CREATING A VOICE FOR
NURSES
Erik van Muilekom MANP, OCN, RN
Clinical nurse specialist Netherlands Cancer institute-
Antoni van Leeuwenhoek hospital Amsterdam
!
European Oncology Nursing Society
2014
!Charity established 1984 UK!
!30 European countries represented
– 22.000 cancer nurses
!
!Affiliated NGO´s – Non Governmental Organizations other cancer organisations
ECCO, ESO, ONS, ISNCC, UICC
EONS 2014
Austria Belgium(2) Bulgaria Czech Republic Croatia Cyprus Denmark Estonia Finland France Germany Greece Hungry Iceland Ireland Israel Italy Lithuania Malta Norway The Netherlands Poland Portugal Serbia Sweden Switzerland Slovenia Spain Turkey UK(2)30 countries and 26 languages EONS = English
Vision
!
That all people affected by cancer across Europe will benefit from the care of well
educated, well informed and highly
competent cancer nurses, who will play a central role in providing support, promoting
Mission
!
Working in partnership to develop and promote
excellence in cancer nursing practice
through
!
education, research, leadership and support
Values
!
To be an inclusive and credible organisation, which aims to provide effective and practical support to
all members across Europe.
!
Work in co-operation with a range of
multidisciplinary organizations to optimise the nursing contribution to cancer care in Europe.
CREATING A VOICE FOR NURSES
!
Proud to be a nurse
!
Cancer in Europe
!
Nursing workforse
!
Let’s hear your voice
!
Organisation
!
Education
!
Advanced nursing practise
Nursing staffing cuts to save money, effects patients, increase bachelor education for nurses could reduce hospital deaths!
Nursing staffing and education and
hospital mortality in EU
!Increase workload-increased mortality
!> 6 patients per nurse higher mortality
!More bachelor’s degree nurses decrease mortality
!
!Cutting nurse staffing to same money affects patients outcomes
!Increase education prevent hospital deaths (Aiken et al, (2014), Lancet)
What is happening in Europe with cancer
care
!Aging populations and professionals
!
!Fast changing treatments
!
!Change in how we deliver cancer services
!
(Ferlay et al (2013) EJC, 49, 6, 1374 – 1403)
♀ Cancer patients 3.45 miljoen ♂ Cancer deaths 1.75 miljoen
♀
Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012
(Ferlay et al (2013) EJC, 49, 6, 1374 – 1403)
Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012
Europe and Ageing population
(United Nations New York , World Population Ageing 2013)
Facts
!Ageing population
!Increasing demand for healthcare
!Elderly people multiple chronic conditions
(Gatta G et al , 2014 Lancet Oncol)
Improved survival but differences between countries, accesibility to good care, variation different reasons
Health workforce
!
Also
Aging
Insufficient new recruits to
replace those retiring
2010 2060
Patients > 65 years
87 million 152,7 million Doctors 30% > 55 years
Nurses Age 41-45 years
The average age of the nurse in many countries > 40 year ! Canada - 44.6 ! Denmark - 43.8 ! Iceland - 44 ! Ireland - 41.4 ! Germany - 39.4 ! Japan - 37.9 ! New Zealand - 44 ! Singapore - 35 ! Thailand - 41 ! United Kingdom - 42 ! United States - 46.8*
Health workforse
!
Also
Growing feminization
healthcare workforce
!13.1 million Women 2010=75%
of the workforce
!Health workforse
!Also Increasing turnover health professions ! Due to !Low pay!Long working hours
!Stress
Estimated shortage in EU 2020
!Undersupply of health professionals rural, poor
populated areas
!Unequel distribution of health professionals
Estimated shortage 2020 Estimated % care not covered Physicians 230.000 13,5% Dentist, pharmacists and physiotherapists 150.000 13,5% Nurses 590.000 14% Total 970.000 13,8%
EU action plan
!
Forcasting workforce needs
!
Anticipating future skills needed in health
professions
!
Share good practice
!
Effective recruitment
What can
we do as
Nursing pr
ofession
Policy: EU Green paper
“
Progress on improving the health status of
the population and providing better
provision of, and access to, healthcare for
all across Europe cannot be realised
without a workforce of sufficient capacity
and with the right skills.”
!
Caring in Crisis
!Nurses in EU work harder than before, asked to provide more for less
!
!Nurses (female) are unequally and hardest hit
!
!Lack of equipment, reduced supplies, inadequate staffing, placing patients lives in danger
Current Challenges
!Increasing public awareness of oncology nurses potential in Europe
!Shortage of oncology nursing workforce
!Diversity of roles, titles and qualifications*
!Mobility
!Rapidly changing healthcare systems
!Personalized care
*Schneider & Faithfull (2008) http://www.cancernurse.eu/documents/newsletter/2011spring/ EONSNewsletter2011springPage28.pdf
!
