C3 tapping the potential of primary care nurses

Tapping into the Potential of Primary Care Nurses in a CHC setting Kim Cook RN MSHSA Vice President, Community Health & Chief Professional Practice

Ade Oyemade RN MN Interim Professional Practice Manager

Faculty/Presenter Disclosure Speakers: Kim Cook, Vice President and Chief Professional Practice Ade Oyemade, Professional Practice Manager Relationships with financial sponsors: • Grants/Research Support: None • Speakers Bureau/Honoraria: None • Consulting Fees: None • Patents: None • Other: None

Disclosure of Financial Support • This program has not received financial support • This program has not received in-kind support • Potential for conflict(s) of interest: – Speakers have not received payment from any organization supporting this program.

– No organization will benefit from the products that will be discussed in this program

Overview • • • •

Who Are We? Learning Objectives Provincial Context CHC environment context • Propose for change

• Enhancing the role of primary care RNs – Need Assessment  Self Assessment tool  RN themes(assessment & Nurse led programs)

– Implementation  Education  Passport

• Metric • Lesson Learned

Who Are We? • SCHC operates 40 distinct and integrated programs across 11 sites • Programs are organized into three different departments: – – – – – –

Community Health Services Three CHC sites CHC have Six Primary care nurses Interprofessional team based model of care Community Service Programs Community Engagement Programs

Learning Objectives • Participants will: – Understand the process required to implement full scope of practice of RNs as an independent discipline within the context of Interprofessional team in Primary care – Identify strategies to address gaps in RN practice to support full scope of practice implementation – Gain insight into Competency Self- Assessment tool to assess the knowledge, skills and judgement of RN, along the continuum of Benner’s novice to expert framework

PROVINCIAL CONTEXT

Provincial Context • On May 17, 2017, the Ontario government approved changes to the Nursing Act that will permit RNs to prescribe medication according to a list, and to communicate a diagnosis for the purpose of prescribing medication.

• The College of Nurses of Ontario is developing the regulatory framework to support the changes • Consultation of stakeholders is well underway

College of Nurses of Ontario

Provincial Context • Association of Ontario Health Centres – Position Statement – Advocacy for RN prescribing in primary care – CHC member organization, participant of the RN prescribing round table of the College of Nurses of Ontario

College of Nurses of Ontario

RN Prescribing in Ontario • Not all RNs will be authorized to prescribe medications • RNs working in hospitals and outpost nursing stations governed by a provincial hospital will not be authorized to prescribe medications • RNs are to check with their organization regarding the policies set regarding scope of practice

College of Nurses of Ontario

RN Prescribing in Ontario • RNs working in the following sectors will be authorized to prescribe and include: – Long-term Care – Retirement homes and – Community Settings including Primary Care

College of Nurses of Ontario

RN Prescribing in Ontario • Medications RNs will be authorized to prescribe include: – Immunizations – Contraception – Medications to support smoking cessation – Medications to support travel health – Topical medications used in providing wound care

College of Nurses of Ontario

RN Prescribing in Ontario • The College of Nurses of Ontario will evaluate these areas first before including additional types of medications • Employers will provide: – direction regarding scope of practice within the organization, – access to other health professionals for consultation, – access to resources, and – opportunities to maintain competence in prescribing

College of Nurses of Ontario

RN Prescribing in Ontario • RN prescribers will: – only prescribe medication after fulfilling the College of Ontario’s requirements to become authorized – comply with requirements (e.g., laws, practice standards) – ensure they maintain competence in prescribing – understand how their role differs from other nursing roles – communicate their role to clients, the public and others (e.g., employers, other health professionals) – work collaboratively with other nurses and health professionals

College of Nurses of Ontario

PRIMARY CARE CONTEXT College of Nurses of Ontario

RN Prescribing in Primary Care • Multiple primary care models in Ontario • Recognition of nursing as a profession with a defined autonomous scope of practice • Variation in scope of practice of nurses in primary care • Opportunity to expand the RN scope of practice within an interprofessional model of care

