality cancer clinicians for today and

the future

Cancer statistics – Cancer Council Australia (Feb 2011)

• 114,000 new cases of cancer were diagnosed in

Australia in 2010.

• 1 in 2 Australians will be diagnosed with cancer by the

age of 85.

• Cancer is a leading cause of death in Australia – more

than 43,000 people are estimated to have died from

cancer in 2010.

• Nearly 15,000 more people die each year from cancer

than 30 years ago, this is due mainly to population

growth and aging.

Demand drivers

• The death rate (number of deaths per 100,000 people )

has fallen by 16%.

• More than 60% of cancer patients will survive more than

five years after diagnosis.

• The survival rate for many common cancers has

increased by 30 per cent in the past two decades.

• Cancer costs $3.8 billion in direct health system costs

(7.2%).

• $378 million was spent on cancer research in 2000-01,

22% of all health research expenditure in Australia.

The Cancer Workforce

• Workforce shortages and systemic inefficiencies are restricting

access to care across all domains of cancer control:

– Chemotherapy utilisation in Australia could be as low as 19%

(50.8% of cancer patients should receive chemotherapy (Ng et al,

2010), due largely to medical oncologist shortages (MOGA, 2010);

– Under-utilisation of radiotherapy (ROJIG, 2003) is linked to

shortfalls in the radiation oncology workforce;

– There are widely reported barriers for cancer patients requiring

psychosocial support (COSA 2003).

Career Wisdom

• Really successful people are clear about what they want

• They can tell you want they want to do with their career

• About 14% of people have a plan; the rest just hope for

the best

• Peter Mac’s ANP Framework aims to improve this

statistic

(Further reading; Career Wisdom – 101 proven Strategies to Ensure

Career Success by John McKee)

Peter Mac’s Nursing Workforce Strategy

• Investing in the training and retention of cancer care

professionals

• Redesign of professional roles

• Innovative roles: nurses as 1st assistant in robotic

surgery, nurse practitioners and other advanced practice

roles, built around patient-centred, multidisciplinary care.

The Development of an Advancing

Nursing Practice Framework

Advanced Practice Exemplars (adapted from McCaffery Boyle 1996)

• Active case finding

• Chronic illness care (Griffiths & Jones 2001)

• Interpersonal competence and responsive communication skills

• Skilled clinical inquiry

• Skilled documentation

• Skill in anticipating the future

• Role assertion

• Awareness of limits

• Facilitation of change

• Ethical decision-making

The Purpose of Advanced Practice Roles

• Contribute to improved outcomes for patients and families

• Develop and lead improvements in nursing practice and care delivery

• Foster innovation and support change management

Purpose of the Framework:

• To guide the advancement of nursing practice in the

interest of better care and improved patient experience

• Some very experienced cancer nurses use it to pursue

endorsement – NP

• Others are using it to advance their abilities to perform

more effectively and increasingly independently

• Some quite junior nurses are using it to guide their study,

professional development and career choices

What’s Does The Framework Cover?

1. Principles

2. Career Structure

3. Description of specialist roles and advanced practice

nurses

4. Clinical competencies for advanced practice

5. Governance process

1. Principles

• The priorities, needs and experiences of people affected

by cancer are the key driver of the development of

nurses and the pursuit of advanced nursing practice

• Nurses are uniquely placed to positively impact on

outcomes for people affected by cancer

• The ANP process is governed by our values as well as

the regulatory bodies requirements

• The ANP Framework assists nurses to expand their

scope of practice in a context of appropriate

organisational and professional support

3. Description of Specialist & ANP Roles

• Clinical Nurse Specialist

• Practice Development Nurse

• Clinical Nurse Coordinator

• CNC Advanced Practice Nurse (credentialed)

• Clinical Nurse Consultant

• Nurse Practitioner

• Senior Clinician Researcher

• Lecturer Practitioner

Credentialing Framework for Advanced

Practice Nurses & NPs

• A clear pathway

• Identification of a perceived patient care gap

• Completion of Post Graduate Studies

• Peter Mac Formal endorsement & credentialing

• Nurse practitioner AHPRA credentialing

Data to indicate service gap might

include:

• Numbers of in-patient admission due to uncontrolled

symptoms;

• Numbers of patients presenting for unplanned clinic

appointments;

• Numbers of calls from patients or family members for

symptom advice;

• Numbers of patients presenting to an ED elsewhere;

• Extended Length or repeated admission

Retention and Advanced Practice

Peter Mac 2010-2011

• Since launching the framework in October 2010

• 8 nurses have been credentialed as APNs

• 4 nurses are completing studies and preparing their

applications

• 3 NP

• 4 nurses commenced Master’s of NP in 2011

• All nurses who have been credentialed as APNs or NPs

and those who have been identified as having the

capabilities of progressing to APN have continued at

Peter Mac

Qualifications

2012 Number of RNs with postgraduate level qualifications

0 50 100 150 200 250 300 350 400 450

Tot al post graduat e qualif icat ion

2012 Type and proportion of post graduate level qualification of RNs (n =238)

4 9 %

3 1 %

1 9 %1 %

Postgraduate certificate

Post graduate diploma

M aster

PhD

Nurse Agency Spend by Financial Year

from BI

Source: Business Intelligence (BI)

Nurse Agency Spend by Financial Year

from BI

$1,022,048$1,102,597

$1,514,223

$1,895,409

$1,445,117

1,069,414

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

$2,000,000

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012

Improved Patient Outcomes

• Satisfaction with nurse-led telephone follow up for low to

intermediate risk prostate cancer patients treated with

radical radiotherapy: A comparative study

• There was no statistically significant difference in patient

satisfaction on any of the study measures between the

nurse-led and standard medical follow up at six months

following treatment completion. However, where there

was a trend towards significance (p ¼ 0.051), it favoured

the nurse-led follow up regimen.

Outcomes cont.

• Trial: evaluate the acceptability, feasibility and safety of a

post transplant nurse-led clinic (NLC) model, with the

aim to reduce risk through managing ongoing symptoms

and thus minimising unnecessary in-patient admissions

• A total of 154 patients have attended the post-transplant

NLC between November 2009 and March 2011. All

patients were seen in the NLC within the first week of

their discharge following their transplant, replacing the

traditional medical follow-up appointment that patients

usually received at this time.

Current Evaluation Activities

• Nurse-Led Survivorship Care Intervention for Long-term Survivors of Hodgkin Lymphoma.

Primary aim: To establish whether receiving a health promoting intervention from a specialist cancer nurse demonstrates capacity to improve HL survivors’ knowledge of and motivation to adopt health promoting behaviours.

Secondary aims: To establish whether receiving a health promoting intervention from a specialist cancer nurse demonstrates capacity to:

• Improve HL survivors’ perceptions of their health status

• Reduce patient-reported unmet information needs in relation to late effects

• Reduce health worry associated with the knowledge of risk of developing late effects.

Advancing Nursing Practice at

Peter Mac www.petermac.org/AdvancingNursingPractice

Acknowledgements

• Associate Professor Meinir Krishnasamy, Director of

Nursing and Cancer Experienced Research, Peter

MacCallum Cancer Centre

• Professor Sanchia Aranda, Former Director, Department

of Nursing and Supportive Care Research, Peter

MacCallum Cancer Centre and the University of

Melbourne

• The Nursing Executive Team, Peter MacCallum Cancer

Centre

• Trevor Saunders, former Nurse Director Clinical Practice

Wendy.Wood@petermac.org