Oncology Advanced Practice Nurse...

Label Version ix 07/29/2005 Page

1

Oncology APN Questionnaire

Includes:

Oncology APN Questionnaire

Information and Instructions

Pilot Review Form

Reviewer Feedback Form


2

ONCOLOGY ADVANCED PRACTICE NURSE (APN) QUESTIONNAIRE

SECTION I - ADVANCED PRACTICE NURSE CHARACTERISTICS

In this section, we are interested in learning about your education and work experience.

1. What is your educational background? (Check all COMPLETED programs)

1 Nursing Diploma 7 Oncology Nursing Certificate Program

2 B.Sc.N 8 Palliative Care Certificate Program

3 Baccalaureate (other than nursing) 9 Community (Adult/Family/Maternal Child) or

Primary Health Care Nurse Practitioner Program

4 Master of Nursing 10 Specialty or Acute Care Nurse Practitioner

Program

5 Master of __________________ (specify) 11 Other: ____________________________(specify)

6 PhD

2. a. Are you currently enrolled in an education program? (Check one only)

1 No 2 Yes

b. If yes, in what type of educational program are you currently enrolled? (Check all that apply)

1 Nursing Diploma 7 Oncology Nursing Certificate Program

2 B.Sc.N 8 Palliative Care Certificate Program

3 Baccalaureate (other than nursing) 9 Community (Adult/Family/Maternal Child) or

Primary Health Care Nurse Practitioner

4 Master of Nursing 10 Specialty or Acute Care Nurse Practitioner

Program

5 Master of __________________ (specify) 11 Other (specify): _________________________

6 PhD

3. a. Do you have current certification in oncology nursing? (Check one only)

1 No 2 Yes

b. If yes, what type of oncology nursing certification have you achieved? (Check all that apply)

1 Basic Certification (Canadian Nurses Association, CONC)

2 Basic Certification (Oncology Nursing Society, OCN)

3 Advanced Certification (Oncology Nursing Society, AOCN)

4 Other (specify) __________________________________________________________________

Continue……


3

4. What type of nursing license do you hold? (Check all that apply)

1 Certificate of Competence

2 Extended Class License

3 Other ______________________(specify)

5. How many years in total have you practiced as a registered nurse? _______ years

6. How many years in total have you worked as a registered nurse in oncology? _______ years

7. Prior to your most recent position, how many years in total did you work in an APN role?

_______ years

8. How many months have you worked in your current oncology APN role? ________months

9. a) What is your age? _______ years

b) What is your gender? 1 Female 2 Male

10. Questions 10a to 10d consider the impact of your educational preparation and work experience on

your APN role. Check the one BEST answer for each question below. Not At All

Prepared

Somewhat

Prepared

Prepared Very

Prepared

Extremely

Prepared

a) At the time you were FIRST hired for your current APN

role, how well had your APN education PREPARED you

for this role?

0 1 2 3 4

b) In general, how well has your PREVIOUS WORK

EXPERIENCE as a registered nurse PREPARED you for

your current APN role?

0 1 2 3 4

c) At the time you were FIRST hired for your current role,

how CONFIDENT did you feel in these aspects of APN

roles:

Not At All

Confident

Somewhat

Confident

Confident Very

Confident

Extremely

Confident

1) Knowledge about patient health problems 0 1 2 3 4

2) Health assessment & diagnostic skills 0 1 2 3 4

3) Performing technical skills or procedures (e.g., management

of CV access devises, insertion of NG tube, bone marrow

biopsy, thoracentesis, lumbar punctures)

0 1 2 3 4

4) Knowledge about medical interventions 0 1 2 3 4

5) Knowledge about nursing interventions 0 1 2 3 4

6)Knowledge about supportive care interventions 0 1 2 3 4

7) Collaborative practice skills (working with other providers) 0 1 2 3 4

8) Level of autonomy and independent practice 0 1 2 3 4

9) Teaching skills 0 1 2 3 4


4 Not At All

Prepared

Somewhat

Prepared

Prepared Very

Prepared

Extremely

Prepared

10) Evidence-based practice skills 0 1 2 3 4

11) Research skills 0 1 2 3 4

12) Organizational leadership & change management skills 0 1 2 3 4

13) Professional development & leadership skills 0 1 2 3 4

14) Managing interdisciplinary & work place conflicts 0 1 2 3 4

15) Time management and setting role priorities 0 1 2 3 4

16) Other(specify)____________________________________ 0 1 2 3 4

d) NOW that you have been in your role for some time,

how confident do you feel in these aspects of APN roles:

Not At All

Confident

Somewhat

Confident

Confident Very

Confident

Extremely

Confident

1) Knowledge about patient health problems 0 1 2 3 4

2) Health assessment & diagnostic skills 0 1 2 3 4

3) Performing technical skills or procedures (e.g., management

of CV access devises, insertion of NG tube, bone marrow

biopsy, thoracentesis, lumbar punctures)

0 1 2 3 4

4) Knowledge about medical interventions 0 1 2 3 4

5) Knowledge about nursing care interventions 0 1 2 3 4

6) Knowledge about supportive care interventions 0 1 2 3 4

7) Collaborative practice skills (working with other providers) 0 1 2 3 4

8) Level of autonomy and independent practice 0 1 2 3 4

9) Teaching skills 0 1 2 3 4

10) Evidence-based practice skills 0 1 2 3 4

11) Research skills 0 1 2 3 4

12) Organizational leadership & change management skills 0 1 2 3 4

13) Professional development & leadership skills 0 1 2 3 4

14) Managing interdisciplinary & work place conflicts 0 1 2 3 4

15) Time management and setting role priorities 0 1 2 3 4

16) Other(specify)____________________________________ 0 1 2 3 4

Continue……..


