The Nurse Practitioner Role In Newfoundland & Labrador

Transcription

1 The Nurse Practitioner Role In Newfoundland & Labrador Occupational Review for Nurse Practitioners 2015 Prepared for the Provincial Government of NL March 19, 2015

2 What is a Nurse Practitioner (NP)? A Registered Nurse with advanced education and experience: At least 2 years as RN for program entry (5 years for jobs) Masters Degree Completion of an approved nurse practitioner program Completion of a national credentialing exam

3 What can a NP do? As per ARNNL s 2013 Standards for NP Practice in NL, identifying entry level competencies for safe, ethical, quality care (replaces 2008 Framework) Works independently Autonomously perform health assessments diagnose illnesses order and interpret diagnostic tests prescribe pharmaceuticals perform procedures/interventions Competency-based since 2013 (contingent on NP knowledge, experience, skill, population served, etc.)

4

5 What can a NP do? Provide a comprehensive range of essential health care services Chronic disease management Acute and critical care Health promotion Disease prevention Holistic care Provide care throughout the lifespan (prenatal, birth, death) Improve access to care, reduce wait times Improve quality of care delivered, offer continuity of care Improved health outcomes

6 What can a NP do? Additional involvements: Research Management Program development/expansion Academic responsibilities Professional committees Local, regional, provincial and national committees Special interest working groups

7 Where do NPs work? Health care centers, outposts, home visits throughout the province rural and urban Acute Care settings Med/Surg. Critical care CV surgery Bariatric surgery Cancer care Neonatology Rheumatology Hematology Plastic surgery Adolescent medicine Long term care, palliative care, justice, community health, mental health, addictions, emergency departments, outreach programs, Telehealth More and more areas inquiring about adding NPs to their care team In some rural areas, the NP is the only provider In any setting, the NP could serve as the main care provider

8 PAY NP Timeline in NL <1997 Regional Nurses 1998 Primary Care NP roles, rural and remote areas, few specialty NPs Gaps in specialty care areas leading to support for Specialty NP roles, growing need for PHC NP role 2012 Nationally recognized streams (Family/All ages, Adult, Pediatric) 2013 New ARNNL Standards for NP Practice competency-based scope, Controlled Drugs and Substances EDUCATION PRACTICE NP Certificate program established in NL at CNS. Grads from rural and remote areas NP Primary Care Bac. Program Masters NP Program for Acute Care MUN 2012 Masters NP program MUN 2013 National Certification Exam required 1998 NPs took pay cut from reg. nurse, NO PAY EQUITY! 1999 NP NS30 after strike with promise of future occ. review 2002 NP NS32 Nurse 1, for comparison: <2000 Nurse 1 NS Nurse 1 NS NP NS Nurse 1 NS 28

9

10

11

12 NP vs. Nurse Educator Same pay level yet nurse educators have NONE of the patient care responsibilities of a nurse practitioner!

13 NP vs. Clinical Associate Salary Comparison + retention bonuses after 12, 24, and 36 months Nurse Practitioner Clinical Associate Annual Salary

14

15 NP Reporting Structure Nurse Practitioner Councils working with Health Authorities regarding this issue Current issues include: no performance reviews being performed for most NPs managers identify difficulty managing NPs because of unfamiliarity with NP role NPs voicing frustration with lack of managerial leadership NPs report to various levels of hospital administration, based on the direction of the regional health authority, contingent on available resources and changes in organizational structure, delegation of reporting duties because of organizational changes Variability across the Country (tiered reporting, director level, manager level, physician reporting) Essentially, the current reporting structure is not representative of the level of work NPs do across this province

16 Impact and Outcomes ARNNL (2009) - Public Survey 87% strongly agreed that the quality of care provided by the NP was excellent 98% would see a NP again 99% would like to see more NPs working in their community Three-quarters of respondents who reported they had not seen a NP indicated they would do so if the opportunity was available

17

18 Impact When nurse practitioners were added to an emergency department, patients were more than twice as likely to be seen within waittime benchmarks, their length of stay was cut in half and the proportion of patients leaving without being seen was down by one-third.

19 Impact A 2002 review of scientific studies compared nurse practitioners and physicians providing first-contact care to patients in primary healthcare settings and found that patient health outcomes were equivalent.

20 Impact patients who saw a nurse practitioner reported higher levels of satisfaction and better quality of care in comparison to the care provided by physicians

21 Summary ARNNL s 2013 Standards for NP Practice in NL reflects education, experience and competence rather than proscriptive and restrictive lists/rules/protocols. NP education requires Masters Degree and national exam for entry to practice NP is responsible and accountable for decisions and outcomes of patient care NP practice is independent of physicians or any other health care professional Remuneration of NPs in NL has not kept pace with advances in education, practice and level of accountability

22 Thank-You! Questions/comments?