I would like to respectfully acknowledge the Traditional Owners of the land on which this event is taking place and pay my respect to their Elders both past and present."
Moving Beyond Contemporary Nursing Practice to Bridge the Gap Margaret Barton-Burke, PhD, RN, FAAN Director, Nursing Research (and Innovation) Memorial Sloan Kettering Cancer Center New York Professor Emeritus, University of Missouri St. Louis Adjunct Professor, QUT, Brisbane, AU
Good Morning Bonjour G DAY Jambo / Karibo Salam Alaikum Sawasdee ka Magandang hapon Hola
Objectives Present a MEANINGFUL policy lecture after a night of partying Invite nurses to consider advocating for Policy change re: equity Suggest that cancer nurses take a leadership role in Health Care (not Sick Care)
HAPPY ONCOLOGY NURSES MONTH
HAPPY NURSES WEEK
Happy International Nurses Day 2016 Florence Nightingale's birth
Gallop Poll in the U.S. Did You Know? As the single largest group of health professionals, with a presence in all settings, nurses can make an enormous impact on the resilience of health systems. By promoting the nursing voice, we can help guide improvements in the quality of health service delivery and inform health systems strengthening. ICN President, Dr. Judith Shamian It is our duty to ensure that governments and policymakers understand that confident, well-informed nursing leaders who understand their role in developing a workforce to meet new challenges are essential to ensure the success of the Sustainable Development Goals and to meet the health challenges of the future. Dr. Frances Hughes, ICN s Chief Executive Officer
Cancer/Oncology Nurses: A Force for Change Globalisation: a process of increasing global connections, interdependence & integration, especially in economic arena, affecting cultural, social political, ecological and technological aspects of life. (Tuschudin & Davis, 2008, p.4) Move from MDGs to Sustainable Development Goals SDGs relevant to all countries & cover economic, environmental social pillars of sustainable development with focus on equity addressing root causes of poverty http://www.icn.ch/images/stories/documents/publications/ind/ind_kit_2016.pdf
17 Sustainable Development Goals SDG Goal 3: Ensure healthy lives & promote well being for all at all ages Goal 3 most specific to health & well-being, has 13 targets (3.1-3.9) & enablers (3.a-3.d) WHO Framework Convention on Tobacco Control Support R & D vaccines & medicines for non-communicable diseases developing countries provide access medicines for all Substantially increase health financing & recruitment, development, training & retention of health workforce in developing countries, especially in leastdeveloped countries & small island developing States
Global Strategy on Human Resources for Health: Workforce 2030 (WHO 2015e) Overall goal: To improve health & socioeconomic development outcomes by ensuring universal availability, accessibility, acceptability & quality of health workforce through adequate investments & implementation of effective policies at national, regional & global levels
. Commission on the Social Determinants of Health Framework
So What Does This Have to Do with ME? Social justice means the fair distribution of resources and responsibilities among the members of a population with a focus on the relative position of one social group in relationship to others in society as well on the root causes of disparities and what can be done to eliminate them (CNA 2009) Every health professional has potential to act as advocate for individuals, communities, health workforce & general population, many factors affect health lie outside health sector, in early years experience, education, working life, income & living & environmental conditions - health professional may need to use positions as experts in health & as trusted respected professional to encourage or instigate change in other areas. Institute of Health Equity (2013), p.5
I m Just The Nurse ICN Code of Ethics for Nurses states nurses responsibility for initiating & supporting action to meet health & social needs of public, in particular - vulnerable populations (ICN 2012a). Role of nurse as advocate for equity & social justice appears in guidance of many National Nursing Associations There are examples of health professionals working together to have greater influence on policy makers to improve opportunities in this area (Allen et al 2013). American Nursing Association Social Policy Statement (2015) ONS Position Statement on Quality Cancer Care https://www.ons.org/advocacy-policy/positions/policy/access
1.In all settings in which nurses work, ethical challenges are embedded in everyday practice 2.The need to strengthen the ethical foundation of nursing is urgent, particularly in light of pressures that threaten the integrity of individual nurses, the profession, and the people they serve 3.The ANA Code of Ethics is foundational to understanding the ethical landscape for nurses, and serves as an invaluable resource and guide for how nurses carry out their professional ethical obligations 4.Many ethical pressures arise more from disparities in the human resources, social capital, and financial resources available across the system (many of which result from resource allocation decisions and waste, rather than from resource scarcity) and contribute to persistent problems in access to care 5.Moral distress is a pervasive reality for nurses when they are unable to translate their moral choices into action because barriers prevent them from practicing in accord with their values 6.Nurses must define the boundaries of their professional responsibility with interprofessional colleagues in the environments where they practice 7.Nurses are ideally situated to lead and contribute to contemporary models of care delivery, policy, research, and education [see The Future of Nursing: Leading Change, Advancing Health] 8.Efforts to improve the ethical environment for nurses have a direct impact on the quality of care provided to patients and families and the sustainability of the health care system
IOM: Delivering High-Quality Cancer Care Care often is not patientcentered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. IOM, (2013). Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Author: Washington, D.C.