5

11 At the time you were FIRST HIRED for your current APN role, which of the following strategies ould

have been helpful for improving your INITIAL APN educational preparation for the role? (Check all that

apply)

1) Completing a Masters level nursing program 6) Access to faculty with oncology expertise

2) Oncology nursing courses at the Masters level 7) Internship or Fellowship programs

3) Research practicum 8) Mentorship from Masters prepared oncology nurse

4) Leadership practicum (e.g. project management, 9) Mentorship from oncology physician

organizational development skills)

5) Longer clinical practicum 10) Post Masters preparation (e.g. ACNP, NP, research)

11) Other (describe)__________________________

12 Which of the following strategies would be helpful NOW for improving your CONTINUED educational

preparation for the role? (Check all that apply)

1) Completing a Masters level nursing program 7) Continuing education courses or programs

2) Oncology nursing courses at the Masters level 8) Internship or Fellowship programs

3) Research practicum 9) Mentorship from Masters prepared oncology nurse

4) Leadership practicum 10) Mentorship from oncology physician

5) Longer clinical practicum 11) Other (describe)__________________________________

6) Access to faculty with oncology expertise

13. The scale below illustrates the potential range of practice philosophies. Medical practice is focused on the

diagnosis and treatment of cancer and cancer treatment-related complications. Nursing practice is focused on the

diagnosis and treatment of actual and potential health needs related to cancer.

Using this scale, place an X on the line at a point that BEST describes your practice philosophy.

____________________________________________________________

Continue………

SECTION II - CHARACTERISTICS OF PATIENTS RELATED TO YOUR CLINICAL ROLE


6

In this section we are interested in learning about the patients who are the focus of your clinical role.

14. In terms of your clinical role, what percentage (estimate) of time do you spend with patients at these

stages of the cancer continuum?

1) Prevention _____%

2) Screening (2a) General Cancer Screening _____%

(2b) Genetic Screening & Counselling _____%

3) Diagnosis _____%

4) Initial Treatment _____%

5) Post Treatment Follow-up/Survivorship _____%

6) Treatment for Recurrence _____%

7) Palliation _____%

8) Bereavement _____%

Total = 100%

15. What percentages (estimate) of patients in your clinical practice are male or female?

1) Male _____%

2) Female _____%

Total = 100%

16. What percentages (estimate) of patients in your clinical practice are in the following age groups?

1) birth to less than 5 years _____%

2) 5 to 11 years _____%

3) 12 to 17 years _____%

4) 18 to 39 years _____%

5) 40 to 65 years _____%

6) Over 65 years _____%

Total = 100%

17. What percentages (estimate) of patients in your clinical practice have the following stages of cancer?

1) Pre-cancer _____%

2) Stage 1 to Stage 2 (Early stage, localized or low grade disease) _____%

3) Stage 3 (Early stage, locally advanced, or intermediate or high grade disease) _____%

4) Stage 4 (Metastatic disease) _____%

Total = 100%

Continue………


7

18. What percentages (estimate) of patients in your clinical practice have the following types of cancer?

1) Breast _____%

2) Lung _____%

3) Gastrointestinal _____%

4) Genitourinary _____%

5) Gynecological _____%

6) Haematological _____%

7) Neurological _____%

8) Skin _____%

9) Head and Neck _____%

10) Sarcoma _____%

11) Melanoma _____%

12) Other______________ _____%

(specify)

19. What percentages (estimate) of patients in your clinical practice receive the following cancer treatments?

1) Systemic _____%

2) Radiation _____%

3) Concurrent Therapy _____%

(Specific treatment protocols that involve concurrent systemic and radiation therapy)

4) Surgery _____%

5) Other ________________________________ _____%

(describe)

20. Rank the estimated FREQUENCY of the following health needs experienced by patients in your clinical

practice at the time of YOUR FIRST CONTACT.

Rank each item from 1 to 10. (1 = MOST frequent health needs, 10 = LEAST frequent health needs)

ONLY USE EACH RANKING NUMBER ONCE. (i.e. only one health need can have a rank of 1)

Rank ( 1 = MOST frequent health needs to 10 = LEAST frequent health needs)

a) Pain Management _______

b) Symptom Management _______

c) Psychological Support _______ (e.g. for mental health problems such as anxiety or depression)

Continue……..

d) Emotional Support _______

(e.g., need for supports related to coping with cancer)


8

e) Practical Assistance _______ (e.g. finances, transportation, equipment, home care, child care)

f) Family Support _______

g) Informational _______

h) Nutritional _______

i) Spiritual/Psychosocial _______ (e.g., faith, life meaning, self-esteem, body image)

j) Physical Care Needs _______

k) Other _______________________ _______

(describe)

21. Overall, how well do you feel that patients in your clinical practice have ACCEPTED your APN role?

1

Not

Accepted

At All

2

Poorly

Accepted 3

Somewhat

Accepted 4

Well

Accepted 5

Very Well

Accepted 6

Extremely

Well

Accepted

SECTION III - APN ROLE CHARACTERISTICS AND ACTIVITIES

In this section we are interested in learning about the setting in which you work and your perceptions

regarding specific aspects of your APN role and role activities.

