Overview

A significant barrier to Nurse Practitioner (NP) implementation can be the time and resources to prepare an advanced nurse to be endorsed as a NP. Supporting supervised clinical practice and professional supervision is a significant “up front” training cost for health services that cannot be off set by productivity in the short term.

NPCSP’sare an initiative of Nurse Policy as part of the Victorian Nurse Practitioner Project (VNPP).Eligible public health services can apply for a NPCSP through VNPP funding rounds. The funding is a contribution towards the costs of providing clinical and professional supervision and support for a Nurse PractitionerCandidate (NPC).

Following the appointment of a NPC, organisations who have received model development funding Round 4.8 are required to notify Nurse Policy. Following notification the funds will be distributed.

Refer to section 3 for full details of eligibility and assessment criteria.

The NPCSP funds will be transferred to health services in this financial year.

CONTENTS

Rationale

NP Candidate Support Package details

NP Candidate Support Package eligibility

Eligible costs

NP Candidate Support Program

Transition planning

Funding assumptions

Evaluation of program

Reporting

Withdrawal of candidature

Department of Health /

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VNPP Phase 4, R4.8-NPC Support Package Guidelines Page 1

NP Candidate Support Packages

  1. Rationale

The preparation to become a NP includes formal educational preparation, workplace training and coaching. Whilst nurses undertaking preparation to become a NP will have well developed advanced practice skills in their given area of practice, a period of supervision and clinical training is generally needed to support the transition to practice as an endorsed NP.

Nursing is a practice-based discipline and the NP role is at the peak of clinical practice. The preparation of a NP requires the integration of academic theory with clinical practice as well as mastery and application of advanced clinical assessment and diagnostic skills and knowledge and competence in pharmacotherapy and other treatment options. In addition to these competencies[1], NPs need to develop strong research abilities and demonstrate advanced clinical leadership ability.

Academic programs for NPs (such as Masters of Advanced Practice) often require students to undertake periods of supervised clinical practice. In addition, employers may identify specific clinical competencies that they will require NPs to have to meet service demands that need to be developed in the NP candidates.

One approach is for employers to provide a “clinical internship” for NP candidates – a structured and supported program of clinical and professional supervision that is individualised and aligned with the academic program. Such an approach is in the interest of both employers and the nurse as it contributes to the overall likelihood that an individual will successfully complete their academic program and will progress to endorsement in a timely manner.

  1. NP Candidate Support Package details

Nurse Policy is offering up to $8,000 to health services as a contribution towards the costs of providing clinical and professional supervision and support for each NP candidate. Funding is provided to health services as a one–off, capped unit price and may be pro rata depending on the intensity and length of support required. Public health services may apply for a NPCSP for a nurse, in their employment and who they are supporting to prepare for NP endorsement.

The NPCSP is not intended to cover the full costs associated with providing supported preparation and it is recognised that a significant up front contribution is made by employers that cannot be readily offset by productivity gains in the short to medium term. However, it is also clear that creating a critical mass of candidates has the potential to reduce the cost of delivering programs by reducing duplication and sharing of resources.

In particular, providing supervision for NPC in rural areas and/or smaller services may necessitate travel to larger centres or sites to ensure candidates have access to the range of clinical services and supervisors needed.

NOTE:The VNPP does not provide separate funding for NP positions/salaries. Funding for ongoing positions for endorsed NPs must be found from existing funding streams and the provision of an NPCSPby DH is not linked to, or an undertaking to, provide additional salary support in the future.

Health services need to undertake an analysis of the internal budget optionsfor supporting NPs as part of the NP model development.

  1. NPCSPEligibility

In this NPCSP, public health services can apply for NPCSP for nurses that:

(i)Have received model development funding VNPP Round 4.8

(ii)Eligible for endorsement as a NP in Victoria (Registered in Victoria in Division 1, 3 or 4)

(iii)Employed in a Victorian public hospital or health service (rural, regional or metropolitan)

(iv)Nominated/engaged as a NP candidate with a formal letter of employment stating the expectations and responsibilities of both employer and employee with respect to the candidacy including negotiated timeframes to complete studies and present application for endorsement, commitment to employment as NP when endorsed, etc.

