ARNNL Nurse Practitioner Evaluation M I C H E L L E C A R P E N T E - PowerPoint PPT Presentation

ARNNL Education Session 2018‐11‐20 ARNNL Nurse Practitioner Evaluation M I C H E L L E C A R P E N T E R , N U R S I N G C O N S U LTA N T J U L I E W E L L S , R E S E A R C H & P O L I C Y O F F I C E R 1

ARNNL Education Session 2018‐11‐20 B ACKGROUND  NP practice initially established in 1998  NL was 2 nd jurisdiction in Canada to authorize NP practice  NP regulation and practice has evolved in the last 20 years Initially Today Education Post-Basic Diploma Master’s Degree Streams Primary Health Care; NP-Specialist Family-All Ages; Adult; Pediatric Scope Restricted - schedule of tests/drugs; Broad - Standards/Scope practice protocols (NP-S) (competent, educated, authorized) 2

ARNNL Education Session 2018‐11‐20 B ACKGROUND  No recent studies completed in NL  Only one evaluation of NPs in NL since 2001  Purpose  address information gaps  obtain input on opportunities to further advance the role in the interest of the public 3

ARNNL Education Session 2018‐11‐20 P ROJECT T IMELINES Date Project Activity March 2015 Funding obtained from provincial government (DHCS) November 2015 NP Evaluation Advisory Committee (NPEAC) established Spring 2016 Completed conceptual framework to guide evaluation Fall 2016 RFP for evaluation team (awarded December 2016) Winter 2017 Develop data collection tools (evaluation team & ARNNL) Spring/Summer 2017 Pilot testing and data collection (April 30-August 31) Fall 2017 Data analysis January 2018 Interim Report May 2018 Final Report October 2018 Presented to ARNNL Council 4

ARNNL Education Session 2018‐11‐20 O BJECTIVES 1. Identify the characteristics of NP practice within various practice settings; 2. Determine the implementation process in both public and private organizations to create and develop a new NP role; 3. Identify factors that influence the integration of the NP role into various practice settings within both public and private organizations; 4. Determine the impact of the NP role on the health care system; and 5. Determine the future direction for the NP role. 5

ARNNL Education Session 2018‐11‐20 R ESEARCH P ROCESS  5 phase process:  develop tools  collect data  analyze data  interim report  final report 6

ARNNL Education Session 2018‐11‐20 P ARTICIPANT R ECRUITMENT  Letter of introduction sent to stakeholders from ED (March/April)  NPs contacted and asked to identify their managers  Survey invitations  ARNNL sent invitation to NPs  NLMA contacted MDs re: survey and focus groups  Managers identified by NPs were asked to forward survey invitation from ARNNL to RNs and clinical educators who work with NPs; information also posted to ARNNL website 7

ARNNL Education Session 2018‐11‐20 P ARTICIPANT R ECRUITMENT  Focus Groups/Key Informant Interviews  Surveys included invitation to participate in focus groups/key informant interviews  ARNNL sent invitations to managers, administration, professional practice, SON, and DHCS  NLPB contacted pharmacists  NLASW posted information about the evaluation in their newsletter  Evaluation team contacted other stakeholders directly (RNUNL, PANL, NLMA, CPSNL, etc.) 8

ARNNL Education Session 2018‐11‐20 D ATA C OLLECTION  Online surveys (Survey Monkey)  Surveys Responses  88 NPs (58.7%)  31 RNs  40 MDs  Focus Groups/Interviews  61 key stakeholders  13 focus groups  15 interviews 9

ARNNL Education Session 2018‐11‐20 R EPORT  Number of action items identified by participants  Overarching recommendations provided by consultants  Results consistent with literature  Final report reviewed by the NPEAC  Presentation to ARNNL Council  All recommendations provided in the Executive Summary (available on ARNNL website) 10

ARNNL Education Session 2018‐11‐20 K EY T HEMES : F UNDING M ODELS  Lack of funding models highlighted as barrier to role implementation and integration  Health System funding (availability, budget process)  Payment for practitioners outside RHA (fee-for-service physician’s office, independent practice)  Suggest current funding models inadequate to sustain NP workforce  Many options discussed but no consensus on an appropriate funding model  Recent CFNU report (June 2018) corroborates recommendation to adopt/implement sustainable funding models 11