22 What type of agency is your primary employer? (Check one only)

1) Cancer Centre

2) Tertiary Care Hospital

3) Community Hospital

4) Community Agency

5) Other (describe)__________________________________

23. In which type of health care setting(s) do you work? (Check all that apply)

1) Cancer Centre

2) Hospital Inpatient Unit

3) Hospital Outpatient or Ambulatory Care Unit

4) Community Agency

5) Patients’ Homes

6) Other (Specify)__________________________________

24. What type of position is your role? (Check one only)


9

1) Full-time

2) Part-time

25. What is the title of your role? _____________________________________________________________

26. How WELL is your role DEFINED? (Check one only)

1

Not Well

Defined

At All

2

Poorly

Defined 3

Somewhat

Well Defined 4

Well

Defined 5

Very Well

Defined 6

Extremely

Well

Defined

27. a) Do you have a written position description SPECIFIC to your APN role? (Check one only)

1 No If no, skip questions b to d and move on to question #25

2 Yes

3 Not Sure

28. What is the primary PURPOSE of your APN role? (Describe)

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

29. a) Are you expected to achieve specific GOALS or OUTCOMES related to your role? (Check one)

1 No

2 Yes

3 Not Sure

b) If yes, list all of the goals or outcomes expected from your role.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Continue……..

30. On an average weekly basis, what percentage of work time do you spend in each of the following

components of an APN role?


10

Percentage of Time

a) Direct Clinical Care _________________ %

b) Education _________________ %

c) Research _________________ %

d) Organizational Leadership _________________ %

e) Scholarly/Professional Development _________________ %

Total = 100%

31. What is the average number of patients you see each day? _______Patients Per Day

32. a) Do you work overtime hours on a regular basis?

1 No If no, proceed to question #30

2 Yes If yes, answer questions b & c

b) If yes, on average, how many hours per week do you work overtime?

_______ Overtime Hours Per Week

33. How do you FIRST become involved in a patient’s care? (Check all that apply)

1) I see patients during their scheduled appointments to see the physician

2) Patients are referred directly to me by a physician at the cancer centre

3) Patients are referred directly to me by health care team members at the cancer centre

4) Patients are referred directly to me by hospital health care providers

5) Patients are referred directly to me by community health care providers

6) Patients can refer themselves directly to me

7) Other _________________________________________________________________(describe)

34. How do you provide ONGOING care to patients following initial contact? (Check all that apply)

1) I see patients during their scheduled appointments to see the physician

2) I have separate clinic time in which patients have scheduled appointments to see me

3) I provide telephone advice and support for patients and families

4) I make home visits

5) I see patients in hospital

6) I provide consultation for health care providers directly involved in the patient’s care

7) Other ________________________________________________________________(describe)

35. For what estimated percentage of your patients are you the PRIMARY PROVIDER of cancer care?


11

_______%

36. In your clinical practice, what is the estimated percentage of patients for whom you are identified as the

primary person responsible for the COORDINATION of their cancer care (e.g. planning, initiating, and

organizing the delivery of health services and communicating relevant patient information among

health care providers).

_______%

37. What estimated percentage of your clinical role time is focused on NURSING INTERVENTIONS in the

following areas?

a) Genetic screening and counselling _____ %

b) Health promotion _____ %

c) Pain management _____ %

d) Symptom management _____ %

e) Patient education _____ %

f) Family education _____ %

g) Individual psychosocial counselling _____ %

h) Family psychosocial counselling _____ %

i) Group support _____ %

j) Bereavement support _____ %

k) Other ____________________________ _____ %

(describe) Total = 100%

38. Rate your level of performance for each of the following APN SCHOLARLY/PROFESSIONAL ROLE

competencies. Check one level of performance that BEST applies to YOU for each ITEM, regardless of whether it is a

routine aspect of your role.

Scholarly/Professional Development Competencies Novice Advanced

Beginner

Competent Proficient Expert

a) Disseminate oncology knowledge, including research findings,

through presentation and/or publication at local, regional, national, and

international levels

1 2 3 4 5

b) Participate in collaborative projects with academic institutions 1 2 3 4 5

c) Maintain university cross-appointment 1 2 3 4 5

d) Engage in continuous reflective practice to increase competency and

professional growth 1 2 3 4 5

e) Participate in continuing educational activities 1 2 3 4 5

f) Participate in professional and specialty nursing organizations 1 2 3 4 5

g) Function in accordance with the legal and ethical guidelines set by the

regulatory body of the profession 1 2 3 4 5

h) Demonstrate an understanding of the legislative and socio/political

issues that influence health care decision-making 1 2 3 4 5

i) Develop strategies to influence health outcomes 1 2 3 4 5

j) Advocate for changes and influence decision-making in health policy

by participating on provincial and/or federal committees 1 2 3 4 5

Continue

39. Rate your level of performance for each of the following APN RESEARCH ROLE competencies. Check one level

of performance that BEST applies to YOU for each ITEM, regardless of whether it is a routine aspect of your role.


12

Research Role Competencies Novice Advanced

Beginner


a) Consistently integrate research into the care of the patient & family 1 2 3 4 5

b) Apply a broad range of theories and relevant research to clinical

practice 1 2 3 4 5

c) Interpret relevant research findings and link findings to clinical practice 1 2 3 4 5

d) Share relevant research findings with health care team members 1 2 3 4 5

e) Identify the need for research to answer questions about patient care 1 2 3 4 5

f) Conduct research relevant to patient care as principal or co-investigator

with other members of the health care team 1 2 3 4 5

g) Participate in the review of research proposals 1 2 3 4 5

h) Participate in the process of grant writing and/or funding applications 1 2 3 4 5

i) Generate proposals and seeks funding for nursing research 1 2 3 4 5

j) Acts as a resource regarding research issues for other nurses 1 2 3 4 5

40. Rate your level of performance for each of the following APN LEADERSHIP ROLE competencies. Check one

level of performance that BEST applies to YOU for each ITEM, regardless of whether it is a routine aspect of your role.