(v)in their early/mid phase of candidacy and enrolled in or completed a course of study (Masters and pharmacology units) that leads to endorsement as a NP, OR are being supported to meet the NMBA requirements for endorsement.

(vi)Have an agreed structured program of clinical and professional supervision in place designed to assist in meeting endorsement and course requirements

(vii) Are practising in an area/service that is aligned with the organisation’s service and/or strategic plan

Further, the organisation will have:

(viii) developed or has a commitment to develop a model of care, inclusive of a NP role that demonstrates the service benefits in the area the NPC is practising

(ix) a proven track record of successful implementation of endorsed NPs

(x) ability to accept the funds in the current financial year.

  1. Eligible costs

NPC preparation involves clinical supervision by expert practitioners. Given the neophyte nature of the NP role, this clinical supervisor role will generally need to be undertaken by senior clinicians from other disciplines (radiographers, pharmacists, surgeons or physicians depending on the clinical specialty) until there are sufficient numbers of NPs who can take on the supervisor role.

The NPCSP may be used for reasonable costs associated with the clinical and professional supervision provided by health services to nominated NPCs, such as:

  • Accessing supervision when supervisor is not employed by health service (such as payment of GPs, community pharmacist, payment of sessional rates for supervisors). Note: there is an expectation that salaried staff will provide supervisory services as part of their commitment to training and development.
  • Contribution to backfill for NPCs whilst having supervision
  • Reasonable cost of teleconferencing or travelling to access supervisors
  • Participation in collaborative activities

The NPCSP funds are not to be used for course fees associated with undertaking postgraduate studies (either Masters or pharmacology units) [2], for the fees associated with applying to NBV for an endorsement as an NP, or any costs directly associated with preparation of documents for assessment by NBV.

  1. NP Candidate Support Program

Health services who receive funding for a NPCSP are required to establish a support program that bridges the clinical requirements of the academic program as well as any specific skills and competencies that will be required in the service model in which the nurse will be employed as a NP.

The NPCSPisintended to support:

  • Clinical supervision for activities that are extensions to nursing practice
  • Specific skills acquisition
  • Professional supervision/mentoring

A comprehensive and individualised package will include:

  • Description of the skills/competencies to be achieved and assessment requirements
  • Learning objectives and specific performance expectations
  • Expectations regarding timeframes

The specific program developed by the health service as part of the NPCSPneeds to recognise and accommodate that:

  • each NPC will start at different levels, progress at a different rates and respond differently to learning experiences therefore the learning needs of a NPC will vary from NPC to NPC as well as across the period of candidacy
  • the program may be required to extend over 1-2 years
  • the NPC may be accessing study leave to undertake formal education requirements whilst undertaking candidacy
  • supervision of a NPC may be provided by a range of people over the course of their candidacy including but not limited to, the disciplines of nursing, medical, pathology, and pharmacy, radiology and physiotherapy. This model of inter disciplinary supervision is particularly needed where there are no endorsed NPs practising who can provide the candidate with the additional teaching and training expertise[3]
  • the NPC will access existing training opportunities where the competency/skill development is shared (e.g. registrar/specialist training sessions, teaching rounds, clinical audit etc)
  • clinical exposure and supervision may need to be provided outside the nurse’s current work setting or even outside the employing organisation
  • both structured and unstructured learning opportunities and support are necessary and time may be dedicated to a range of activities such as seminars, group discussion, observation, reflective practice techniques, journaling, research and investigation, peer support and personal supervision or mentoring
  • as NPCs develop their capacity to practise with increasing autonomy, they can assume responsibility for a more complex and diverse clinical workload
  • NPCs generally begin a candidacy as advanced practice nurses and as such supervision should focus on new practice capability
  • a range of assessment methods and tools are applied throughout the program to ensure the learning objectives of the NPC are met and competence is demonstrated.