College of Nurses of Ontario

RN Prescribing in Primary Care • Benefits – Early Adopter – Consistency of scope of practice of RNs in Primary Care – Enhanced timely access to care and care coordination – Key enabler to optimizing client outcomes

College of Nurses of Ontario

CHC Context • CHC Model of care is based on the model of health and well being grounded in anti- oppression and cultural sensitive practice • Interprofessional integrated based team approach • Primary care nurses skills are not fully utilized, focus is more on tasks • Leadership support to enhance the role of both RN & RPN

Scope of Practice Framework Assessment

Optimization role of PHCN

Registered Nurse

Nurse Interventions

RN Led Programs

Model of care: Proposal for Change 1. Move towards enhanced use of nursing skills rather than non nursing skill mix(ex: interpretation, clerical duties) 2. Education 3. Optimize scope and differentiate roles of RN and RPN 4. Provide refresher/education training for nurses in new or where skills may have been lost from disuse over many years (ex – Skills in Well Woman Care at McMaster University)

Optimization of Primary Care Registered Nurses College of Nurses of Ontario

Scope of Practice Strategy Competency Self assessment tool

Passport/Education

Indicators

ASSESSMENT THEMES

Competency Self Assessment Tool • Primary Care Nurse Competency Self Assessment include: – Professional Practice competencies – Critical thinking, research & leadership – Core- medicine & surgical health – Public/Community health

• Benner Framework from No experience to Expert • 100% completion of Self Assessment compliance • Common assessment themes identified

RN-Assessment Themes • Expand day to day scheduled Clients appointments with RNs: – Triage – Cervical screening and well woman exams for clients of male physician – Well baby visits for Canadian born children* • 45 minutes with nurses, 15 minutes with NP/MD at end of appointment for consult in case • Issue comes up (health concern, client off immunization schedule) • Baby sees NP/MD for first postpartum visit, and 18 month visit

RN-Assessment Themes – Harm Reduction counselling – Birth control & sexual health counselling – HIV Point of Care Testing(POCT) – Immunization appointments for children who receive Public Health letter from school

EDUCATION & PASSPORT

Education • • • • • • •

Cervical Screening HIV POCT Harm Reduction Routine Physical Assessment (well baby and adult) Principles of Triage Prevention, health promotion and maintenance Social determinant of health principles

Passport

REGISTERED LED PROGRAMS THEMES

RN- Led Programs • Cardiovascular disease management – 1x/week group education and support for clients with HTN & hypercholesterolemia; stroke & MI prevention – 1.5 hour education/support group, followed by BP checks and medication review

• Sexual health drop-in – 1x/week group education and support – STI & pregnancy testing and pap tests – Contraceptive counselling – Birth control dispensing

RN- Led Programs • Harm Reduction – Needle distribution and exchange – Naloxone treatment – Safe drug use counseling

METRICS

Scope of Practice Indicators Indicators

Current Value

Frequency of reporting

 Well baby

70%

Quarterly

 Routine Physical Assessment (Adult)

70%

Quarterly

100%

Quarterly

 Sexual health Drop in

50%

Quarterly

 Harm Reduction

100%

Quarterly

Assessment

Nursing Intervention  Routine Cervical Screening

Nurse-Led Program

Lesson Learned • Change strategy to provide education for RN and RPN • Provide education on difference between RN & RPN CHC setting • Leadership support critical to during implementation

NEXT STEPS

Provincial Context • The College of Nurses of Ontario is determining – Competency – Public Register – Practice

College of Nurses of Ontario

RN Prescribing in Primary Care • What can you and your organization do to support the implementation of RN prescribing?

– Shift the conversation – Assess current scope of practice of RNs within your organization – Develop a plan to move to full scope of practice by optimizing nursing roles – Develop nursing role descriptions that reflect full scope of practice, offer role clarity and enable interprofessional practice

Discussion

Contact Information Kim Cook RN MSHSA Vice President & Chief Professional Practice Scarborough Centre for Healthy Communities kcook@schcontario.ca AdeAde Oyemade RN MN Interim Professional Practice Manager Scarborough Centre for Healthy Communities aoyemade@schcontario.ca College of Nurses of Ontario