Organizational Leadership Competencies Novice Advanced

Beginner


a) Have a vision for oncology nursing practice and patient care 1 2 3 4 5

b) Implement vision of oncology nursing practice and patient care 1 2 3 4 5

c) Participate in the development of policies, clinical practice guidelines,

and protocols 1 2 3 4 5

d) Enable implementation of best practices in cancer symptom

management 1 2 3 4 5

e) Provide leadership in the development, implementation, and

evaluation of innovative approaches for complex cancer practice issues 1 2 3 4 5

f) Provide leadership on inter/intra disciplinary committees related to

development, implementation, and evaluation of policies and

procedures, education, research, quality initiatives, and clinical practice

1 2 3 4 5

g) Initiate or participate in program development and evaluation leading

to enhanced client outcomes 1 2 3 4 5

h) Facilitate strategic planning and goal setting for programs and/or

departments at all levels of the organization 1 2 3 4 5

i) Mobilize supportive therapies for the individual within the community

when typical resources are not available 1 2 3 4 5

j) Diagnose gaps in the system and network to avoid gaps 1 2 3 4 5

k) Mobilize resources to support the individual in the community where

resources are limited and advocate for resources 1 2 3 4 5

l) Encourage the best use of nurses in delivery of care and help

institutions find the bridge between care components 1 2 3 4 5

m) Dialogue with regulatory bodies to promote the development and

implementation of nursing roles 1 2 3 4 5

n) Facilitate the implementation of new oncology nursing roles 1 2 3 4 5


13

Organizational Leadership Competencies Novice Advanced

Beginner


o) Advocate for advances in the delivery of cancer care services 1 2 3 4 5

41. Rate your level of performance for each of the following APN EDUCATION ROLE competencies. Check one level

of performance that BEST applies to YOU for each ITEM, regardless of whether it is a routine aspect of your role.

Education Role Competencies Novice Advanced

Beginner


a) Identify learning needs of patients 1 2 3 4 5

b) Identify learning needs of nurses & other health care team members 1 2 3 4 5

c) Provide patient education that is based on identified needs 1 2 3 4 5

d) Initiate, plan, coordinate, & conduct continuing education programs

based on identified needs, priorities, & organizational resources 1 2 3 4 5

e) Coach and mentor staff nurses and other members of the health care

team in the development and use of clinical knowledge 1 2 3 4 5

f) Serve as clinical faculty for undergraduate and graduate nurses 1 2 3 4 5

g) Monitor and evaluate outcomes of educational offerings 1 2 3 4 5

h) Document outcomes of educational offerings 1 2 3 4 5

42. Rate your level of performance for each of the following APN CLINICAL ROLE competencies. Check one level

of performance that BEST applies to YOU for each ITEM, regardless of whether it is a routine aspect of you role.

Clinical Role Competencies Novice Advanced

Beginner


a) Use theoretical & empirical knowledge to plan patient care 1 2 3 4 5

b) Use theoretical & empirical knowledge to implement patient care 1 2 3 4 5

c) Develop multiple patient assessment strategies within a holistic cancer

care framework 1 2 3 4 5

d) Use multiple patient assessment strategies within a holistic cancer care

framework 1 2 3 4 5

e) Understand the differences between qualitative & quantitative sources

of data, in ambiguous and complex situations 1 2 3 4 5

f) Draw on experiential and empirical knowledge about the patient

population to anticipate a wide range of patient responses to actual &

potential health problems

1 2 3 4 5

g) Draw on experiential & empirical knowledge about the patient

population to manage a wide range of patient responses to actual &

potential health problems

1 2 3 4 5

h) Use critical thinking and synthesis skills to guide decision-making in

complicated, unpredictable and dynamic situations 1 2 3 4 5

i) Integrate multiple interventions (interpersonal, coaching, teaching,

counselling, technological, diagnostics, pharmacological) to effect patient

health status & quality of life

1 2 3 4 5

j) Co-ordinate the plan of patient care 1 2 3 4 5

k) Mobilize resources to achieve integrated comprehensive health care 1 2 3 4 5

l) Plan care to achieve goals that are mutually established in collaboration

with the patient & family 1 2 3 4 5


14

Clinical Role Competencies Novice Advanced

Beginner


m) Implement care to achieve goals that are mutually established in

collaboration with the patient & family 1 2 3 4 5

n) Effectively communicate & collaborate with the client, family, & health

care team members to achieve optimal patient & family outcomes 1 2 3 4 5

o) Effectively communicate and collaborate with members of the health

care team to achieve optimal outcomes for patient and family 1 2 3 4 5

p) Monitor & evaluate outcomes of assessment, decision-making, &

interventions 1 2 3 4 5

q) Document outcomes of assessment, decision-making, & interventions 1 2 3 4 5

SECTION IV - CHARACTERISTICS OF THE HEALTH CARE TEAM

In this section we are interested in learning about your perceptions and characteristics of health care team

members associated with your APN role.

