Department of Health

Victorian Nurse Practitioner ProjectVictorian Nurse Practitioner Project

Katy FieldingManager, Nurse Workforce Policy & Programs, Nurse Policy

Mental Health NP Collaborative 10 December 2009

What is a NP?What is a NP?

New capacity for existing health worker –not a new role or a new worker.

We want to create environments were all nurses are enabled, encouraged and expected to have responsive, dynamic practice that evolves in response to clients needs.

There are opportunities for all divisions and practice levels emerging constantly.

NPs are one possible part of a comprehensive workforce strategy

What is a NP? What is a NP? The NP is a clinical role. The majority of NP clinical

work must be in providing direct services to clients/patients (rather than consultancy, education, support etc).

NPs:• Autonomous, collaborative practice• Manage an episode of care

• Order a test Vs order the right test, interpret the result and decide on the right treatment

• Initiating a protocol Vs Differential diagnosis

NP roles -where are we?NP roles -where are we?• The end of the first decade • First 5 years preparing the ground, • next 5 sowing the seeds, now…..

• 450 nationally, >50 in Victoria• Over 110 are “emergency”• National agreement about education & standards• In Victoria, “100%” employment, portability of prescribing

authority, partnership between NPC & employer, processes that are compatible with the employers governance structures.

NP progress in VictoriaNP progress in VictoriaThe fundamentals are in place in Victoria:

– Demonstration projects – positive evaluations– Legislative framework (DPCS, protected title) – EBA – (Grade 6)– NBV endorsement process – Masters education programs– VNPP $ to assist/stimulate in priority areas

Health services now need to champion the change where they see the need/value.

Victorian Nurse Practitioner Project Victorian Nurse Practitioner Project (VNPP)(VNPP)

Phase 4 – Integration & Sustainability

Package of VNPP funding in targeted areas for: • One off funding for health services to identify &

implement a service model (change management)

• NP Candidate Support Packages• NP scholarships• Publication grants • Collaborative/CoP

VNPP currently supports:VNPP currently supports:

• Stroke care (9 health services)• Renal care (7 sites)• Palliative care (12 metro sites & 5 regional

models)• Oncology (6 services) • Mental health, Alcohol and drug services

(10 services) and

Sites may have multiple candidates

NP Models in Round 4.6 NP Models in Round 4.6 (n=10 services)(n=10 services)

Austin Health within the Acute Adult Psychiatric Unit

Alfred Health within Caulfield Aged Psychiatry Service

Eastern Health role to support the ED, psychiatric triage service & CATT

Forensicare to provide enhanced specialist services to those in justice system

Latrobe Health Service – clients within the emergency department

Melbourne Health Emergency CATT role, Youth Mental Health NP & Drug/ Alcohol NP

Mercy Health between the Consultation and Partnership (CAP) team and EDs at Western and Werribee

Northeast Health - young people's early psychosis group

Southern Health - Eating Disorders & Dual Diagnosis NP

Western Health- (DASWest) supporting clients across acute care & community services including community withdrawal units.

NP Models in Round 4.6NP Models in Round 4.6

Funding is to support the establishment of a NP model for the service including:

• role implementation activities ($37,000)

• appointment of at least one NPC (NPC support package $8,000 and $10,000 for second)

• First offer was oversubscribed• Good quality of applications• Second call for applications for MH & AD models

and candidates will be in 2010-11

Phase 4 Priorities for NPPhase 4 Priorities for NP

NP priorities based on local service planning & workforce data

Rolling priorities to establish critical mass

in key areas

Stroke care – Stroke Care StrategyRenal - Revised Renal Service modelMHD - Mental Health Act reviewPalliative Care & Oncology – Cancer Action Plan

VNPPHealth Services

Key dates:Key dates:

Successful sites notified by email by 28 September 2009

Industry Briefing in October 2009.

• Successful sites commence work by end of October 2009.

• Processes to appoint first NPC commenced by March 2010.

• Description of service model by February 2010 – 4 pages!

• NP Service Model’s 5 year plan by April 2010 – 1 page!

• Confirmation of NPC appointments & NPC logbook of supervision (log book 6 monthly)

• Budget acquittal (model dev. Funds) no later than April 2010

• Differentiate NP from other (advanced) roles

• Role underpinned by measurable competencies

• SoP opportunities under MH Act review

• PBS & MBS access• Implementation Guide • Cohort of NPs in MH• Dialogue with other groups• Support for candidacy

Guidelines: Scope of nursing & midwifery practiceGuidelines: Scope of nursing & midwifery practice

www.nbv.org.au

CollaborativeCollaborative

• To work together, esp. in some literary, artistic, or scientific undertaking

• Team up

• Cooperate

Informal support network for NPCs and NP (or those interested in becoming a NPC/PN):

– Support for NP candidates/NPs – Support for the supporters– Share knowledge, skills and resources– Learn & practice leadership skills – Identify strategies to build success (individual,

organisation and system levels)– Advise DH & others (eg clinical networks) on issues

impacting on role implementation

CoP/Collaboratives Purpose

….of the NPs, by the NPs, for the NPs!

Why a collaborative/CoP?Why a collaborative/CoP?

• Learning from past – ED models• Long journey• New models – pioneer roles• Single practitioner models• Understanding of role variable• In nursing narratives, validation and authentic

conversations are valued

If it hadn’t have been for it [emergency

collaborative], I wouldn’t be endorsed today!

Victorian NP, 2008

DH supported NP collaboratives/CoPDH supported NP collaboratives/CoPOncology Community of

PracticeSouthern Health

MH & AD NP CollaborativeAustin and NE Health -Wangaratta

Stroke care NP CollaborativeLeanne Turner – Austin Health(03) 9496 5056leanne.turner@austin.org.au

Renal care NP CollaborativeElizabeth Morley – Bendigo Health(03) 5454 6428EMorley@bendigohealth.org.au

Palliative care NP Collaborativewww.pallcare.unimelb.edu.aucpcpa@medstv.unimelb.edu.au

Victorian Emergency NP CollaborativeTash Jennings- Alfred HealthN.Jennings@alfred.org.au

What might be activities for the What might be activities for the collaborative/CoP?collaborative/CoP?

• Contacts list• Sister sites/networks • Preferred ways of connecting (face to face, teleconferences,

website, list server, etc) – that reflect membership needs– rural, out of hours

• Develop guiding principles/values/ways of engaging • Learning needs analysis (clinical and other eg change

management, NBV processes, oral presentation skills, media skills, etc)

• Share resources• Learn about the system beyond your organisation• Social, debrief, celebration and support• Work with other Collaboratives/CoP• Others…..

Along the way, remember….Along the way, remember….• Role of Collaborative will change & evolve

• Value diversity of service provision/organisations – no “one” model for NPs in a specialty

• NP roles need to improve care and fill gaps in service delivery, not simply add another member to the team

• Investment for the long term (not projects/pilots)

• Scope of any/all practitioners is not fixed– dynamic role, change is inevitable

• Push boundaries - facilitation Vs permission seeking

• National Registration Scheme

• Commonwealth/State relations – esp. in health arena

• Other role redesign initiatives are all around

Candidates/potential candidates!Candidates/potential candidates!NBV NP Information day• 12 February 2010• Registration required. Pre-reading: NBV

fact sheets (www.nbv.org.au)

***Equivalence assessment by NBV pre June 2010***

mthomas@nbv.org.au

Nursing in VictoriaNursing in Victoria

www.health.vic.gov.au/nursing

katy.fielding@dhs.vic.gov.au

www.health.vic.gov.auwww.health.vic.gov.auNP Implementation guide & resources