Caring for people with cancer: Nurses professional and career - - PowerPoint PPT Presentation

Caring for people with cancer: Nurses’ professional and career development needs

Denise Bryant-Lukosius, Mary Jane Esplen, Esther Green, Grace Bradish, Tazim Virani, Diana Morarescu CANO 2010 Conference – Edmonton, AB

Objectives Objectives

 Highlight the objectives and methods of a provincial

assessment of nurses’ professional development needs in cancer control.

 Highlight the critical role of stakeholders for conducting an

effective needs assessment.

 Summarize key findings/recommendations for meeting the

professional development needs of generalist and specialized nurses who provide cancer care.

 Introduce new resources in the expanded Oncology Nursing

e-Mentorship Program

Ontario Oncology APNs had identified significant need for mentorship and role development support:

– A survey of community of practice (APN-COP) members – Needs assessment studies & Cancer Care Ontario

Consensus meetings (Bryant-Lukosius et al., 2007; CCO 2006 &

2008)

• Led by the Mentorship Sub-Committee of the APN-

COP an e-Mentorship Program was established and evaluated in 2008 with the aid of funding from the MoHLTC.

Background Background

Oncology APN –Mentorship Oncology APN –Mentorship Program Evaluation Results Program Evaluation Results

Modest investments in mentorship over 2 months had significant impact

– Improved mentorship knowledge, skills, confidence &

readiness

– Improved APN intra/interprofessional collaboration – Improved APN skills & activities related to research, EBP

& leadership

– Improved APN job satisfaction: time & professional, social

community interaction

Implications Implications

 A formalized program with structured education

components & access to support prepares participants for mentorship & promotes their transition through mentorship stages

 An e-based approach increases access to APN

mentors & is appropriate, feasible & acceptable

 Interprofessional mentorship was appropriate &

acceptable & increases APN access to mentors

Program Expansion Fall 2008 Program Expansion Fall 2008

 New program partner with long-term funding to 2013  Expansion to include services for all nurses who care for adult/pediatric

populations at risk for or affected by cancer in Ontario

Provincial Needs Assessment Provincial Needs Assessment

Purpose



To identify the professional development needs of generalist and specialized oncology nurses (CANO, 2001) across the cancer continuum in Ontario that may be met through coaching, preceptorship and/or mentorship.



To examine the feasibility of providing such supports and the types of models that may be most appropriate for specific sub-groups of nurses involved in cancer control.

Professional Development Professional Development

“The ongoing commitment to ensure that your skills and ability to implement your role in

• ncology nursing are relevant and up to date.”

Provincial Advisory Committee Provincial Advisory Committee

(n= 16) (n= 16)

• Generalist, specialized & advanced RNs
• Clinical managers, senior administrators, regional VP
• Nurse educators & faculty
• Allied health providers, e-learning & technical experts
• Researchers, LHIN – health planners, provincial decision-

makers

• RNs with adult, pediatric, oncology, palliative, or public

health expertise

• Tertiary acute care & community hospitals, community

nursing agencies, home care & primary health care settings

• Urban, rural & remote settings

Provincial Advisory Committee Provincial Advisory Committee

 Participated by teleconference/email to:

– Develop needs assessment objectives & research questions – Design data collection plan – Provide feedback on data collection tools – Facilitate recruitment of participants

 One day onsite meeting to develop recommendations

about program priorities and design of new program

 Final teleconference for input on draft report and

program plan

Assessing Needs Assessing Needs

 Vision/strategies for nursing capacity development in cancer

care within organizations/programs/regions

 Clinical priorities for improving patient care through enhanced

nursing knowledge and skill

 Priorities for nursing competency development  Effectiveness of ways RNs currently address professional

development needs

 Variability in professional development needs among different

types of RN groups across the cancer continuum

Assessing Feasibility & Assessing Feasibility & Implementation Issues Implementation Issues

 RN readiness & preferences for accessing coaching,

preceptorship, mentorship services

 Availability of existing services & expertise  Potential best practice mentorship models or features  Personal, organizational & health system barriers &

facilitators to RN participation

 Integration with existing APN program

Methods of Data Collection Methods of Data Collection

Generalist & Specialized Oncology Nurses

 Online survey & telephone focus groups

Key Decision Makers

 Managers & senior nursing & non-nursing administrators  Telephone focus groups & interviews

