1. Role of Clinical Nurse Specialists in WRHA Palliative Care Program Lori Embleton, Program Director WRHA Palliative Care Program November 21, 2008

2. WRHA Palliative Care Program Provides care to patients and families living with life limiting illness –Patients of all ages –Spans the continuum of care settings Palliative Care Program settings – community, inpatient units and hospices Need to provide support to practitioners in other care settings -acute care facilities, PCHs, outpatient clinics

3. CNS Role in Palliative Care Program Created in 2001 to: Build capacity for quality end-of-life care throughout the continuum of care within the WRHA Promote evidence-based palliative care nursing practice through education and program development activities

4. CNS Role in Palliative Care Program Initially – 3 EFT with 2 EFT located in acute care facilities, 1 EFT in community Currently funded for 5 EFT –3 EFT for community and community hospitals –1 EFT – Pediatric Palliative Care –1 EFT – HSC * 1 EFT at SBGH

5. Successes Consultation service utilized widely: 2006/2007 - ~ 600 consults 2007-2008 - ~ 900 consults *(excludes SBGH and HSC)

6. Successes Development of a number of program specific initiatives to support care –Medication kits –Nursing procedures / guidelines / protocols Educational initiatives aimed at building capacity and including all members of the health care team –Within Palliative Care Program –Within sites and programs across WRHA

7. Challenges Increasing focus on consultation leaving less time available for other domains of CNS role Practice has evolved to meet Program demands

8. CLINICAL NURSE SPECIALIST Overlap with role of physician NURSE PRACTITIONER Education Research Professional Development Education Research Professional Development Direct Patient Care SCOPE OF NURSING PRACTICE: OVERLAP OF CNS/ NP ROLES Promote excellence in nursing practice Bryant-Lukosius, D. (2003). Continuum of advanced practice nursing roles. Unpublished document. School of Nursing, McMaster University. PC CNS

9. Strategies to Support CNS Role Program actively developing plans to expand “team” approach to support care outside of program settings –Model developed for consultative service to include MD/CNS and psychosocial support

10. Strategies to Support Meetings to support CNS in practice Consultation review with PC physician and Program Director Open discussions regarding scope of practice and CNS role Continue to evaluate evolving role Continue to explore opportunities for APN roles in Program