43. Which ONE of the following items BEST describes your interaction with other health care providers? (Choose one only)

1 I function solely as an independent practitioner and not as a member of any one health care team.

2 I function as a collaborative member within one health care team.

3 I function as a collaborative member within two or more health care teams.

44. a) Which cancer centre health care providers do you interact with on a regular basis

regarding patient care issues? Check all that apply using the boxes on the LEFT side of the table.

b) For those with whom you interact, RATE overall how well YOU FEEL the MAJORITY of them

have ACCEPTED your APN role, using the check boxes on the right side of the table. (N/A=not applicable)

Not

Accepted

At All

Poorly

Accepted

Somewhat

Accepted

Well

Accepted

Very Well

Accepted

Extremely

Well

Accepted

N/A

1) Primary Nurse (PN)0 1 2 3 4 5 6

2) Staff Nurse (other than PN)0 1 2 3 4 5 6

3) Supportive Care Nurse0 1 2 3 4 5 6

4) Advanced Practice Nurse0 1 2 3 4 5 6

5) Resident0 1 2 3 4 5 6

6) Medical & Nursing

Students 0 1 2 3 4 5 6

7) Surgical Oncologist0 1 2 3 4 5 6

8) Radiation Oncologist0 1 2 3 4 5 6

9) Medical Oncologist0 1 2 3 4 5 6

10) Psychiatrist0 1 2 3 4 5 6

11) Clinical Psychologist0 1 2 3 4 5 6

12) Social Worker 0 1 2 3 4 5 6


15

Not

Accepted

At All

Poorly

Accepted

Somewhat

Accepted

Well

Accepted

Very Well

Accepted

Extremely

Well

Accepted

N/A

13) Occupational Therapist0 1 2 3 4 5 6

14) Physiotherapist0 1 2 3 4 5 6

15) General Practitioner in

Oncology 0 1 2 3 4 5 6

16) Dietician 0 1 2 3 4 5 6

17) Radiation Therapist 0 1 2 3 4 5 6

18) Home Care Coordinator 0 1 2 3 4 5 6

19) Palliative Care Physician 0 1 2 3 4 5 6

20) Other_______________ (specify)

0 1 2 3 4 5 6

45. a) Which HOSPITAL and COMMUNITY health care providers do you interact with on a regular basis

regarding patient care issues? Check all that apply using the boxes on the left of the table.

b) RATE overall how well YOU FEEL the MAJORITY of these hospital and community health care

providers have ACCEPTED your APN role, using the check boxes on the right side of the table.

(N/A = not applicable)

Not Accepted

At All

Poorly

Accepted

Somewhat

Accepted

Well

Accepted

Very Well

Accepted

Extremely

Well

Accepted

N/A

1) Family Physicians 0 1 2 3 4 5 6

2) Hospital Nursing Staff0 1 2 3 4 5 6

3) Long-Term Care Providers0 1 2 3 4 5 6

4) Medical Specialists 0 1 2 3 4 5 6

5) Occupational or Physio

Therapists 0 1 2 3 4 5 6

6) Palliative Care Providers 0 1 2 3 4 5 6

7) Emergency Room Providers 0 1 2 3 4 5 6

8) Home Care Providers0 1 2 3 4 5 6

9) Other Advanced Practice

Nurses_________________ (describe)

0 1 2 3 4 5 6

10) Social Workers

11) Other_________________ (describe) 0 1 2 3 4 5 6

Continued.

SECTION V - RELATIONSHIPS WITH PHYSICIANS AND MEDICAL SUPPORT


16

In this section we are interested in learning about your perceptions of your work relationships with

physicians and types of medical support.

46. Which item BEST describes how your clinical role is associated with physicians? (Check one only)

1 I have a joint practice with one physician.

2 I have a joint practice with more than one physician

3 My role is not linked to a physician. Skip questions #47 and #48 and move on to question #49

4 Other ____________________________________________________________________(describe)

47. If your clinical role is associated with one or more physicians, how would you BEST describe the

relationship between your clinical role and the physician(s)? (Choose one only)

1 The physician(s) provide clinical supervision for medical role functions only.

2 I have a written collaborative practice agreement with one or more physicians.

3 I have a verbal collaborative practice agreement with one or more physicians.

4 Other ____________________________________________________________________(describe)

48. OVERALL, how would you describe the QUALITY of your relationships with the majority of

physician(s) associated with your role?

My work relationship with physicians associated

with the role has the following characteristics:

Strongly

Disagree

Disagree

Somewhat

Disagree

Somewhat

Agree

Agree

Strongly

Agree

a) Mutual trust 1 2 3 4 5 6

b) Mutual respect 1 2 3 4 5 6

c) Cooperation 1 2 3 4 5 6

d) My role is perceived by physicians to contribute in

different but equally important ways to patient care

1 2 3 4 5 6

e) Sharing of workload and responsibilities 1 2 3 4 5 6

f) Mutual understanding of each other’s clinical role 1 2 3 4 5 6

g) Clearly defined role autonomy appropriate to one’s

scope of practice

1 2 3 4 5 6

h) Effective communication 1 2 3 4 5 6

i) Frequent opportunities for interaction and

information exchange regarding patient care

1 2 3 4 5 6

j) Effective use of individual expertise for patient care 1 2 3 4 5 6

k) Shared decision-making regarding patient care 1 2 3 4 5 6

49. a) Which of the following supports are in place to enable implementation of the MEDICAL functions


17

of your clinical APN role? Check No or Yes for each item.

b) Then REGARDLESS of whether these supports are in place, RATE how important these supports

ARE or WOULD be for implementing your clinical role.