Supportive Key Informants

 APNs, faculty & in-house educators, interprofessionals  Telephone focus groups & interviews  APN mentors also completed online survey

Recruitment Strategies Recruitment Strategies

– Personalized invitation on program letterhead tailored to

specific key informant groups

– Reminders & recruitment updates – Scheduled & adhoc/flexible meeting times – Telephone interviews & focus groups – Program Champions

 Project team, advisory committee, current program

participants

 Personal contact, invitation to participate & promote

needs assessment

 Maximized use of their contacts, networks & list serves

Data Management & Analysis Data Management & Analysis

 Interviews & focus groups – Audiotaped & transcribed – Content analysis to identify key themes  Survey – Descriptive statistics: frequency counts,

percentages

Results Results

 Focus Groups

• 13 teleconference focus groups/interviews
• 76 participants from various backgrounds
• 18 APNs
• 19 RNs/Staff Nurses
• 22 Managers/Directors/Coordinators
• 2 Faculty Members
• 5 Educators
• 6 Health Promoters/Genetic Counsellors
• 1 Researcher
• 3 New Grads - RNs

Results Results

 Electronic survey – Completed by 619 nurses

• Adult & paediatric
• Regional Cancer Centres
• Tertiary Care
• Community Hospitals
• Small Town/Rural/Remote
• Community/home care
• Public health/health promotion
• Palliative care/Hospice
• Geographic spread

– 79% of participants completed all 34 questions

Demographic Survey Data Demographic Survey Data

 Nursing profile – Over 60% were generalists – 62% were diploma prepared – 58% had 20+ years of RN experience – 47% had 10+ years of oncology experience – 42% worked in a community hospital – 82% care for adult patients – 32% had CON (C)

Results – Role Development Needs Results – Role Development Needs

 Identified a broad range of oncology

professional development needs

 Most frequently reported needs related to: – Assessment & management of disease &

treatment related complications/side effects

– Health promotion & cancer prevention – Psychosocial interventions – Palliative care

Results – Role Development Needs Results – Role Development Needs

 Some differences in the frequency of reported

needs among various types of nurses:

– Those with/without oncology or palliative care certification – Those working in cancer centre, tertiary care hospitals,

community hospitals and the community

– Generalist and specialized nurses

Results – Career & Professional Results – Career & Professional Development Experience Development Experience

 28% had engaged in a formal career

planning process

 51% had a professional development plan

Professional Development Professional Development Facilitators Facilitators (n=619)

(n=619)

Top 5 most frequently reported

– Personal motivation (49%) – Internet & e-learning (45%) – Management support (38%) – Local access to programs (35%) – Funding (35%)

Professional Development Professional Development Barriers Barriers (n=619)

(n=619)

 Top 5 most frequently reported – Lack of funding (43%) – Not able to get time off work (41%) – Staff shortages (40%) – Lack of skilled replacement staff (22%) – Lack of organizational support (18%)

Service Delivery Preferences Service Delivery Preferences

 Intra (38%) versus interprofessional (20%) or

distance mentorship (19%)

 Traditional, step ahead or peer nurse mentor from

• ne’s own organization vs outside of organization

 No difference in willingness to participate in

coaching, preceptorship or mentorship

Support Needs for Participating in Support Needs for Participating in Professional Development Activities Professional Development Activities

Top 5 most frequently reported (n= 619):

 Resources to increase knowledge about effective

coaching, preceptorship, mentorship (51%)

 Practical tools (50%)  Identifying a suitable coach, mentor, preceptor (48%)  Release time from work (43%)  Facilitate supervisor/employer support (39%)

Interview/Focus Group Interview/Focus Group Results - Priorities Results - Priorities

 All stages of the cancer continuum were identified as having

need for enhanced nursing roles & professional development

 Priority nursing groups included those providing cancer care:

– In patient homes or in the community – Rural, remote or isolated setting – Variable nurse education & experience in oncology or

palliative care

– Lack of oncology resources & role development supports – Lack of nurse awareness of available resources – High patient volumes & complex care needs