NPCs should also be provided with appropriate resources including:

  • time to undertake the program and maintain manageable workloads
  • access to suitable supervisors (clinical and professional) and mentors that understand the role and objectives of the supervision
  • flexible rostering to allow them to meet study requirements and work with/spend time with supervisors
  • access to library facilities (including on-line), office equipment and clinical skills development equipment/simulators etc.
  1. Transition planning

The NPCSPshould also be used to develop a suitable strategy to manage the transition from NPC to endorsed NP including re-negotiation of conditions of employment (if required) to meet service need.

Planning for employment as an NP also needs to recognise that although a primarily clinical role, there is a requirement that NPs continue to undertake those elements of their practice that are essential (and a requirement of ongoing endorsement) such as clinical leadership, audit and research and these activities need to be accommodated within the NP role and workload.

  1. Funding assumptions

The cost of the clinical supervision component of current NP master degrees is at present estimated to be in the range of $15-25,000 per individual however total costs are dependant on factors such as on base grade of the nurse/NP candidate, the service setting, model of supervision, number of nurses or NPC being supported within a given health service, ability to access to other relevant advanced clinical training programs (e.g. registrar training) and base level of competence, preparation and education of the nurse when appointed as a candidate.

One-to-one supervisory arrangements are not necessarily the most cost effective and there are clearly economies of scale and larger organisations or collaborative models with cost and resource sharing will be more cost effective.

The funding approach for NPCSPalso assumes the full use of each nurse’s EBA entitlements (e.g. study leave) and recognises that smaller/rural health services may have to pay GPs, whilst larger organisations will have a greater capacity to access salaried staff for supervision.A “pro-rata” funding package may be negotiated for NPCswho are well advanced or midway to endorsement at the time of this funding round.

  1. Evaluation of program

It is anticipated that NP Candidate Support Programsprovided by health services will evolve in response to evaluation and the organisational and candidate needs and experiences. Local evaluations should be structured to elicit information about:

  • Satisfaction of candidates, clinical and professional supervisors with program
  • Completion of specific clinical competencies
  • Changes to care delivery, clinical outcomes or process measures indicating the uptake of the model and/or impact of the NP role
  • Time to endorsement.

Nurse Policy will request health services collect and provide information about the packages and the types of programs offered to assist the department in informing the policy framework and funding allocation for this initiative.

  1. Reporting of NPCSP

Health services receiving funding for NPCSP are required to provide a quarterly log (summary level data) of the supervision provided to each candidate, supervisors and the focus of the supervision.To ensure standardised data is received, a template log book page will be provided by Nurse Policy for all candidates receiving a package. Acquittal of funds used for additional candidate support and supervision costs (travel, teleconferencing etc) will be included in the log.

The log of candidate support will provide DH with information about the cost of supporting NP candidates and assist in identifying the actual costs associated with role implementation.

  1. Withdrawal of candidature

If a nurse who has been receiving a NPCSPceases employment with the health service(or takes leave of longer than 6 months), Nurse Policy must be notified as soon as practicable to discuss the funding.

NPCSP funding is not transferable to another candidate without the written permission of Nurse Policy. If a NP candidate transfers to another public health service into a candidate position, pro rata transfer of funds may be required. A case by case assessment including consideration of the costs incurred to date and time to presentation to the registration authority will be made by Nurse Policy.

  1. Further information or assistance:

Health services that have not taken part in recent VNPP funding rounds are encouraged to contact Nurse Policy to discuss their application for a NPCSP prior to submitting an application.

For more information please contactKaty Fielding

(03) 90968227.

Andrea Hutchinson

90967798

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VNPP R4.8,NPC Support Package Guidelines Page 1 of 6

[1]The ANMC National Competency Standards for the Nurse Practitioner have been accepted by allnursing and midwifery registration authorities (including the Nursing andMidwifery Board of Australia) and form the basis by which NPs are performance is assessed to obtain and retain their license to practice as a nurse practitioner in Australia. The standards build on the core competency standards for registered nurses and midwives, and the advanced nursing practice competency standards. The competency standards act as a framework for assessing competence and are used by higher education providers when developing nursing curricula, and to assess student performance for those specific courses that prepare nurses for endorsement as an NP.

[2]Postgraduate scholarships for NPs are offered by Nurse Policy as well as other organisations such as RCNA and professional organisations.

[3] Refer to NP Fact Sheet “NPs and supervision”