Clinical Role Supports

(List examples where indicated)

Supports Currently In

Place For Your Role

(Check One Only)

Not

Important

At All

Not Very

Important

Important

Very

Important

Extremely

Important

a) Medical directives for initiating

medication

1 No 2 Yes 1 2 3 4 5

b) Medical directives for titration

of medications

1 No 2 Yes 1 2 3 4 5

c) Medical directives for initiating

diagnostic tests

1 No 2 Yes 1 2 3 4 5

d) Medical directives for initiating

lab tests

1 No 2 Yes 1 2 3 4 5

e) Medical directives for

performing procedures

1 No 2 Yes 1 2 3 4 5

f) Medical directives for initiating

patient referrals

1 No 2 Yes 1 2 3 4 5

g) Clinical Care Pathways

1 No 2 Yes 1 2 3 4 5

h) Practice Guidelines

1 No 2 Yes 1 2 3 4 5

i) Other Organizational Policies

(describe)

1 No 2 Yes 1 2 3 4 5

j) Physician is readily accessible for

clinical consultation.1 No 2 Yes 1 2 3 4 5

k) Physician provides mentorship

for developing medical role

functions

1 No 2 Yes 1 2 3 4 5

l) Other (describe): 1 No 2 Yes 1 2 3 4 5

SECTION V I - CHARACTERISTICS OF ROLE SUPERVISOR(S), REPORTING MECHANISMS, AND

ADMINISTRATIVE SUPPORT

In this section we are interested in learning about the characteristics of role supervisors and reporting

mechanisms and your perceptions of the administrative support for your APN role.

Continued……

50. To whom are you accountable for your CLINICAL ROLE activities? (Check all that apply)


18

1) Senior nurse administrator (e.g. Director or Chief of Nursing) 5) Physician Partner

2) Senior non-nursing administrator (e.g. VP or Director) 6) Medical Director

3) Nurse manager 7) Not Sure

4) Non-Nursing Manager (e.g. Program Manager) 8) Other _______________________

(specify)

51. a) Do you have NON-CLINICAL ROLE responsibilities?

1 No If no, skip question b and move on to question #52

2 Yes If yes, answer question b

b) If yes, to whom are you accountable for your NON-CLINICAL ROLE activities?

(Check all that apply)




4) Non-Nursing Manager (e.g. Program Manager) 8) Other_________________________

(specify)

52. a) Do you have an ANNUAL PERFORMANCE APPRAISAL?

1 No If no, skip question b and move on to question #53

2 Yes If yes, answer question b

b) If yes, who is responsible for your ANNUAL PERFORMANCE APPRAISAL? (Check all that apply)




4) Non-Nursing Manager (e.g. Program Manager) 8) Other_________________________

(specify)

53. At times OTHER than an annual performance appraisal, on average how often do you meet with at least

one or more of your supervisors to discuss your ROLE PERFORMANCE? (Check one only)

0 Never 3 Once a month 6 Once every 12 months

1 Daily 4 Once every 3 months 7 Other (specify)_____________________________

2 Weekly 5 Once every 6 months

54. On average, how often do you meet with at least one or more of your supervisors to discuss issues about

ROLE DEVELOPMENT AND IMPLEMENTATION (Check one only)

0 Never 3 Once a month 6 Once every 12 months

1 Daily 4 Once every 3 months 7 Other (specify)________________________

2 Weekly 5 Once every 6 months

Continued……..


19

55. a) Identify the types of SUPPORT you have received from ADMINISTRATORS and/or ROLE

SUPERVISORS to help with the development and implementation of your new APN role, by checking

YES or NO for each item.

b) IF you RECEIVED administrative support, RATE how helpful or unhelpful these SUPPORTS were

for developing and implementing your role using the boxes on the right side of the table.

Types of Administrative Support

Received This

Support

(Check Yes or No)

Not

Helpful

At All

Somewhat

Helpful

Helpful Very

Helpful

Extremely

Helpful

a) Provided adequate orientation time at the

onset of the role

1 No 2 Yes 0 1 2 3 4

b) Were available for regular contact and

support

1 No 2 Yes 0 1 2 3 4

c) Initiated and/or supported development of

organizational policies necessary for the

role

1 No 2 Yes 0 1 2 3 4

d) Introduced me to key stakeholders and

other health care providers relevant to the

APN role

1 No 2 Yes 0 1 2 3 4

e) Introduced me to advanced practice

nurses and nursing faculty

1 No 2 Yes 0 1 2 3 4

f) Facilitated and/or supported obtaining a

university appointment

1 No 2 Yes 0 1 2 3 4

g) Invited me to participate in

organizational committees

1 No 2 Yes 0 1 2 3 4

h) Facilitated involvement in research

activities

1 No 2 Yes 0 1 2 3 4

i) Provided opportunities for mentorship

from key experts

1 No 2 Yes 0 1 2 3 4

j) Provided opportunities for continuing

education

1 No 2 Yes 0 1 2 3 4

k) Provided leadership opportunities

1 No 2 Yes 0 1 2 3 4

l) Provided timely mediation to resolve role

conflicts

1 No 2 Yes 0 1 2 3 4

m) Other (specify) ___________________

1 No 2 Yes 0 1 2 3 4

Continued……..

SECTION VII - JOB SATISFACTION


20

In this section we want to learn about how satisfied you are with the different aspects of your APN role.

