Adopting a State-Wide Approach to

Palliative Care Nurse Practitioner

Development in South Australia

Karen Glaetzer Palliative Care Nurse Practitioner

Heather Broadbent Palliative Care Nurse Practitioner

Southern Adelaide Palliative Services

Flinders University

SA Health

SA Health Palliative Care Plan

2009-2016

Recognised the need for Nurse

Practitioners as a workforce strategy

Proposed up to 20 Palliative Care NP’s

working across SA by 2016

SA Health

Process

Nurse Practitioner Sub-Committee

established under Palliative Care

Clinical Network

Membership included representation

from SA Health, University Sector,

Specialist Palliative Care Services,

Senior Nursing, Service Directors

SA Health

Terms of Reference

NP Sub-Committee

Ensure consistency

Outcomes link with and contribute to the implementation

of the palliative care service plan and the goals of the

palliative care clinical network

Develop and clearly articulate a training pathway

Integrate the Nurse Practitioner into palliative care

service delivery and outcomes informed by evolving

practice and research

Contribute to health professionals and the communities

understanding of the role of the Nurse Practitioner within

the SA Health system

Develop a nurse practitioner workforce development

program

SA Health

Opportunities

COAG Funding to Sub-Acute Services

SA Health Nursing and Midwifery

Scholarships

State Government commitment to

establishing 100 NP positions with

palliative care recognised as priority area

SA Health

Achievements

Training pathway developed

Advisory panel established

NP Chair

Psychosocial Representative

Palliative Medicine Consultant

Nursing Director

3 initial Candidates appointed in each

Metropolitan Palliative Care Service in

August 2010

Palliative Care NP Pathway

1. ACCEPTED INTO A NURSE PRACITIONER CANDIDACY IN A LEVEL 6 PALLIATIVE CARE

SERVICE.

2. AT ENTRY:

THREE YEARS OF STUDY

ELECTIVE

4. INFRASTRUCTURE

SUPPORT

RESEARCH

PROJECT

5. ADVISORY PANEL ESTABLISHMENT OF A

PLAN

9

COMMUNITY

INPATIENT

CONSULTATION

LIAISON

10. MINIMUM TW O PLACEMENTS IN OTHER THAN ‘HOME’ LEVEL 6 SERVICE

RURAL

SETTING

7.

COMMUNITY

6.

INPATIENT

8.

LIAISON

3. AT ENTRY: TW O

YEARS OF STUDY

SA Health

First Candidates

SA Health

Positives

Provided structure to training programme

Forced State-wide and Multi-D approach

Consistent training across multiple settings

Academic requirements varied so allowed some

consistency

Assisted candidates to identify learning needs

Guided mentors

SA Health

Positives

Resulted in credibility so influenced service

commitment to the roles

Model adopted by other specialties as process

viewed as tangible

Joint fortnightly tutorials with Oncology NPC’s

Resulted in interstate collaboration

Nurse Advisor to Victorian Collaborative

Shared Competencies

SA Health

Pitfalls

Misunderstanding about advisory panel role

Lack of engagement by some candidates

Variable understanding of the expectations

Confusing around governance responsibilities

Panel unable to mandate only recommend

Resignation of one candidate after 18 months

Personal Reasons

Local Health Networks variable supervision and

support to the roles

SA Health

2014

2 endorsed candidates from first cohort

1 has accepted role in renal

4 current candidates

1 has recently moved to country Victoria

1 has submitted for endorsement

3 candidates appointed in Country SA

1 endorsed in Aged Care/Palliative Care

Mentoring extended to 2 Oncology candidates

SA Health

2014

COAG not refunded

Succession planning stalled

Palliative Care Clinical Network Workforce sub-

committee put on mothballs

NP sub-committee reconvened in late 2013

Advisory Panel re-established with State-wide role

Consistent scope of practice and P-list with local

variations allowable

SA Health

Holding on… for dear life

State level

The organization

Mentorship

NPC as an individual

Across the spectrum

The organization:

Southern Adelaide Palliative Service

Metropolitan specialist palliative service

2012-13

1415 referrals, 470 current patients

age: 84% > 61 years, 14% 41-60 years

site of care : 76% in own homes at referral

diagnosis

The organization

> Multi-disciplinary

> Demonstrated commitment

Provide contemporary best practice by

utilising a team that is made up of advance

practice clinicians*

*SAPS Mission statement

The mentorship offered

> Qualities

• Availability

• Preparedness

• Willingness to commit

• Aspirational

• Personal philosophy

The NPC as an individual

> Robust

> Resilient

> Humble

Novice

Advanced beginner

Competent

Proficient

Expert Novice

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park,

CA: Addison-Wesley.

The importance of a framework

for the NPC experience

> Diversity of settings offered

• Outpatient clinic with Palliative Medicine Consultant

• Introductory clinics: Nurse–led

• Consultant liaison

• Inpatient unit

• Community

• Rural/peri-urban

> Accountability and reporting

> Encouragement, negotiating clinical experience

Identifying the gaps

> Where can I have the greatest impact?

> What are the needs of my service /

patient cohort?

> What key partnerships should I look to

develop or nurture?

> Linking to my interests and strengths

SA Health

Key linkages

> Disability sector, Aged care

> Ambulatory care in x 2 GP Plus centres

> Motor Neurone Disease related groups

> Mental health services in southern

Adelaide

> ECP’s

> Other NPs and NPCs

SA Health

Looking ahead

> the revolutionary notion that the practice

itself could and should inform theory

Role description