caring for people with cancer: nurses’ professional and
TRANSCRIPT
Caring for people with cancer: Nurses’ professional and
career development needs
Denise Bryant-Lukosius, Mary Jane Esplen, Esther Green, Grace Bradish, Tazim Virani, Diana Morarescu
CANO 2010 Conference – Edmonton, AB
ObjectivesObjectives Highlight the objectives and methods of a provincial
assessment of nurses’ professional development needs in cancer control.
Highlight the critical role of stakeholders for conducting an effective needs assessment.
Summarize key findings/recommendations for meeting the professional development needs of generalist and specialized nurses who provide cancer care.
Introduce new resources in the expanded Oncology Nursing e-Mentorship Program
Ontario Oncology APNs had identified significant need for mentorship and role development support: – A survey of community of practice (APN-COP) members– Needs assessment studies & Cancer Care Ontario
Consensus meetings (Bryant-Lukosius et al., 2007; CCO 2006 & 2008)
• Led by the Mentorship Sub-Committee of the APN-COP an e-Mentorship Program was established and evaluated in 2008 with the aid of funding from the MoHLTC.
BackgroundBackground
Oncology APN –Mentorship Oncology APN –Mentorship Program Evaluation ResultsProgram Evaluation Results
Modest investments in mentorship over 2 months had significant impact – Improved mentorship knowledge, skills, confidence &
readiness– Improved APN intra/interprofessional collaboration– Improved APN skills & activities related to research, EBP
& leadership– Improved APN job satisfaction: time & professional, social
community interaction
ImplicationsImplications A formalized program with structured education
components & access to support prepares participants for mentorship & promotes their transition through mentorship stages
An e-based approach increases access to APN mentors & is appropriate, feasible & acceptable
Interprofessional mentorship was appropriate & acceptable & increases APN access to mentors
Program Expansion Fall 2008Program Expansion Fall 2008
New program partner with long-term funding to 2013 Expansion to include services for all nurses who care for adult/pediatric
populations at risk for or affected by cancer in Ontario
Provincial Needs AssessmentProvincial Needs AssessmentPurpose To identify the professional development needs of
generalist and specialized oncology nurses (CANO, 2001) across the cancer continuum in Ontario that may be met through coaching, preceptorship and/or mentorship.
To examine the feasibility of providing such supports and the types of models that may be most appropriate for specific sub-groups of nurses involved in cancer control.
Professional DevelopmentProfessional Development
“The ongoing commitment to ensure that your skills and ability to implement your role in oncology nursing are relevant and up to date.”
Provincial Advisory Committee Provincial Advisory Committee (n= 16)(n= 16)
• Generalist, specialized & advanced RNs• Clinical managers, senior administrators, regional VP• Nurse educators & faculty• Allied health providers, e-learning & technical experts• Researchers, LHIN – health planners, provincial decision-
makers• RNs with adult, pediatric, oncology, palliative, or public
health expertise• Tertiary acute care & community hospitals, community
nursing agencies, home care & primary health care settings• Urban, rural & remote settings
Provincial Advisory CommitteeProvincial Advisory Committee Participated by teleconference/email to:
– Develop needs assessment objectives & research questions– Design data collection plan– Provide feedback on data collection tools – Facilitate recruitment of participants
One day onsite meeting to develop recommendations about program priorities and design of new program
Final teleconference for input on draft report and program plan
Assessing NeedsAssessing Needs Vision/strategies for nursing capacity development in cancer
care within organizations/programs/regions
Clinical priorities for improving patient care through enhanced nursing knowledge and skill
Priorities for nursing competency development
Effectiveness of ways RNs currently address professional development needs
Variability in professional development needs among different types of RN groups across the cancer continuum
Assessing Feasibility & Assessing Feasibility & Implementation IssuesImplementation Issues
RN readiness & preferences for accessing coaching, preceptorship, mentorship services
Availability of existing services & expertise
Potential best practice mentorship models or features
Personal, organizational & health system barriers & facilitators to RN participation
Integration with existing APN program
