Nurse Practitioners in New Zealand

Case Studies

Nurse Practitioner in Palliative Care
Jackie Robinson

Background

I work for Auckland District Health Board as a Palliative Care Nurse Practitioner. I completed my nursing training at Middlemore Hospital in South Auckland in 1985. After graduation I spent a year on a general medical ward before embarking on my OE spending the next four years working and travelling around Australia, UK and Europe.

I returned to New Zealand in 1990 and in 1994 I began working at South Auckland Hospice where I learnt about palliative care as a specialty providing care for patients in an inpatient setting and in their own homes. In those days most of the work provided by hospice services was predominantly end of life care and after two years I made the decision to return to the acute hospital setting in an attempt to develop an understanding of a person’s experience of diagnosis, treatment and the transition to a more palliative approach.

I spent a year on a haematology ward before moving into a Palliative Care Nurse Specialist role in 1997. The role was initially only within the Respiratory Service at Green Lane Hospital but in 1999 was integrated into a hospital wide palliative care team for all adult services. At the same time I completed a Masters Degree in Palliative Care.

Setting up the role

With the support of the Auckland City Hospital Palliative Care Team and the DHB a business plan for the Nurse Practitioner role was written and accepted with agreement that this would be a completely new role with 100% back fill into what would be a vacant nurse specialist role. This has enabled me to develop the NP role without the added pressure of trying to fill the gap I had left behind as a nurse specialist particularly with the large amount of clinical work I had become involved in over the preceding years.

I registered as a Nurse Practitioner in December 2005 and in May 2006 took up the post. As one of the three senior clinicians (2 SMO’s and 1NP) on the hospital palliative care team I provide specialist palliative care advice and input into the care of adults with a life threatening illness. This includes promotion and maintenance of health and wellbeing as well as the provision of individualised palliative care.

Clinical Practice

The role continues to evolve over time and whilst the clinical part of my work (50% of the role) is predominantly within the hospital environment my vision is to be able to use my clinical skills where ever there is a high level of patient need providing direct patient care and/or supporting clinicians to provide that care themselves regardless of hospital boundaries. Being a NP requires me to remain immersed in the clinical arena with patients, families and other health professionals. This provides me with an invaluable perspective of the clinical reality for patients and families and continues to inform me in other aspects of my role such as policy development and service initiatives at a local, regional and national level and in leadership, quality and research activities.

Professional Leadership

I have line management responsibility for three nurse specialists within the hospital palliative care service. This involves not only the usual management responsibilities such as support with professional development and performance appraisals but more importantly providing clinical role modelling and mentoring for nurse specialists new to the specialty of hospital palliative care. This is a unique role which many nurse specialists in the past have not had the benefit of.

In addition I currently hold the Nurse Adviser portfolio for the Auckland Regional Cancer Service which involves leadership responsibilities such as advocating for nursing at a management and operational level. This part of my role continues to evolve as partnerships develop with the four Clinical Directors and Business Manager.

Current Priorities

Sometimes it can be overwhelming when I consider the many exciting initiatives in palliative care at the moment I continue however to be inspired and grounded by the patients and families I work with to continue working towards accessible, equitable and high quality palliative care across all clinical settings. This helps me to set the current priorities in my role as follows:

• Support the development of a specialist nursing workforce in palliative care.
  • National, regional and local workforce planning for palliative care nurses.
  • Education and competency based framework for generalist and specialist palliative care nursing.
  • Inspire and encourage palliative care nurse specialists to develop skills that will enable them to work to their full potential.
  • Provide clinical expertise and mentoring to nurses across settings.

• Contribute to a seamless continuum of care model across the DHB to enable patients and families to be cared for in their setting of choice.
  • Facilitate linkages and relationships between the various clinical services/settings involved in the delivery of palliative care including hospices, primary health care and private hospitals.
  • Find ways to break down the barriers between the various clinical settings in which people with palliative needs are cared for.

• Support the development of a representative national organisation for palliative care nursing as a vehicle to influence change in national policy and development.
  • In partnership with several other senior nurses in palliative care we have developed a proposal with some financial backing from a local trust to create a professional group for nurses working in palliative care. This is an exciting opportunity to ensure that the nursing voice is accessed appropriately to influence change in palliative care at a national level.

• Develop flexibility in the clinical case load by ensuring that those patients and families with the greatest complexity and need are able to access specialist palliative care in a timely way wherever they may be.
  • 100% of my clinical case load is currently within the hospital setting but this needs to evolve over time to ensure that access to the NP is possible regardless of the care setting.

The Future

I would like to see more open debate and discussion on the contribution that advanced practice roles such as Nurse Practitioners and Nurse Specialists can make to achieving positive outcomes for people with palliative care needs.

It has been suggested that the work of the NP in New Zealand will contribute to the reduction in inequalities and inequity in health care. For palliative care in New Zealand this includes issues such as accessibility to an appropriate level of palliative care for all people who need it regardless of diagnosis, place of care, ethnicity or geographical location. This is inclusive of generalist palliative care as an integral part of all health care and access to specialist palliative care when the complexity and acuity of a person’s care demands it.

It is exciting to see the NP role is now a formal career option for nurses and I would be more than happy to provide support and assistance to anyone interested in this pathway.

Jackie Robinson BHSc, MPallCare
Auckland District Health Board

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