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Scope of Practice: Intra & Interdisciplinary Ann Syme, RN, MSN, PhD student Provincial Program & Network Director: Pain & Symptom Management/Palliative.

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Presentation on theme: "Scope of Practice: Intra & Interdisciplinary Ann Syme, RN, MSN, PhD student Provincial Program & Network Director: Pain & Symptom Management/Palliative."— Presentation transcript:

1 Scope of Practice: Intra & Interdisciplinary Ann Syme, RN, MSN, PhD student Provincial Program & Network Director: Pain & Symptom Management/Palliative Care BC Cancer Agency

2 Pharmacy Leadership Conference 2007 Overview Expansion of nursings scope of practiceExpansion of nursings scope of practice –Nurse anesthetists –Nurse endoscopists –Nurse practitioners Intersection of the role of nursing and pharmacy as the pharmacists role expandsIntersection of the role of nursing and pharmacy as the pharmacists role expands

3 Pharmacy Leadership Conference 2007 Disciplinary Scope of Practice Metaparadigm for the nursing discipline is comprised of four concepts (Fawcett, 2005):Metaparadigm for the nursing discipline is comprised of four concepts (Fawcett, 2005): –Human beings –Environment –Health –Nursing Also - caring, cultural competenceAlso - caring, cultural competence

4 Pharmacy Leadership Conference 2007

5 Pharmacy Leadership Conference 2007 Nurse Practitioners One of two types of Advanced Practice Nurses CNS – RNs with Masters or doctoral preparation that specialize in an area of nursing practice byCNS – RNs with Masters or doctoral preparation that specialize in an area of nursing practice by –area, such as emergency –population, such as pediatrics –disease, such as breast cancer. provide direct care, expert consultation to nurses and other care providers, and implement system changes to improve health care deliveryprovide direct care, expert consultation to nurses and other care providers, and implement system changes to improve health care delivery NP - RNs with advanced Masters degree plus clinical training which enables them to diagnose and treat health problems including prescribing drugs.NP - RNs with advanced Masters degree plus clinical training which enables them to diagnose and treat health problems including prescribing drugs.

6 Pharmacy Leadership Conference 2007 NPs – History and Current State The NP role has come and gone several times in Canada, beginning with a program at McMaster University in Hamilton during the 1970s.The NP role has come and gone several times in Canada, beginning with a program at McMaster University in Hamilton during the 1970s. It takes special legislation to create the NP in each jurisdiction but the concept is spreading and there are 900 licensed NPs across the country.It takes special legislation to create the NP in each jurisdiction but the concept is spreading and there are 900 licensed NPs across the country. In Ontario – NPs reintroduced in the 1990s as Acute Care PractitionersIn Ontario – NPs reintroduced in the 1990s as Acute Care Practitioners In BC – NPs reintroduced in early 2000 as Primary Care PractitionersIn BC – NPs reintroduced in early 2000 as Primary Care Practitioners As discussed, specialization of the role is proceedingAs discussed, specialization of the role is proceeding

7 Pharmacy Leadership Conference 2007 Barriers & Facilitators Barriers & Facilitators Attitudinal (intra- & interdisciplinary)Attitudinal (intra- & interdisciplinary) Accreditation & licensureAccreditation & licensure LegislationLegislation FundingFunding TitleTitle Skill limitationSkill limitation Liability issuesLiability issues Practice model limitationPractice model limitation Policies and legislation Funding Inclusive practice models Education Evaluation and measurement of outcomes Human resource shortages

8 Pharmacy Leadership Conference 2007 NPs - What they are and are not What an NP is NOTWhat an NP is NOT –a physician extender –a physician replacement What an NP IS –a Masters prepared nurse with advanced preparation in diagnostics and prescriptive practices which are grounded in the discipline of nursing

9 Pharmacy Leadership Conference 2007 The NP at Cancer Care Transitions

10 Pharmacy Leadership Conference 2007 Nurse Anesthetists Began in USA Civil War and the Franco-Prussian WarBegan in USA Civil War and the Franco-Prussian War 1919 - formally recognized in the US as the first nursing specialty1919 - formally recognized in the US as the first nursing specialty 1937 – claimed by the AMA but not taken up until the end of WWII1937 – claimed by the AMA but not taken up until the end of WWII turf shared in the US – 60% of anesthesiology is nurse delivered (up to 70-80% in rural areas) and in 11 other countries (MacDonald & Schreiber, 2003)turf shared in the US – 60% of anesthesiology is nurse delivered (up to 70-80% in rural areas) and in 11 other countries (MacDonald & Schreiber, 2003)

11 Pharmacy Leadership Conference 2007 Nurse Anesthetists In Canada – MD anesthesiology is the most difficult to fill specialty positionIn Canada – MD anesthesiology is the most difficult to fill specialty position Cost of one CRNA = 1/10 of MD (USA)Cost of one CRNA = 1/10 of MD (USA) Demonstrated equality in clinical outcomesDemonstrated equality in clinical outcomes Stemming from the Romanow Report, there is movement afoot in Canada to develop this role as a specialty NP roleStemming from the Romanow Report, there is movement afoot in Canada to develop this role as a specialty NP role

12 Pharmacy Leadership Conference 2007 Endoscopic Nurses With the national push for colorectal cancer screening, the need for nurse endoscopists is being investigatedWith the national push for colorectal cancer screening, the need for nurse endoscopists is being investigated Studies show equality in rate of complication & accuracy between NP(E) & gastroenterologists (Wallace et al, 1999) and greater efficiency and effectiveness between NP & FP (Schoenfeld et al, 1999)Studies show equality in rate of complication & accuracy between NP(E) & gastroenterologists (Wallace et al, 1999) and greater efficiency and effectiveness between NP & FP (Schoenfeld et al, 1999) If developed, would come under a specialized NPIf developed, would come under a specialized NP

13 Pharmacy Leadership Conference 2007 Examples Where RNs work with Pharmacists with Expanded Roles Palliative carePalliative care Inpatient clinical consultationInpatient clinical consultation Community primary careCommunity primary care –nurses employed by pharmacies - S. Africa –Infusion programs (USA and Canada) –PhwSIs - consult on diabetes, chronic disease, sexual health (UK) Oncology careOncology care EducationEducation –Nurse curriculum re: pharmacology –UBC Interprofessional team education : AIDs and Palliative Care

14 Pharmacy Leadership Conference 2007 Pros & Cons Creates better access to care, more pt-centredCreates better access to care, more pt-centred Care planning is more comprehensiveCare planning is more comprehensive Pharmacists are more in touch with patientsPharmacists are more in touch with patients Nurses can share the burden of pharmacological careNurses can share the burden of pharmacological care Pharmacists have limitations too Not everybody needs every team member always Potential for role overlap and role conflict – need to manage the relationship

15 Pharmacy Leadership Conference 2007 Patient & Family Ph RN MD SW


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