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
Recommended
