1. Advanced Practice Nurses Where we’ve been, Where we are now, Where we’re going. Jan Currie Vice President and Chief Nursing Officer Winnipeg Regional Health Authority November 2008

2. Workshop Objectives Provide a forum for networking and information sharing Provide evidence of successful health care outcomes in MB employing NPs and CNSs Clarify the differences in the roles of NP and CNS Provide an update about what employers now know for successful implementation of NPs and CNSs

3. Where We’ve Been Nurse Practitioners have been in Manitoba for over 30 years, mainly in the North. Clinical Nurse Specialists have been practicing all over Manitoba for many years. Both roles are well established in other countries

4. Where We’ve Been Position paper on Advanced Practice Nursing in the WRHA (2001) 1999 introduction of new Registered Nurses Act (proclaimed 2001) which provides new opportunities for the RN to work beyond the traditional scope of nursing practice

5. Position Paper Highlights Support for NP and CNS roles Educational Preparation of NPs and CNS Remuneration and Union Status Advocate for regulatory changes Explore role development in a variety of health care settings Seek new funding model and financial supports

6. Where We are Now Regulations in place Availability of educational programs Liability issues resolved NP title protection granted The session from the CRNM this afternoon will give you more information.

7. WRHA Positions in Place ProgramJune 2006June 2008 Cardiac Sciences15 Child Health23 Emergency39 Family Medicine22 Medicine1 Home Care1 PCH22 Primary Care1019 Oncology2 TOTAL2143

9. Where We’ve Been WRHA Nursing Leadership Council-provides region- wide leadership & direction to the practice of nursing within the WRHA Advanced Nursing Practice Implementation Steering Committee has been working since 2000 Program specific implementation initiatives for APN –ED –Primary Care –Acute care

10. Advanced Practice Nursing Steering Committee Linkages with –WRHA via NLC –Manitoba Health –College of Registered Nurses of Manitoba –University of Manitoba Faculty of Nursing –National efforts of Canadian Nurse Practitioner Initiative

11. Advanced Practice Nursing Implementation Steering Committee Job descriptions for CNS and NP implemented Tool Kits for CNS and NP developed and implemented Facilitated implementation of NP regulations in primary and acute care Provided forum for problem solving for NPs in new roles Liaison role to ensure clinical placements for NP students

12. A Guide to Implementation of the Advanced Practice Nurse http://www.wrha.mb.ca/professionals/nursing/apn06.php

13. Advanced Practice Nursing Steering Committee Committee has focused to date on NP introduction Next focus will be the Clinical Nurse Specialist role

14. Where Are We Going? Advanced Practice Nursing Steering Committee Further clarification of CNS role Collaborative Practice model development Integration Tools development Evaluation plan Lobby for more CNS and NP positions

15. Where are We Going? Role Clarification Needs to Continue Nurse Practitioner Clinical Nurse Specialist Primary Care Nurse Clinical Assistant/Physician Assistant Nurse Clinicians

16. Where Are We Going? Recruitment Recruitment strategies in place in WRHA Links between WRHA and RHAs through HPSEN. NLC linked with Program Liaison committee – U of M Faculty of Nursing Conditional Grant (NRRF) applies if outside Winnipeg and Brandon Relocation (NRRF) support available if moving to Manitoba

17. Visions for the Future Villeneuve and MacDonald (2006) Toward 2020 Visions for Nursing What will health and illness look like in 2020? What roles, scopes and practice settings?

18. A Sense of the Scenarios Focus on health and communities Enhanced roles for all providers Integrated interprofessional education Core competencies taught in schools Targets for increasing diversity

19. If we maintain current delivery models and levels of demand, then the shortages of nurses, physicians and other professionals being experienced in 2006 are irresolvable. We can stay on this course of another few years (more seats) or we can change demand and delivery

20. We are not working in the health care system we grew up in. Even if you wanted to keep that, it’s too late, it’s already gone. Porter-O’Grady, 1998