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

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 ? P/UPCTGPRACFDirectHosp 4031793538 25%19%5%6%22%24%

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…. NP RACFCommunity Wauchope PCU Chronic Disease NP Led Clinic

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

17. Questions…