Methods of Data CollectionMethods of Data CollectionGeneralist & Specialized Oncology Nurses Online survey & telephone focus groups
Key Decision Makers Managers & senior nursing & non-nursing administrators Telephone focus groups & interviews
Supportive Key Informants APNs, faculty & in-house educators, interprofessionals Telephone focus groups & interviews APN mentors also completed online survey
Recruitment StrategiesRecruitment Strategies– Personalized invitation on program letterhead tailored to
specific key informant groups– Reminders & recruitment updates– Scheduled & adhoc/flexible meeting times– Telephone interviews & focus groups
– Program Champions Project team, advisory committee, current program
participants Personal contact, invitation to participate & promote
needs assessment Maximized use of their contacts, networks & list serves
Data Management & AnalysisData Management & Analysis
Interviews & focus groups– Audiotaped & transcribed– Content analysis to identify key themes
Survey– Descriptive statistics: frequency counts,
percentages
ResultsResults Focus Groups
13 teleconference focus groups/interviews 76 participants from various backgrounds
18 APNs 19 RNs/Staff Nurses 22 Managers/Directors/Coordinators 2 Faculty Members 5 Educators 6 Health Promoters/Genetic Counsellors 1 Researcher 3 New Grads - RNs
ResultsResults Electronic survey
– Completed by 619 nurses• Adult & paediatric• Regional Cancer Centres• Tertiary Care• Community Hospitals• Small Town/Rural/Remote• Community/home care• Public health/health promotion• Palliative care/Hospice• Geographic spread
– 79% of participants completed all 34 questions
Demographic Survey DataDemographic Survey Data Nursing profile
– Over 60% were generalists– 62% were diploma prepared– 58% had 20+ years of RN experience– 47% had 10+ years of oncology experience– 42% worked in a community hospital– 82% care for adult patients– 32% had CON (C)
Results – Role Development NeedsResults – Role Development Needs
Identified a broad range of oncology professional development needs
Most frequently reported needs related to:– Assessment & management of disease &
treatment related complications/side effects– Health promotion & cancer prevention– Psychosocial interventions– Palliative care
Results – Role Development NeedsResults – Role Development Needs
Some differences in the frequency of reported needs among various types of nurses:– Those with/without oncology or palliative care certification– Those working in cancer centre, tertiary care hospitals,
community hospitals and the community– Generalist and specialized nurses
Results – Career & Professional Results – Career & Professional Development ExperienceDevelopment Experience
28% had engaged in a formal career planning process
51% had a professional development plan
Professional Development Professional Development Facilitators Facilitators (n=619)(n=619)
Top 5 most frequently reported – Personal motivation (49%)– Internet & e-learning (45%)– Management support (38%)– Local access to programs (35%)– Funding (35%)
Professional Development Professional Development Barriers Barriers (n=619)(n=619)
Top 5 most frequently reported– Lack of funding (43%)– Not able to get time off work (41%)– Staff shortages (40%)– Lack of skilled replacement staff (22%)– Lack of organizational support (18%)
Service Delivery PreferencesService Delivery Preferences Intra (38%) versus interprofessional (20%) or
distance mentorship (19%)
Traditional, step ahead or peer nurse mentor from one’s own organization vs outside of organization
No difference in willingness to participate in coaching, preceptorship or mentorship
Support Needs for Participating in Support Needs for Participating in Professional Development ActivitiesProfessional Development Activities
Top 5 most frequently reported (n= 619): Resources to increase knowledge about effective
coaching, preceptorship, mentorship (51%) Practical tools (50%) Identifying a suitable coach, mentor, preceptor (48%) Release time from work (43%) Facilitate supervisor/employer support (39%)
Interview/Focus Group Interview/Focus Group Results - PrioritiesResults - Priorities
All stages of the cancer continuum were identified as having need for enhanced nursing roles & professional development
Priority nursing groups included those providing cancer care:– In patient homes or in the community– Rural, remote or isolated setting– Variable nurse education & experience in oncology or
palliative care– Lack of oncology resources & role development supports– Lack of nurse awareness of available resources– High patient volumes & complex care needs
Interview/Focus Group Interview/Focus Group Results - FacilitatorsResults - Facilitators