An Adequately Staffed, Trained & Coordinated Workforce High-Quality Cancer Care Delivery System IOM, (2013). Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Author: Washington, D.C.
Current Status: Oncology Workforce Inadequate Physician workforce Inadequate Geriatrician workforce Insufficient Nursing workforce Little, if any, dedicated cancer content Few graduate programs with oncology content Only 1.2% of the 1 million with certification in clinical specialty are OCN or AOCN (HRSA, 2010) Insufficient Rehabilitation workforce Aging out of the Nursing workforce (tsunami) IOM, (2013). Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Author: Washington, D.C.
ASCO Workforce Study 48% Increase In Demand 14% Increase In Supply
Australia The Australian Medical Oncologist Workforce Study MJA 196 (1) 16 January 2012 Conclusion: The current shortage of MOs is expected to persist in the future. National strategies are needed to increase the capacity of the medical oncology workforce and the chemotherapy utilisation rate.
Workforce Recommendation An Adequately Staffed, Trained, and Coordinated Workforce Goal 3: Members of the cancer care team should coordinate with each other and with primary/geriatrics and specialist care teams to implement patients care plans and deliver comprehensive, efficient, and patient-centered care. GOAL 4: All individuals caring for cancer patients should have appropriate core competencies. IOM, (2013). Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Author: Washington, D.C.
The Future of Nursing Report Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and an improved information infrastructure. IOM. (2010). The Future of Nursing: Leading Change, Advancing Health. Author: Washington, DC.
The Future of Nursing Report Update 2014: 1. 60% increase RN-to- BSN programs increased 2010 & 2014 (77,000 -> 130,300) 2. Enrollment increased 6.6% masters; 3.2% research-focused doctorate; 26.6% practice-focused doctorate 3. 9 states modernized APN laws Everyone in America can live a healthier life, supported by a system in which nurses are essential partners in providing care and promoting health. IOM. (2010). The Future of Nursing: Leading Change, Advancing Health. Author: Washington, DC.
Nursing Models of Care Advanced practice registered nurses practice to full extent of education & training Engage student nurses early Care Coordination Certification measure outcomes Nursing Education Curriculum/Faculty Practice Cancer Nursing Education Curriculum Clinical Academic Partnerships
What Women Want (Dr. Rainey) Study of 218 breast cancer survivors (USA) Evaluation of self-perceived impact on survival, worrying & cancer-related stress of follow-up visits to different clinic types, or virtual visits Conclusions: BC survivors comfortable with GP or nurse practitioner follow-up care, although preferred medical oncologists Virtual visits perceived negative impact on cancer survival & cancer-related stress Study of 722 breast cancer survivors (AU) Evaluated what follow-up would be preferred if specialist care was no longer available Conclusions: Beyond 2 years, women prefer follow-up in routine breast cancer clinic i.e. face to face every 6 months with breast physician* or breast care nurse, in preference to GP Drop in clinics also highly valued
Inadequately Prepared Oncology Nursing Workforce Accrediting bodies for basic preparation focus on minimum for safe care but currently do not address basic information on health care economics, quality measures Lack of competency in health informatics, managing data sets, benchmarking to measure outcomes Little dedicated oncology content in basic programs, few graduate programs in oncology Not prepared to function in teams, much less highperforming teams Not prepared to be leaders/lead teams
The Time for Nursing is NOW
Where Will These Changes Take Place?