56. How SATISTIED are you with the following RESOURCES and SUPPORTS for your APN role?

Resources and Supports

Very

Satisfied

Satisfied Minimally

Satisfied

Minimally

Dissatisfied

Dissatisfied Very

Dissatisfied

1) Office space 6 5 4 3 2 1

2) Clinical examination space 6 5 4 3 2 1

3) Communication technology (e.g. phone,

fax, computer, pager) 6 5 4 3 2 1

4) Clerical support 6 5 4 3 2 1

5) Computer technology support 6 5 4 3 2 1

6) Data management support (e.g. access to

data base records, access to data analysts and

statisticians for developing and analyzing data

bases relevant to the APN role)

6 5 4 3 2 1

7) Organizational policies that support full

implementation of the APN role 6 5 4 3 2 1

57. What are the 3 most POSITIVE aspects of your APN role?

1) ______________________________________________________________________________________

2) ______________________________________________________________________________________

3) ______________________________________________________________________________________

58. What are the 3 most NEGATIVE aspects of your APN role?

1) _______________________________________________________________________________________

2) _______________________________________________________________________________________

3) _______________________________________________________________________________________

Continued……..

59. Misener Job Satisfaction Scale (Misener, 2000)


21

The following is a list of items known to have varying levels of satisfaction among advanced practice nurses.

There may be items that do not pertain to you; however, please answer them based on your employer’s policy.

(i.e. IF YOU NEEDED IT, WOULD IT BE THERE?)

Please check (√) the one best answer for each

question below

Very

Satisfied

Satisfied Minimally

Satisfied

Minimally

Dissatisfied

Dissatisfied Very

Dissatisfied

1. Vacation/leave policy

6 5 4 3 2 1

2. Benefit package

6 5 4 3 2 1

3. Retirement Package

6 5 4 3 2 1

4. Time allotted for answering messages

6 5 4 3 2 1

5. Time allotted for review of lab & test results

6 5 4 3 2 1

6. Your immediate supervisor

6 5 4 3 2 1

7. Percentage of time spent in direct patient

care 6 5 4 3 2 1

8. Time allocation for seeing patients

(e.g. amount of time allocated to see patients) 6 5 4 3 2 1

9. Amount of administrative support

6 5 4 3 2 1

10. Quality of assistive personnel

6 5 4 3 2 1

11. Patient scheduling policies and practices

(e.g. practices regarding scheduling of patients) 6 5 4 3 2 1

12. Patient mix

6 5 4 3 2 1

13. Sense of accomplishment

6 5 4 3 2 1

14. Social contact at work

6 5 4 3 2 1

15. Status in the community

6 5 4 3 2 1

16. Social contact with colleagues after work

6 5 4 3 2 1

17. Professional interaction with other

disciplines 6 5 4 3 2 1

18. Support for continuing education

(time & money) 6 5 4 3 2 1

19. Opportunity for professional growth

6 5 4 3 2 1

20. Time off to serve on professional

committees 6 5 4 3 2 1

21. Amount of involvement in research

6 5 4 3 2 1

22. Opportunity to expand your scope of

practice 6 5 4 3 2 1

23. Interaction with other advanced practice

nurses including faculty 6 5 4 3 2 1

24. Consideration given to your opinion and

suggestions for change in the work setting 6 5 4 3 2 1

25. Input into organizational policy 6 5 4 3 2 1

26. Freedom to question decisions and

practices 6 5 4 3 2 1


22

The following is a list of items known to have varying levels of satisfaction among advanced practice nurses.

There may be items that do not pertain to you; however, please answer them based on your employer’s policy.

(i.e. IF YOU NEEDED IT, WOULD IT BE THERE?)

Please check (√) the one best answer for each

question below

Very

Satisfied

Satisfied Minimally

Satisfied

Minimally

Dissatisfied

Dissatisfied Very

Dissatisfied

27. Expanding skill level/procedures within

your scope of practice 6 5 4 3 2 1

28. Ability to deliver quality of care

6 5 4 3 2 1

29. Opportunities to expand your scope of

practice and seek advanced education 6 5 4 3 2 1

30. Recognition of your work from superiors

6 5 4 3 2 1

31. Recognition of your work from peers

6 5 4 3 2 1

32. Level of autonomy

6 5 4 3 2 1

33. Evaluation process and policy

6 5 4 3 2 1

34. Reward distribution

6 5 4 3 2 1

35. Sense of value for what you do

6 5 4 3 2 1

36. Challenge in work

6 5 4 3 2 1

37. Opportunity to develop and implement

ideas 6 5 4 3 2 1

38. Process used in conflict resolution

6 5 4 3 2 1

39. Amount of consideration given to your

personal needs 6 5 4 3 2 1

43. Flexibility in practice protocols

6 5 4 3 2 1

44. Monetary bonuses that are available in

addition to your salary 6 5 4 3 2 1

45. Opportunity to receive compensation

for

services performed outside of your normal

duties

6 5 4 3 2 1

43. Respect for your opinion

6 5 4 3 2 1

44. Acceptance and attitudes of physicians

6 5 4 3 2 1

Continue……..

60. Which of the following BEST describes your current plans for future EMPLOYMENT?

(Check one only)


23

1 I am satisfied with my current role and have no immediate plans to seek new employment. (Skip question

#61)

2 I am thinking about seeking a new employment. (Go to question #61)

3 I am actively seeking new employment. (Go to question #61)

61. What are your reasons for thinking about or actively seeking new employment?

1) Salary was too low 13) Insufficient role acceptance by nursing staff

2) Job insecurity 14) Insufficient role acceptance by physician(s)

3) Benefits were poor 15) Insufficient role acceptance by health care team members

4) Union issues 16) Did not like my work relationships with other health providers

5) Did not like the role 17) The demands of the role were negatively affecting my health

6) Did not feel qualified for the role 18) Insufficient administrative support for the role

7) Lack of opportunity for career advancement 19) Insufficient resources to fulfil role expectations

8) New opportunity for career advancement 20) Insufficient mentorship to support role development

9) Returned to school 21) Changes in personal life required me to relocate my home

10) Family issues 22) Workload (describe)___________________________________

11) Wanted more time for my personal life 23) Other (describe) __________________________________

12) Retirement

You have now completed the questionnaire.