Interview/Focus Group Interview/Focus Group Results - Facilitators Results - Facilitators

 Management support  Funding  Telephone access for quick support needs  Technology  Personal motivation  Local champions  On-site mentors  APNs & educators  Networks and communities of practice  Existing educational, preceptorship, fellowship resources

Interview/Focus Group Interview/Focus Group Results - Barriers Results - Barriers

 Nurse fatigue & high workloads  Lack of funding/financial constraints  Lack of replacement staff for release time  Lack of role clarity re innovative nursing roles  Lack of awareness of professional development needs/gaps

among nurses and decision-makers

 Lack of appropriate self-assessments  Lack of administrator awareness of the benefits of mentorship

and professional development for nurses

 Technology  Lack of consistency in the offerings

Interview/Focus Group Interview/Focus Group Key Findings Key Findings

 Some confusion/lack of understanding among participants

about the differences between education, coaching, preceptoring and mentorship needs and activities

 Nurses had limited exposure to career planning and

development support

 Perceived professional practice and mentorship needs not

identified within the context of planning and developing their career in nursing

Conclusions Conclusions

 Study strengths

– High response rate & participation of generalist, specialized

and advanced practice nurses

– Breadth of practice settings and scope of cancer continuum

represented by participants

– Completeness of survey data and richness of qualitative

data

 Study Limitations

– Unable to assess geographic/regional differences – Under-representation of oncology nurse educators,

managers and researchers as targets for program services

– Confusion about education vs mentorship needs

Conclusions Conclusions

 Engagement of Steering Committee was an

asset for:

– Enabling the depth/breadth of recruitment to both

qualitative and quantitative components over a very short period of time (6 weeks)

– Ensuring the relevance of collected data – Formulating recommendations – Building ongoing program participation and support

among committee members

Steering Committee Recommendations Steering Committee Recommendations

• Need to education/prepare nurse mentees and mentors for

effective mentorship

• Mentorship needs to be put into context with other career

planning and professional development activities

• High need/interest in mentorship among nurses in various

roles across patient populations, practice settings and the cancer continuum

• High priority to support generalist & specialized nurses with

limited access to oncology expertise and resources:  Small community hospitals, community & home care

 Isolated & rural communities

Steering Committee Recommendations Steering Committee Recommendations Service preferences:

• Flexibility
• Peers, step ahead mentors and traditional mentors

in the same organization

• Structured resources and activities
• Full day sessions on a weekday
• Distance mentoring would work for some with

appropriate supports

Steering Committee Recommendations Steering Committee Recommendations

• A systems approach to leverage on key stakeholders at

different levels in the system will be required to address barriers to nurse participation in the program

• Consider mentor organizations – create partnerships

between organizations – inter-organizational learning

• Incentives – provide mid-career nurses educational
• pportunities and have them mentor novice nurses
• Personal motivation is a key facilitator – creating readiness is

therefore an important area of activity

Setting the Context: Developing Setting the Context: Developing Your Career in Oncology Nursing Your Career in Oncology Nursing

Professional Development in Oncology Nursing

Career Planning and Development in Oncology Nursing

Mentoring

Preceptoring Coaching

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Enhanced Services & Resources Enhanced Services & Resources

 Confidential, electronic application process for generalist,

specialized & advanced practice nurses

 Electronic, personalized screening & matching process with

program support

 1-day Mentorship Orientation Workshop  Mentorship Workbook  e-based platform & resources  Stipends for distance mentorship & mentor training

New Features New Features

 Career Development Workshop  Online Career Development Program  Individual and group coaching and career counselling  Resume Writing Workshop  New interactive website

 Private and group discussion forms  A wiki space  Coaching & preceptorship resources

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Career Development Workshop Career Development Workshop

“I was able to realize that I need to

further my education in order to fulfill my role more efficiently.” “I networked with colleagues and got tips to move forward in small manageable steps.” “Great session to determine my vision and provided me with clear plan to achieve my goals.”

Contact Information:

• nment@mcmaster.ca

905-387-9711 ext. 67702