Oncology Nursing: Leading the Oncology Nursing: Leading the Way presented by: Esther Green, Provincial Head, Nursing and Psychosocial Oncology at: The 8 th Princess Margaret Hospital Conference on New Developments in Cancer M Management: Conquering Cancer in t C i C i our Lifetime, October 2008
Vision Oncology Nursing Program Vision Oncology Nursing Program gy gy g g g g Working collaborat ively t o advance cancer Working collaborat ively t o advance cancer cont rol t hrough excellence in oncology nursing nursing 2
Outline � Innovative roles for registered nurses g � Improving safety in regional systemic therapy programs � Workforce research: national and Ontario studies � Inter-professional Collaboration Proj ect with Palliative Care � Current proj ects to plan and support nursing resources � Current proj ects to plan and support nursing resources � Fostering collaboration through Communities of Practice 3
A M d l f C ll b A Model of Collaboration to ti t Introduce a New Nursing Role in Cancer S creening: Policy and Practice Partnership p RN-Performed Flexible S igmoidoscopy
Proj ect Team Dr Linda Rabeneck Dr. Linda Rabeneck Chief Odette Cancer Centre S Chief, Odette Cancer Centre, S unnybrook Health unnybrook Health S ciences Centre Regional Vice President, CCO Helen Angus Vice President, Planning & S trategic Implementation, CCO Dr. Mary Anne Cooper S taff Gastroenterologist, S unnybrook Health S ciences Centre Esther Green Provincial Head, Nursing and Psychosocial Oncology CCO Vanessa Burkoski Provincial Chief Nursing Officer, MOHLTC A Annette Ellenor* Ell * Former S F S enior Policy Analyst, Nursing S i P li A l N i S ecretariat i MOHLTC Erin Hughes Director, Innovation and S pecial Proj ects CCO M Marnie MacKinnon i M Ki P Program Director, Colorectal Cancer S Di t C l t l C S creening i Program CCO Julie Gilbert Manager Policy, Research & Analysis CCO Karen Ga man* Karen Gayman* Former Director of N rsing Uni ersit Health Former Director of Nursing, University Health Network * Former t eam members 5
Background g � Ontario Task Force on Large Bowel Endoscopic S ervices (2005) recommended pilot work to explore the implementation of RN-performed flex sig in Ontario � Initial pilot proj ect established regulatory framework and resulted in training curriculum and assessment criteria (Dobrow, 2007) criteria (Dobrow, 2007) � Dobrow, M., Cooper, MA., Gayman, K. Pennington, J., Matthews, J. and Rabeneck, L. (2007). Referring patients to nurses: Outcomes and evaluation of a nurse flexible sigmoidoscopy training program for colorectal cancer screening Canadian Journal of Gastroenterology May colorectal cancer screening. Canadian Journal of Gastroenterology. May, 21(5):280-282 6
RN-Performed Flexible S igmoidoscopy g py � Pilot proj ect supported by the Ontario Pilot proj ect supported by the Ontario Ministry of Health and Long-Term Care and Cancer Care Ontario (CCO) � Obj ective: • To build capacity for colorectal screening • To increase opportunities for Registered Nurses through better use of their knowledge and skill through better use of their knowledge and skill 7
12-11: Patient Safety Issues: Key Components of Chemotherapy Labeling Components of Chemotherap Labeling � What prompted the initiation of this guideline? What prompted the initiation of this guideline? • Concerns around patient safety with respect to the chemotherapy labeling. � Primary Objective: • To determine the necessary components of a good label for chemotherapy such that it will contain the l b l f h th h th t it ill t i th necessary information and minimize delivery errors. 8
Regional S ystemic Treatment Program: Implementation Implementation Current S tate S trategy gy � Complexity of care is increasing; � Work in progress: nursing complexity current funding model does not reflect model in development with Colin Preyra increasing complexity and associated and S T nurse managers workload workload � Chemotherapy competency education Ch h d i � Lack of an approach to systemic therapy program to standardize approach education and certification � Impending nursing shortage � Development of standardized p g g g p chemotherapy education program for novice nurses and ongoing competency assessment � S S upport for oncology nursing upport for oncology nursing certification CON(C) to develop specialized oncology nurses � S � Implementation of CCO S taff safety afe Handling G id li Guidelines 9
