dr frances hughes, nursing and midwifery office, queensland - optimising the nurse practitioner role...
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Optimising the role of the
nurse practitioner a
Queensland overview
Dr Frances Hughes, RN, DNurs, Col (ret RNZNC) ONZM
Chief Nursing and Midwifery Officer,
Queensland
4th Annual Conference: Developing the Role of the
Nurse Practitioner, Tuesday 18 March 2014
Outline
• Queensland context
• Wider context
• Crucial questions and observations
Challenges for the Healthcare system
Health Reform in Queensland
Blueprint for better healthcare in Queensland
released by the Queensland Government in February 2013
Government Objectives:
1. Health services focussed on patients and people
2. Empowering the community and our health workforce
3. Providing Queenslanders with value in health services
4. Investing, innovating and planning for the future
Empower people
Lead, empower and trust
Play to everyone’s strengths
Develop yourself and those around you
Customers First
Know your customers
Deliver what matters
Make decisions with
empathy
Ideas into Action
Challenge the norm and
suggest solutions
Encourage and embrace
new ideas
Work across boundaries
Unleash Potential
Expect greatness
Lead and set clear expectations
Seek, provide and act on
feedback
Be Courageous
Own your actions,
successes and
mistakes
Take calculated risks
Act with
transparency
Five Whole of Queensland
Government Values
– informing how we practice
Queensland’s health budget:
The Queensland Government will spend $12.3 billion
on health in 2013-14
• This is a 3.9 per cent ($464.3 million) increase on the
2012-13 health budget
• The major component of the budget is employee
expenses
• In 2011-12, employee expenses were $7.3 billion (64.51
per cent of total expenditure)
• In 2011-12, the total expense for the nursing workforce
was approx. $2.64 billion (36% of employee expenses)
Nursing Workforce
As at 30 June, 2013:
• 66,795 nurses and midwives were employed in
Queensland
• 49% employed in the public sector
• The Queensland Health nursing workforce comprises:
42% of the entire workforce
61% of the clinical workforce
• Registered nurses equate to
83% of the nursing workforce
(including nurse practitioners)
Nurse Practitioners
in Queensland
• Queensland currently has the
largest number of NP in
Australia
• 274 NP as at December 2013
• Almost 50 NP working in
private and self employed
models, in areas including
primary care, rural and
remote, aged care and
chronic disease.
• Greater growth in private and
self employed models in Qld
compared to public sector
models in past 2 years
• By having nurse
practitioners as part of
Queensland public and
private health services
we are challenging the
status quo, promoting
new options and
embracing reform to
ensure our communities
have safe, accessible
and timely health care
Strengthening health services through
optimising nursing
Five Strategies:
1. Enable nurses to work to their full scope of practice across all
settings.
2. Expand the delivery of nursing services in a range of settings
to increase service capacity and consumer choice.
3. Optimise the influence of nursing, improving quality and value
for money in health services.
4. Support high-performing nursing services through continual
learning and evidenced-based practice.
5. Support nursing services to enhance patient outcomes
through information systems and decision making tools.
Nursing and Midwifery Office, Queensland (2013)
Optimising the contribution of the
registered nurse to healthcare
Nursing and Midwifery Office, Queensland (2013)
1. Enabling nurses to work to their full
scope of practice across all settings
Legislative, regulatory and policy frameworks
to maximise the potential of nursing:
• Remove the barriers to nurse practitioners
practicing to their full scope of practice in
Commonwealth and state legislation
• Expand access to MBS and PBS
• Remove requirement for collaborative
arrangements
• Ensure local policies and procedures support
nursing
1. Enabling nurses to work to their full
scope of practice across all settings
(cont’d….)
A flexible work environment supports efficient and effective
models of patient centered healthcare:
• Expand current provisions enabling access rights to public and
private hospitals for nurse practitioners (admission and
discharge privileges)
• Promote flexible employment opportunities and new ways of
working
• Strengthen the business acumen of nurse practitioners
2. Expand the delivery of nursing services
in a range of settings to increase service
capacity and consumer choice
Increase nurse-led services to reduce
avoidable hospital admissions:
• Expand NP clinics and role of advanced
nurses with NP’s
• Integrated NP clinics (pilot: HF, Renal,
Diabetes- chronic disease)
• Develop sustainable NP models in priority
areas in palliative care, chronic disease,
gastroenterology, aged care, mental health,
primary healthcare
2. Expand the delivery of nursing services in a
range of settings to increase service
capacity and consumer choice (cont’d…)
Increases nurse-led services, improves access to
diagnostic and therapeutic procedures:
• NP in gastroenterology, primary healthcare,
mental health
• Nurse-led triage models to streamline referral
pathways
3. Optimise the influence of nursing,
improving the quality and value for
money in health services
Access to the healthcare system and
outcomes are improved through
strengthening nursing governance and
leadership:
• Disseminating evidence
• Networking
• Building relationships
• Strategic leadership
4. Support high-performing nursing services
through continual learning and evidenced-
based practice
The public have confidence in appropriately
qualified and authorised nurses providing their
care:
• Setting expectations and leading from the front
• Mandatory post graduate qualifications
• Facilitate education responsiveness
• Culture of research
5. Support nursing services to enhance
patient outcomes through information
systems and decision making tools
Quality of care is improved through nursing-
focussed targets and indicators:
• Appropriate information and communication
technology systems
• Nursing-focussed targets and indicators
• Owning and leading nursing data and
interpretation
State wide
Nursing Scorecard
• Nursing as percentage of total workforce
• Nursing skill mix
• RN skill mix
• Internal-external
Skill
Mix
• Age profile
• Graduate profile
• Workcover and leave over limit
• Leave profile S
usta
inab
ilit
y
• EB8 HR measures
• EB8 HR efficiency
• Draft productivity measures. Eg. Nursing cost per WAU
Pro
du
cti
vit
y a
nd
E
ffic
ien
cy
• Blood transfusion incidents
• Medication admin incidents
• Falls
• Pressure Injuries
Qu
ality
HITH Dashboard – Cellulitis W/O CSCC
• 977 referrals into HITH
• Average HITH utilisation 11.80%
• Average in Victoria approx. 90%
All A
BF
F
acilit
ies
•280 referrals into HITH
•Average HITH utilisation 39.60%
•Estimated HITH efficiency for single DRG at this facility totals $470,000 (based on Deloitte modelling)
Sin
gle
Facilit
y
Commission of Audit – progress to date
Nurses (and Nurse Practitioners)
are the key
• Reduce hospital
presentations
• Reduce length of stay
• Reduce duplication of
services
• Improve health outcomes
• Improve patient quality of life
• Improve demand
management
• Improve value for money
and sustainability
• Build research and apply
research into practice
Nurse practitioner -
political reality - why
so few and so much
need?
Thank you,
come work in
Queensland
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