Management support Funding Telephone access for quick support needs Technology Personal motivation Local champions On-site mentors APNs & educators Networks and communities of practice Existing educational, preceptorship, fellowship resources
Interview/Focus Group Interview/Focus Group Results - BarriersResults - Barriers
Nurse fatigue & high workloads Lack of funding/financial constraints Lack of replacement staff for release time Lack of role clarity re innovative nursing roles Lack of awareness of professional development needs/gaps
among nurses and decision-makers Lack of appropriate self-assessments Lack of administrator awareness of the benefits of mentorship
and professional development for nurses Technology Lack of consistency in the offerings
Interview/Focus Group Interview/Focus Group Key FindingsKey Findings
Some confusion/lack of understanding among participants about the differences between education, coaching, preceptoring and mentorship needs and activities
Nurses had limited exposure to career planning and development support
Perceived professional practice and mentorship needs not identified within the context of planning and developing their career in nursing
ConclusionsConclusions Study strengths
– High response rate & participation of generalist, specialized and advanced practice nurses
– Breadth of practice settings and scope of cancer continuum represented by participants
– Completeness of survey data and richness of qualitative data
Study Limitations– Unable to assess geographic/regional differences– Under-representation of oncology nurse educators,
managers and researchers as targets for program services– Confusion about education vs mentorship needs
ConclusionsConclusions Engagement of Steering Committee was an
asset for:– Enabling the depth/breadth of recruitment to both
qualitative and quantitative components over a very short period of time (6 weeks)
– Ensuring the relevance of collected data– Formulating recommendations– Building ongoing program participation and support
among committee members
Steering Committee RecommendationsSteering Committee Recommendations Need to education/prepare nurse mentees and mentors for
effective mentorship
Mentorship needs to be put into context with other career planning and professional development activities
High need/interest in mentorship among nurses in various roles across patient populations, practice settings and the cancer continuum
High priority to support generalist & specialized nurses with limited access to oncology expertise and resources: Small community hospitals, community & home care Isolated & rural communities
Steering Committee RecommendationsSteering Committee Recommendations
Service preferences: Flexibility Peers, step ahead mentors and traditional mentors
in the same organization Structured resources and activities Full day sessions on a weekday Distance mentoring would work for some with
appropriate supports
Steering Committee RecommendationsSteering Committee Recommendations A systems approach to leverage on key stakeholders at
different levels in the system will be required to address barriers to nurse participation in the program
Consider mentor organizations – create partnerships between organizations – inter-organizational learning
Incentives – provide mid-career nurses educational opportunities and have them mentor novice nurses
Personal motivation is a key facilitator – creating readiness is therefore an important area of activity
Setting the Context: Developing Setting the Context: Developing Your Career in Oncology NursingYour Career in Oncology Nursing
Professional Development in Oncology Nursing
Career Planning and Development in Oncology Nursing
Mentoring
PreceptoringCoaching
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Enhanced Services & ResourcesEnhanced Services & Resources Confidential, electronic application process for generalist,
specialized & advanced practice nurses
Electronic, personalized screening & matching process with program support
1-day Mentorship Orientation Workshop
Mentorship Workbook
e-based platform & resources
Stipends for distance mentorship & mentor training
New FeaturesNew Features Career Development Workshop
Online Career Development Program
Individual and group coaching and career counselling
Resume Writing Workshop
New interactive website Private and group discussion forms A wiki space Coaching & preceptorship resources
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Career Development WorkshopCareer Development Workshop
“I was able to realize that I need to further my education in order to fulfill my
role more efficiently.”
“I networked with colleagues and got
tips to move forward in small manageable
steps.”
“Great session to determine my
vision and provided me with
clear plan to achieve my
goals.”