ARNNL Education Session 2018‐11‐20 K EY T HEMES : I NTERPROFESSIONAL (IP) C OLLABORATION  Most stakeholders believe that NPs can assume critical roles within IP collaborative models of care  Need to support strategic approaches directed towards achieving integrated care via IP collaborative teams with all health care professionals (HCPs) working to full scope 12

ARNNL Education Session 2018‐11‐20 K EY T HEMES : I NTERPROFESSIONAL (IP) C OLLABORATION  Participants identified:  Perceived absence of an operational plan to guide IP teamwork and an evaluation plan to monitor impact of IP collaborative team work  Lack of collaborative practice model for PHC  Inadequacy of education programs in preparing HCPs for collaborative practice  Importance of preparing IP team members for the NP role and scope 13

ARNNL Education Session 2018‐11‐20 K EY T HEMES : A PPROACH TO R OLE I MPLEMENTATION & I NTEGRATION  Most common response – there is/was no organized approach guiding role implementation  NPs, RNs, and MDs were seldom part of planning  Needs assessments predominately informal  Limited planning/absence of a long-term strategy for incorporating NPs into the HCS particularly in PHC settings  Acknowledged importance of identifying alternate models to guide role implementation (e.g., PEPPA framework)  NPs are not working to full scope 14

ARNNL Education Session 2018‐11‐20 K EY T HEMES : A PPROACH TO R OLE I MPLEMENTATION & I NTEGRATION  Different views between NPs and Managers re: Resources to Support Role introduction  Managers/Administrators  Resources have improved over time and are at acceptable levels in all clinical areas  Detailed protocol for position descriptions  Informal mentorship  NPs  Orientation/mentorship have insufficient depth and duration  Position descriptions provide limited direction for role enactment  Recommended improvements to all resources – position descriptions, orientation, performance appraisals, mentorship 15

ARNNL Education Session 2018‐11‐20 K EY T HEMES : A WARENESS OF NP R OLE  Limited role awareness (patients and HCPs) and resistance to new or evolving NP roles  Need for greater NP role clarity - role confusion re: how NPs differ from other nurses and physicians.  Need for all stakeholder groups to know what the NP role entails and how it is intended to be implemented in the clinical area  Most stakeholders perceived NP roles in PHC to be poorly understood by the public, other nurses and HCPs, and collaborating physicians  Lack of support/resistance to NPs working in private practice clinics 16

ARNNL Education Session 2018‐11‐20 K EY T HEMES : P UBLIC K NOWLEDGE  ARNNL Public Survey (Feb. 2018)  89% had heard of NPs  two-thirds (68%) felt they knew the difference between NPs and RNs  43.3% of MDs felt patients and families understood what NPs do  NPs and RNs identified increasing public awareness as one of the factors necessary to support future growth and development of the role  NPs felt ARNNL, NLNPA and RNUNL should promote the NP role to all stakeholders  Some stakeholders commented that NPs themselves must take opportunities to inform patients and other HCPs about their role 17

ARNNL Education Session 2018‐11‐20 K EY T HEMES : P HYSICIAN F EEDBACK  Raised questions/concerns re:  responsibility/liability for independent/collaborative NP practice  NP salary (unable to recoup funds from public purse)  quality of NP education, especially new graduates’ clinical skills  Guarded in their support of IP collaborative practice  Only 60% moderately/extremely confident that NPs can work independently of MDs  Compared to other participants:  major differences in perception of how well NPs adjusted to the initial role  least confident of all HCPs re: positive contribution of NPs  less likely to support increased NP utilization or role expansion 18

ARNNL Education Session 2018‐11‐20 K EY F INDINGS : P HYSICIAN F EEDBACK  MDs who worked with NPs were more positive about the role  valued the NP role and advocated for greater NP utilization within all health care settings with greater autonomy and funding supports  viewed as the preferred solution to having physician locums that could result in increased costs/decreased continuity of care, particularly in rural/remote settings 19

ARNNL Education Session 2018‐11‐20 K EY T HEMES : S YSTEM I MPACTS  Most stakeholders believe NPs have a positive impact on patient access and coordination of care within IP teams  Examples: reduce wait times; increase access; enhance patient flow; address patient needs in holistic/comprehensive manner; improve quality/cost of care  Additional research on impacts:  Satisfaction with care received from NP rated 9.3 out of 10 (ARNNL, 2018)  Patients in primary health care clinics within RHAs report a high level of satisfaction with NP services; 98% would see an NP again (Emberley-Burke, 2016)  NPs positively impact patient outcomes and utilization of external health care resources (Cassel, 2018) 20