Who has the power
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What is realistic to reach
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Where are my friends
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Who are my enemies
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Can I make small steps
!
!
When to go for it!!!!!
Dutch Oncology Nursing Society
!
2600 members, oncology nurses
!
!
25 years
!
!
Active membership
!
Depending on individuals
Education of nurses is a major key to quality care and better outcomes for patients
Improve cancer nursing care
! New Core Curriculum is based eight modules and focuses on the adult with cancer
! Can be used for curricula development for all nursing education programs
! Nurses working in cancer centers or in general practice/hospital settings
Did cancer nursing in EU change due to
EONS existence
!Cancer nursing as a specialty
!
!Advanced nursing practice
! !Nursing research ! !Differences in Europe ! !Making progress
EONS member survey 2013
Countries cancer nursing recognized
as a specialist area of nursing Practice
Countries cancer nursing NOT
recognized as a specialist area of nursing Practice Belgium Croatia Cyprus Denmark Estonia Finland Iceland Ireland Hungary Lithuania Norway Sweden Poland The Netherlands Turkey UK Austria Czech Republic France Greece Malta Serbia Switzerland Slovenia Portugal Spain Total: 16 10
Recognition of cancer nursing
Working on a European level
!
Development advanced nursing
practice globally
Development advanced nursing
practice globally
!
Advanced practice nursing rol expanded last
decade
!
!
Education programs but sometimes no jobs
!
!
Requires a healthcare environment of
multidisciplinarity
Advanced practic nurse
“A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert
knowledge base, complex decision-making skills and clinical competencies for expanded practice, the
characteristics of which are shaped by the context and/or country in which s/he is credentialed to
practice.
!
A Masters degree is recommended for entry level.”
!
Advanced practice nurse
! Educational preparation
!Recognition education programs
!Fromal system licensure, registration, certification etc……..
! Nature of practice
!Intergrates research
!Autonomy
!Consultant services etc….
! Regulatory mechanisms
!Right to diagnose
!Prescribe medication, treatment
!Recognized titles etc…..
Best of both worlds
Physicians
domain
Joint
domain
Nursing
domain
(Lewis R., 2009, Journal of Advanced Nursing)
Results/conclusion:
!
4 trials
•No difference in survival, recurrence, psychological morbidity
•Patients more satisfied with nurse follow up
•Telephone follow-up good alternative
•Costs less than of physician led follow up
!
•No statistical comparison
!
(Faithfull, 2001, BJC)
Results/conclusion:
!
•No difference symptom scores over time nurse-led vs physician-led
!
•Patients received nurse-led care more satisfied
•Significant cost benefits (31% reduction)
!
•Evidence nurse-led follow up safe (coping symptoms, telephone support)
Results/conclusion:
!
•Nurse-led symptom management clinic reduces hospitalization
•Toxicities controlled, costs reduce
Results/conclusion:
!
•Nurse-led symptom management toxicity/side effects is possible
Best of both worlds
(VBOC, 2006, Verpleegkundige toekomst in goede banen)
Be visible as a nurse
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Card
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Titles
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Speak openly
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Media newspapers/TV/internet
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Politics
!Evidence besed practice
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Translate research findings in practise
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Use guidelines
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Stimulate education
Patients with voices
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Listen to them
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Collaborate with them
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Policy statements together
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Advocate for them
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Allliance facing
!Politicians
!Other stakeholders
Patients are the best promotion
In order to be successfull
!
! Important for nurses to work together,
! Across employment settings and roles,
! To advocate on behalf of colleagues and the profession.
! Nurses comprise the largest professional group within healthcare
!
! and have been recognized by the public as the
most trusted profession
Patients are the best promotion
In order to be successfull
!
Despite nursing’s strengths inherent in its size,
diversity, and unique relationship with the public, the full potential for influence by the nursing profession
has yet to be realized
! !
THE TURKISH
Participation
!Fatigue Workshop in1996 Milan
!All Spring Conventions, first in Leuven 1998
!First strategic planning meeting for 1998-2002 in Brussels
!Masterclass Programs
!The study of “Complementary and alternative medicine in cancer patients in Europe” with 13 other countries in 2005
Grants and Awards Recieved
!€1000 from Novartis Pharmaceutical Company
!Novice Research Award and Best Poster Award
!EONS Grant for ECCO15
!Clinical Travel Grant
Translation
!Many articles from the EONS Newsletter
!Post Basic Core Curriculum
! Extravasation Guidelines 2007
!TITAN
Our contribution to EONS
!Had an advisory board member in EONS
!Served for the 4th Spring Convention in Edinburgh 2004
!Sultan Kav EONS Board Member and President from 2005 to 2013
Results and Impact
!
!13 TITAN Courses
!3 TARGETcourses
!The extravasation guidelines
!EONS provides a role model
!Courses, workshops, masterclasses,conventions
