Debbie White Nurse Practitioner Palliative Care Port Macquarie Community Health Campus

1. Community Innovation: The Development of a Nurse Practitioner Model of Care in Palliative Care Debbie WhiteNurse Practitioner Palliative CarePort Macquarie Community Health Campus October 2013

2. Purpose • Explore model of care and the NP role • To share a narrative of my experience • Illustrate the highlights and challenges along the way • Demonstrate the benefits for the patients and families

3. Model of Care • A way of working • A multidimensional concept that describes how health services are delivered (QLD Govt 2000) • Encompasses: patient centred, safe, effective, equitable, quality, efficient, cost effective, innovative care (NSW Health 2005, WA Govt 2008) • Ensuring right care, right time, right place

4. Nurse Practitioner “A registered nurse who is educated and endorsed to function autonomously and collaboratively in an advanced and extended clinical role…” • Assessment & management skills • Referral, prescribing medications, ordering diagnostic investigations • The role is grounded in nursing – values, theories, knowledge • Provides innovative and flexible health care delivery that complements other health care providers

5. Safety & Quality Framework for NP’s

6. Nurse Practitioners in Palliative Care • Standards for Palliative Care (PCA) – NP listed as part of specialist level services • In NSW there are 5 NP’s and 1-2 Transitional NP’s in place • A valuable addition to the Palliative Care MDT

7. Palliative Care • For people with a life limiting illness • Multidisciplinary approach • Cares for the patient and family • Impeccable assessment and early treatment of symptoms • Holistic approach: physical, spiritual, cultural, emotional (WHO 2005)

8. Palliative Care in NSW • In rural / regional NSW → 1.6 fte Palliative Care Specialists • High chronic disease burden • 10% of patients with chronic disease receive palliative care • 66% of cancer patients receive palliative care • Flexible, innovative approaches to meet the demand and provide a sustainable service

9. The Journey…..

10. The Beginning…. • Role commenced in 2011 • Hastings Macleay Clinical Network • Community based role • Home • Wauchope PCU • Residential Aged Care • Kempsey Hospital • Nurse Led Clinic • Clinical, Education, Leadership, Research

11. Finding ‘my place’ • An additional position for an already established team • Skilled Clinicians • Transitioning from CNC to NP • Different responsibilities • New CNC role developing • In the team, or an extension of the team?

12. Challenges….. • Doctors and NP’s • MBS Number • Lack of understanding of the role • Covering a large geographical area • No Palliative Care Specialist • Developing a new role • support systems • Structure • expectations

13. Data • 54 weeks • 612 OoS (n of patients 150 – 160) • Referrals n =160 • Malignant 65% Non-Malignant 20% Unknown 15% • Consults ?

14. An Evolving Role…… • Learning, researching, waiting • Changing expectations without changing beliefs and values • Working with the team – challenging ways of working • Introducing innovation, identifying gaps • Collecting data • Expanding own scope of practice

15. A Model of Care….

16. The biggest lesson or realisation.. The role is still very new despite recent progress at state and national level

17. Questions…