Evolution of Nursing in Europe Birgitte Grube RN., Med. Head of education Danish Nurses Organisation Past President European Oncology Nursing Society EONS
Objectives Short about EONS Present future challenges Recognition of cancer nursing Explore impact of changes in the role and competencies for nurses To discuss the importance of educating nurses to deliver high quality care for the patients and relatives 2
European Oncology Nursing Society 2014 Charity established 1984 UK 30 European countries represented 22.000 cancer nurses Affiliated NGO s Non Governmental Organizations other cancer organisations ECCO, ESO, ONS, ISNCC, UICC MASCC, IPOS, EAUN
30 Years of partnership working, building the future Anniversary event 10 april 2014 Royal Marsden Hospital London
Vision That all people affected by cancer across Europe will benefit from the care of well educated, well informed and highly competent cancer nurses, who will play a central role in providing support, promoting health and improving clinical outcomes
Mission Working in partnership to develop and promote excellence in cancer nursing practice through education, research, leadership and support to cancer nurses across Europe
Values To be an inclusive and credible organisation, which aims to provide effective and practical support to all members across Europe. Work in co-operation with a range of multidisciplinary organisations to optimise the nursing contribution to cancer care in Europe.
Austria Belgium(2) Bulgaria Czech Republic Croatia Cyprus Denmark Estonia Finland France Germany Greece Hungry Iceland Ireland EONS 2014 22.000 members from 30 countries Israel Italy Lithuania Malta Norway The Netherlands Poland Portugal Serbia Sweden Switzerland Slovenia Spain Turkey UK(2)
EONS Board: 2013-2015 Erik van Muilekom: President Danny Kelly: President Elect Birgitte Grube: Past President Cristina Lacerda: Treasurer Mary Wells: Board Secretary Andreas Charalambous: Executive BM Paul Trevatt: Communication Patrick Crombez: Advocacy Danny Kelly: Research Lena Sharp : Education
Future challenges Increase in chronic diseases Cancer Diabetes Cardiovascular diseases COLD More older citizens Multidisease Highly specialized hospitals Shorter admission Pressure on primary settings
Changes in Care Fast changing treatments Personalized medicine Chemotherapy Radiotherapy targeted therapy Surgery new technology Shift of care from hospital to home/family Telemedicine Role of the specialist cancer nurse Increasingly complex treatment regimes
Many cancer patients experience Not geting optimal care Compliance Need for rehabilitation Often hospitalized Inadequate information Not enough focus on prevention To many contacts Lack in continuity
Disadvanges groups Inequality in health and social matters The best educated gets the best treatment NCD and comorbidity high incidence in disadvanges groups Changes of survival lower in underserved groups Increased site effects Compliance and adherence issues
Many cancer nurses experience Lack of opportunities for education Diversity of roles, titles and qualifications Specialty not recognised at European level Low quality of the education? Inadequate theory and practice transfer No use of problem- and evidence based practice Not enough nurses go into research? Move away from the clinic No formalised jobdescription Shift of care from hospital to home/family Homecare nurse not getting the right education
Recognition for cancer nursing v Why work together for recognition v EONS strategy work v Advocacy working group v EU level lobby/directives v Position statements on roles and responsibilities v Recognition at different levels v National, at local hospital, clinic and comunity v European level
Why work together for recognition European level Be one strong united voice Stronger in the multiprofessional arena Face EU Parliament Clear message policy statements Lobby work Respond to EU Directive changes National level Face national governments Prove better care - better outcome - research Prioritize education for cancer nurses Rapidly changing health care system Need for high quality care Shift in care hospital to homecare
Patient organisations Patients with voices Listen to them Collaborate with them Policy statements together Advocate for them Allliance facing Politicians Other stakeholders Organisations
National perspective Develop a national cancer group Work together with other national societies - projects Make solid strategic plans Reflect on national problems and the solutions Approach stakeholders Analyze stakeholders positions Genuin and clear communication Risk management control Work for a national education for cancer nurses
Improve cancer nursing care New Core Curriculum is based eight modules and focuses on the adult with cancer Can be used for curricula development for all nursing education programs Nurses working in cancer centers or in general practice/hospital settings WWW.CANCERNURSE.EU
Did cancer nursing in EU change due to EONS existence Cancer nursing as a specialty Advanced nursing practice Nursing research Differences in Europe Making progress
Education is part of the answer Extention of the role involves certain skills and responsibilities acquired, but at a lower level, integrated into the nurse role Expansion of the role happens when major responsibilities and the duties transferred to the profession. A specially trained nurse can take greater responsibility for a specific patient group Progress of the role means that the nurse has clear clinical autonomy and hence requiring training at master's level. Foreign experience shows that prescription rights act as 'key' to clear clinical autonomy.
Roles and levels Basic nurse Extension of the role Nurse specialist Expansion of the role Advanced nurse practitioner Progress to the role
Basic nurses compentencies Carry out the nursing core competencies such as: perform, communicate, lead and manage nursing promote health, prevent disease and alleviate suffering Coordinate the patients pathway Inform and teach patients and their relatives A Basic Nurse can not carry out tasks within cancer care without education
Education at basic nursing level New skills and responsibilities integrated into existing local induction and training course Education and clinical training should meet the requirements related to the specific area in cancer care
Basic/clinical nurse in cancer care Extension of the role Identify needs for care Set up goals, evaluate and adjust nursing Identify and apply research-based knowledge Engage in relations, dialogue and interaction Inform, communicate and support patients and their relatives
Nurse specialist A nurse specialist or a clinical nurse specialist in cancer care perform nursing at a high professional level: can assess and analyze complex clinical problems with the use of relevant knowledge critical thinking and use of new development and research Can articulate and communicate the patients need for care and treatment in a multiprofessional arena
What should be part of an accredited education for cancer nurses at master level? Problem and evidence based learning Theory and practice transfer process Very practice-oriented training and patient orientated Leadership and management Argumentation and presentation Implementation how can practice be change?
Advanced nursing practise Progress of the role At masters level Many countries have no formalised education or title Working at advanced level as Specialised nurses Clinical nurse specialist And other titles
ICN definition An Advanced Nurse Practitioners or Advanced Practice Nurse is registered nurse who has acquired the expert knowledge base, has complex decision making skills and clinical competencies for expanded practice A master degree is recommended for entry level
How do we ensure advanced level Use research proving Better care - better outcome Research shows on chronically ill 65 % is treated by nurses at advanced level Clinical results are as good or better 90% are more satisfied with this system Lower cost ANP on master level Regulated education Prescribe certain medications
Challenges The physicians fight for their right to prescribe Medicine Authorities state Nurse prescribing is not safe Political low ambitions for the nurse s skills Difficulties in existing education systems
Nursing staffing cuts to save money, effects patients, increase bachelor education for nurses could reduce hospital deaths!
Cancer nurses should Ø Be leading and educating cancer care Ø Make independent decisions Ø Do research in cancer nursing Ø Be part of the the multiprofessional teamwork Ø Be responsible for patient-oriented care Ø Open to new knowledge, and new roles Ø Always work for high quality standards Ø High security for patients
Conclusion It takes political willpower and voice Use evidence for better care better outcome! Acknowledge that cancer nursing is a speciality Authorize and formalize scope of practice and education Need for high quality care close to the patient In their homes In the clinic
Thank you for your attention!