Improving the Safety of Ambulatory Intra eno s Chemotherap in Canada Intravenous Chemotherapy in Canada � This proj ect will aim to answer the following questions: p j g q • What are the current end-to-end ordering, labeling, verifying, administering, and documenting practices for ambulatory IV chemotherapy across Canada? py What are the risks in these practices? • What efforts are underway in each province for improving the safe delivery of ambulatory IV chemotherapy? y y py What variations in approach exist between provinces/ centres? • What specific design characteristics of processes and technologies for ordering, labeling, verifying, administering, and g g, g, y g, g, documenting result in safer care? 10
Team Lead(s) Dr. Anthony Easty, University Health Network, Ontario, Dr. Anthony Fields, Alberta Cancer Board, Alberta � Ms. Venetia Bourrier, Cancer Care Manitoba, Manitoba Ms. Andrea Cassano-Piche, University Health Network, Ontario M A d C Pi h U i it H lth N t k O t i Ms. Anj um Chagpar, University Health Network, Ontario Dr. Dhali Dhaliwal, Cancer Care Manitoba, Manitoba Ms. Roxanne Dobish, Cross Cancer Institute, Alberta Ms. Roxanne Dobish, Cross Cancer Institute, Alberta Ms. Esther Green, Cancer Care Ontario, Ontario Ms. S ylvia Hyland, Institute for S afe Medication Practices Canada Ms. Karen Janes, BC Cancer Agency, British Columbia Dr Yoo Joung Ko S Dr. Yoo-Joung Ko, S unnybrook Odette Cancer Centre unnybrook Odette Cancer Centre Dr. S . Eshwar Kumar, New Brunswick Cancer Network, New Brunswick Dr. Brent S chacter, Canadian Association of Provincial Cancer , Agencies Dr. Maureen Trudeau, Cancer Care Ontario, Ontario Ms. Rachel White, University Health Network, Ontario 11
Oncology Nursing Workforce S gy g tudies � Oncology Nursing: Finding the Balance in a Changing Health Care System: Bakker, Fitch, Green, Butler and Olson C S t B kk Fit h G B tl d Ol � Understanding the Factors that Influence Recruitment and Retention in Oncology Nursing: Bakker, Fitch, Green, Butler Olson Cummings and Conlon Butler, Olson, Cummings and Conlon � The Relationship Between Nursing Leadership and Nurses’ Job Satisfaction in Canadian Oncology Work Environments: Cummings, Olson, Hayduk, Bakker, Fitch, Green , Butler, g , , y , , , , , and Conlon � Canada’s Experience Translating Workplace Knowledge in Cancer Settings: Fitch, et al. � Meeting the Needs of Cancer Patients and Families: Today and Tomorrow: Clinical Role Functions: What do Oncology Nurses Do? : Crooks, Green et al. 12
Workforce S tudies: Advanced Practice Nurses in Oncolog in Oncology � The Advanced Practice Nursing Role in Ontario Integrated Cancer Programs: Bryant, Green et al. � The Advanced Practice Nursing Role in Ontario Regional Cancer Centres: An Interim Evaluation: Bryant, Green et al. � Responding to the Role Development Needs of Oncology APN: A Provincial e-Based Mentorship Program: Bryant et al. � Increasing Capacity for the Effective Implementation of g p y p Oncology APN Roles for Under-serviced Populations: A Collaborative, Facilitative Approach: Bryant, Bakker, Green, et al. (in process) � Mentoring NP-MD Dyads in Collaborative Palliative Care Practice: Dudgeon, Green, Bryant, et al. (Phase II) 13
Future research � Workplace environment: best practice Workplace environment: best practice � National and international collaboration � Inter-professional model of care Inter professional model of care � Outcomes related to oncology nursing ‘ dose’ 14
“Mentoring Inter-professional Primary Health Care Teams in Collaborative Palliative Care Practice.” � This proj ect aims at building regional relationships between inter- professional primary health care teams (e.g., family physicians, f i l i h lth t ( f il h i i primary health care nurse practitioners, APN’ s, RN’ s, social workers, pharmacists, and others – mentees) and palliative care experts (palliative care physicians and advanced practice nurses – mentors) (palliative care physicians and advanced practice nurses mentors) to increase competencies in palliative care knowledge and skills, and inter-professional collaborative practice of both mentees and mentors. � This proj ect targets primary health care teams wit hin four h h l h h f designated LHINs (i.e. S outh East, North East, Hamilton Niagara Haldimand Norfolk and Brant, and Waterloo Wellington). Inter- professional mentee teams are being recruited from each of the professional mentee teams are being recruited from each of the designated areas. The mentor dyads are drawn from the palliative care expertise of two local Universities: Queen’ s and McMaster. 15
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