Who Will Lead These Change?
HOW WILL THESE CHANGES TAKE PLACE?
A Professional Practice Model Provides a framework for nursing practice What s important / priorities Provides an identity for nursing What s unique / approach Magnet requirement Management Approach Professional Relationships Professional Values Compensation and Rewards Patient Care Delivery System 34 Leadership Teamwork Developed into We CARE Resource-Driven Practice Professional Nursing Practice Care Delivery Outcomes
Relationship-Based Care Our Professional Practice Model Patient/family-centered Evidence-based Primary nursing Responsibility, authority, accountability for patient care decisions Continuity of care Collaborative interdisciplinary relationships Shared decision-making Professional development
Memorializing RBC Heart Compassion Patient/family is at the heart of what we do Ribbons Iconic cancer awareness ribbons The Meaning of 3 3 relationships 3-fold mission (care, education, research) WeCARE - Every Day, Every Way Underscores our teamwork Depicts our values Refers to the journey / continuum of care Color Diversity of our patients and our staff Different colors associated with different cancers Different colors depict different dimensions
Leadership Leaders know the vision, act with purpose, remove barriers, and consistently hold patients, families and staff as their highest priority. LEADERSHIP: We believe in Shared Leadership Council Structure N-CARE L&OD The hospital, the administration and the institution recognize the importance of having us work to our potential... we have clinical ladders for registered nurses as well as nurse practitioners
Teamwork Healthy teams are characterized by trust, mutual respect, consistent and visible support and open, honest, communication. TEAMWORK: Everyone really just comes together to try and help do whatever is needed to help this patient survive. Diverse but with a shared purpose Multidisciplinary Committees, Rounds Commitment to my Co- Workers I work with incredible nurses that are intelligent, compassionate no one is working on their own
Resources Administrators, managers and staff members partner to design and continuously improve the infrastructure for optimal patient care delivery. RESOURCES: We use our generous resources wisely and with accountability Philanthropy Technology Clinical Support Having the equipment, having the supplies allows you to provide the care that you want to give to patients
Professional Practice Professional nursing exists to provide compassionate care to patients and their loved ones. Nursing is a primary component in a complex and interdependent health care delivery system. PROFESSIONAL PRACTICE: One thing I really treasure here at Memorial Sloan Kettering is that nurses are really respected and valued Compassionate, holistic patient and familycentered care Evidence-Based Practice Authority Responsibility and Accountability
Care Delivery We believe in the power of the therapeutic, healing relationship which primary nursing provides. CARE DELIVERY: You have this rapport with the family that they can really trust you and they really look to the nurses for help and for decisions, and you almost become like one of their family members Primary nursing is core to safe quality care Primary nursing benefits the patient/family and the nurse As a nurse, you really are at the frontlines with those patients and their families
Outcomes Achieving quality outcomes requires planning, precision and perseverance. Goals must be specific, attainable, measurable and meaningful. CARING, HEALING and INNOVATIVE ENVIRONMENT: To be able to advocate for people, to be able to care it is so fulfilling to know that I did what I m called to do. Outcomes are reflective of our nursing practice. Our major outcomes are measurements of: Patient safety (nursing-sensitive indicat0rs) Patient satisfaction Practice environment You have patients that are extremely, extremely giving and so brave and to witness that really helps you grow as an individual, as a nurse I think it s an honor to have even a small part in a patient s course of their treatment here.
There is a river flowing now very fast. It is so great and swift, that there are those who will be afraid. They will try to hold on to the shore. They will feel they are being torn apart and will suffer greatly. Know the river has its destination. The elders say we must let go of the shore, push off into the middle of the river, keep our eyes open, and our heads above the water. And I say, see who is in there with you and celebrate. At this time in history, we are to take nothing personally. Least of all, ourselves. For the moment that we do, our spiritual growth and journey comes to a halt. The time of the lone wolf is over. Gather yourselves! Banish the word struggle from your attitude and your vocabulary. All that we do now must be done in a sacred manner and in celebration. We are the ones we ve been waiting for. http://www.bioethicsinstitute.org/nursing-ethics-summit-report -Oraibi, Arizona, Hopi Nation
"Be the change that you wish to see in the world. Mahatma Gandhi Thank you Merci Asante Sana Salamat