The time and effort you have spent participating in this study is greatly appreciated.

THANK YOU!!!


24

ONCOLOGY ADVANCED PRACTICE NURSE QUESTIONNAIRE

Identification Number: ___ ___ ___ ___

Date of Completion: ___/___/___ dd mm yy

Information and Instructions

Thank you for consenting to participate in this study and for completing this questionnaire. This study is funded by

the Ontario Ministry of Health and Long-Term Care and is a joint initiative of Cancer Care Ontario, nursing leaders

from 5 provincial cancer centres, and McMaster University.

The purpose of this questionnaire is to collect information that describes the characteristics of oncology advanced

practice nurses, their advanced practice nursing roles, and factors influencing the development and implementation

of these roles in Ontario cancer centres and integrated cancer programs.

Your participation is important! The information gained from this study will be used to provide recommendations to decision-

makers at the Ministry of Health and Long-Term Care and cancer care organizations about the resources and strategies required

to support the development and implementation of current and future oncology APN roles.

This comprehensive evaluation of oncology advanced practice nursing roles is based on research literature regarding

the development and evaluation of advanced practice nurse roles, the oncology nursing literature, and the Canadian

Association of Oncology Nurses (2001) Standards and Role Competencies for Advanced Practice Nursing.

Due to the comprehensive nature of the study, the questionnaire will take 30 to 60 minutes to complete. Each

question is important and we appreciate your time, patience, and commitment to completing the questionnaire.

Please read the instructions for each question carefully and answer each question as honestly and completely as

possible. Where indicated, place an ( x ) or () inside the answer box provided.

Please pay close attention to questions with rating scales as the direction of numeration varies for different

questions.

Provide as much detail as possible for open-ended questions or comments. Your participation in this study is

confidential and you will not be identified in the analysis or reporting of the study results.

We would be happy to provide you with a final study report:

Yes, I would like a copy of the final report: _____

No, I do not want a copy of the final report: _____

THANK YOU FOR COMPLETING THE ATTACHED QUESTIONNAIRE!!


25

ONCOLOGY ADVANCED PRACTICE NURSE QUESTIONNAIRE

PILOT REVIEW FORM

Reviewer #: _____

Date of Completion: _________________

Reviewer Instructions

Your assistance in piloting this new questionnaire is greatly appreciated.

Please read the study consent form prior to completing the questionnaire, so that you understand the overall purpose

of the study.

Please complete the questionnaire as if you were a participant in the study.

If there are questions in which the wording of instructions, purpose of the question, or item responses are unclear,

ambiguous, incomplete, intrusive, or inappropriate please indicate this directly on the questionnaire. If possible

provide suggestions for improvement.

Please circle any typographical, grammar, or spelling errors directly on the questionnaire.

Please complete the attached reviewer feedback form.

Please do not photocopy or duplicate the questionnaire in any manner without the written permission of the principal

investigator, Denise Bryant-Lukosius.

Return the entire package including reviewer instructions & feedback form, consent form, and questionnaire as soon

as possible in the courier envelope provided.


26

Oncology APN Questionnaire: Reviewer Feedback Form

1. From start to finish, how many uninterrupted minutes did it take you to complete the questionnaire?

_________ minutes

2. The time it took to complete the questionnaire was (check one):

Appropriate for the study purpose

Too long

Too short

3. As a study participant, the length of the questionnaire would (check one):

Be feasible for me to complete

Be a possible but unlikely barrier for me in completing the questionnaire

Be a likely and major barrier for me in completing the questionnaire

4. In terms of overall content, are there any questions NOT included in this questionnaire that you feel would be important for

describing the characteristics of oncology advanced practice nurses in your setting?

No Yes If yes describe…..

5. In terms of overall content, are there any questions NOT included in this questionnaire that you feel would be

important for describing the characteristics of oncology advanced practice roles and role activities in your

setting?


6. In terms of overall content, are there any questions NOT included in this questionnaire that you feel would be

important for identifying factors that negatively or positively influence the development and implementation of

oncology advanced practice nursing roles in your setting?



27

7. Are there questions you feel are unimportant, irrelevant, or redundant and could be eliminated from the questionnaire without

jeopardizing the accuracy and completeness of the study results?

No Yes If yes, please list the questions by their number:

8. Questionnaire Format:

a) The overall format of the questionnaire was:

Very Easy to Read Easy to Read Somewhat Easy to Read Difficult to

Read

b) Overall, the questionnaire instructions were:

Very Clear Clear Not Very Clear Confusing

c) Overall, the font size made the questionnaire:

Very Easy to Read Easy to Read Somewhat Easy to Read Difficult to

Read

d) Overall, the white space between questions was sufficient and made the questionnaire easy to read.

Strongly Agree Agree Disagree

e) Overall, the questions were ordered in a logical and organized manner that was easy to follow:

Strongly Agree Agree Disagree

9. The 3 most important suggestions I have for improving this questionnaire are:

Oncology Advanced Practice Nurse...

Documents

Transcript of Oncology Advanced Practice Nurse...