alyson wheelhouse, southern health: understanding role development, fostering clinical leadership...

Role Development and Ensuring a

Sustainable Model: Mental Health

Eating Disorder Nurse Practitioner

Alyson Wheelhouse

Nurse Practitioner (Mental Health)

Wellness and Recovery Centre – Eating Disorders, Southern Health

Southern Health

Workforce Sustainability

• “Sustainable models of Nurse Practitioners in public mental health and drug clinical services” prepared for Nurse Policy Brach, DoH

• Increased need for high level mental health expertise

• Overall decline in the workforce – need for ED specialists

• Emergence of increasing numbers of patients with complex needs

Role Development

• SH Internal service review (2010)

• ED exceeding current resources

• Interface between psychiatry and medicine fragmented

• Significant growing burden on health and illness

• Need to improve capacity and expertise

• NP role identified as key priority in the workforce

• Funding required to develop effective model

Key Principles

• Model does not replace existing services, or positions

• Role is to fill the gap where positions do not already exist

• To be an extension of the current service, allowing improved capacity and expertise

• Aim to utilise advanced knowledge and skills (leadership and clinical) in psychiatric, physical and nutritional assessment and treatment

Eating Disorder Wellness and Recovery Centre: Intake and Assessment (Diagnostic, Evaluation and Treatment Planning)

Inpatient Medical Psychiatric

Outpatient Treatment (clinic based) Child and Youth Adult

Southern Health Intensive Outpatient Treatment Program/ Adult Day Program

Southern Health/ Butterfly Eating Disorder Day Program

Adolescent Medicine – ED Clinic

Primary Mental Health and Early Intervention Team

Referrals from: Southern Health Psychiatric Triage Service

Referrals from: General Practitioners, and other Health Care Providers Referrals from:

GPs, Paediatricians, Primary care, SH and regional CAMHS

Assessed as Suitable for Shared Care Community Models (tier 1 & 2). Nurse Practitioner/Coordinator to facilitate in partnerships with PMH&EI or General Medicine

Case Study

• 21 year old medical student referred by GP

• Weight 38kg, BMI 13

• Obesity one year ago

• Rapid weight loss

• Seen in emergency x 2. Discharged home

• Ax by NP one week later, further weight loss and medical instability

• Patient offered a medical admission

Support Sustainability

• Clearly defined Governance – individual and service driven steering committees

• Strategic Management – direction of goals / vision

• Organisational support

• Mentoring – clinical and professional support

• Education and training

• External supports - collaborative

Governance

• Governed by the Nursing and Midwifery Executive Leadership Team (NMELT) – shows commitment the role

• SH NP Steering Committee identifies and prioritises areas for future development

• Identifies education requirements

• Allows the service to evaluate the current roles and explore future roles

Steering Committee

• Ensures Governance and oversight of role

• Ensures preparation

• Forum to share and discuss common themes

• Clarify expectations

• Facilitate updates

• Networking

• Collectively meet key stakeholders / experts

Organisational Support

• Implications for ongoing role development

• Support for Education (university studies) – funding and time

• Willingness of Senior Management including the Director of Nursing and Executive Director to provide support and mentorship

• Philosophical approach to the NP being seen as a clinical leader working as part of a MDT

NP/NPC Meetings

• NP/NPC Group meet monthly

• Supported by Nurse Consultant – Professional Practice

• 1 hour to discuss common challenges

• 1 hour for professional development (usually presented by a member of the group)

• Quarterly 3 hour professional development Master class – usually provided by craft experts

Communities of Practice

• Opportunity to develop support networks

• Capacity building

• Provide forum for advice

• Facilitate sharing of resources

• Practice innovation and development

• Role profiling

• Group representation

Education

• 20% non clinical role ( 1 day week FT NPC/NP)

• Built into budget

• Initial and ongoing education requirement

• Medical and Nursing supervision

• Attendance internal and state-wide

• Seminars and conferences

• Yearly plan

• Keep a log

Mentoring and Supervision

• Access (time and support) to Medical Consultants, Psychiatrists, Dietitians and Physicians

• Need to ensure NP can perform the role

• Access to clinical guidelines, and training needs

• Link to existing training

Funding

• Government funding based on delivery of target domains

• Need to demonstrate effective and efficient use of resources

• 2010 DoH approved SH service model

• Pilot funding for 18mths based on data analysis and feedback forums

• Secure funding was granted June 2012

Evaluation Tools

• Required to ensure quality of delivery and responsiveness

• Requirement that NP demonstrates outcomes

• Develop Key Performance Indicators

• Develop audit tools – identify expanded role and assess impact on service

• Include in annual performance appraisal- DON and Manager

Leadership

• Envisioning a better service – quality activities

• Motivating / empowering others – encouraging change, and role modeling

• Enticing others to join the vision – being available, consultation and liaison

• Thinking in a different way – evidence based practice, initiate and contribute to quality improvement, assist in policy development, taking risks, propose alternatives

Interpersonal Qualities

• Be committed, resilient and driven

• Academic ability

• Operate independently

• Organised

• Manage conflict / draw backs

• Good communication skills

• Collaborate – representation on committees and conferences, liaison

Barriers to Sustainability

• Endorsement process seen as a deterrent

• Inability to identify suitable candidate

• Lack of support

• Lack of resources

• Inability of NP to meet expectations

• Productivity limited by current legislation

• Fill a service gap

Barriers to Sustainability

• Risk of evaporating into existing position

• View that the role is not transferable across the service

• Model - Answer to all the problems!!

Benefits of Role

• Efficient and timely assessment

• Reduction in admissions

• Engagement in early treatment and detection

• Enhancing clinical and professional leadership

• Improvement in research activities

• Enhancement in opportunities for the nursing profession

• Enhancement of opportunities for collaboration

Key take home message

• Recognise positions require extensive availability of support

• Clear and sustainable model

• Research and consult prior to employing into Candidate positions

• Ensure Governance arrangements

• Organisation and Candidate to commit

• Shared vision and understanding of the Scope of Practice

Questions

Alyson Wheelhouse

Nurse Practitioner

Wellness and Recovery Centre – Eating Disorders, Southern Health

03 9594 1300

0438 353 722

alyson.wheelhouse@southernhealth.org.au