The latest on Nurse Navigators
We are writing to provide a update on the Nurse Navigator (NN) Program, since our last update there has been a delay in the Department confirming with HHSs the number of NN positions we understand this was due to some HHSs not being pleased with the proposed numbers.
What that has meant is that the majority of HHSs have not been advised how many Nurse Navigator positions they will be funded for, which has then meant they are unsure how/ where they will use those resources. In saying this, there has been one HHS – the Gold Coast that has had their numbers confirmed and as such we met with GC HHS last week as they were in a position to consult with our members on how they propose the NNP will roll out in their HHS.
The meeting was positive. The GC HHS were able to answer our questions in reasonable detail and are open for request for further clarity if needed.
Below are our questions and the responses from Gold Coast Hospital and Health Service.
Q1. What will be the role of the Nurse Navigators in GCHHS?
Their role will be focussed on facilitating care coordination across the continuum from home through hospital and back to home, primarily targeting patients with chronic disease. The combination of Nurse Practitioners and Nurse Grade 7's will enable them to prescribe and treat patients. They will also aim to keep patients well in the community and prevent readmissions into hospital. Where appropriate, they will liaise with Gold Coast Integrated Care. We expect models of care to be redesigned to accommodate Nurse Navigators and we will ensure Nurse Navigators and their teams will receive training in this new model of care, especially around relational coordination skills
Q2. How many nurse navigators will be across GCHHS and where will they be located?
Q3. When will these roles commence?
The proposed numbers are for a total of 13 Nurse Practitioners, and 37 Nurse Grade 7's. The roles will be gradually phased in over the next 4years as follows:
- 5 in February 2016
- 5 in October 2016
- 10 in July 2017
- 15 in October 2017
- 10 in October 2018
- 5 in May 2019
We have considered our services and service needs -and plan to start with paediatrics. The roll out to mental health and maternity teams will follow, building on lessons learned with the paediatric roll out.
Q4. What will be the reporting lines with these new roles?
A Nurse Grade 9 was proposed to lead the program but this position is not funded yet. It is planned that this position will report through to Professor of Nursing. More clarification will be available when the number of positions is confirmed. Progress is being made towards setting up a governance group and finalising the terms of reference.
Q5. What is GCHHS doing to ensure workloads for social work do not increase as a result of more referrals as suggested at the RCG?
Following discussion about the potential for better screening to identify more patients, there was recognition that a useful discharge screening tool, the Distress Screening Tool, was developed between cancer care coordinators and social workers. With the gradual rollout of the Nurse Navigator positions in discrete teams, there will opportunity to develop screening tools and appropriate models of care at the inception of these roles, together with social workers and other allied health professionals.
A separate project is looking to develop systems and tools to ensure allied health staff area appropriately contributing in areas of service need.
Discussion of the limited community resources for safe discharge of many patients was also noted. It was recognised that Nurse Navigators may be able to improve advocacy re discharge planning eg lack of referral pathways for safe housing, complexity of my aged care.
Q6. Can you provide a written commitment that there will be no loss of allied health roles or resources as a result of the NNP?
In GCHHS, there has been no discussion about role swapping. Nursing resources are separate to and independent of allied health resources. The organisation is committed to provide appropriate numbers of nurses and allied health professionals to provide quality and safe patient care.
Discussion about the similarities in role description between Nurse Navigators and Social Workers was noted - there will be opportunities for nurses and allied health professionals to work together and for the Nurse Navigators to potentially increase the efficiency of referrals to allied health, in order to maximise outcomes for patients
Q7. What process for consultation and review are going to be in place for the development and roll out of this new program? How will allied health be included?
Wide consultation has begun with executive teams, and clinical leads of the 4 directorates, through developing the business case. The Professor of Nursing will work with these key stakeholders in determining roll out and will ensure allied health are included in discussion in each clinical area. There will be open dialogue and a formal evaluation of the programme.
Q8. The impact of any NN positions on anticipated growth in SW positions - concerns regarding these roles intruding on future SW roles.
These are 2 separate issues and there is no intention to bring them together. The aim is for greater collaboration in the interests of the patients, so that nursing and social work roles complement each other. Project work is in place to develop staff and systems to ensure appropriate allied health staffing.
Following member feedback, we will need further follow up outside of this meeting on the response to Question 6. Together members and your local organiser Ty Prior are pursuing this issue.
We expect that over the next week or two more of the HHSs should also receive information from the department confirming the number of Nurse Navigator positions they will get and the timeframes.
Some Services have already expressed that they will be in contact as soon as they receive this information to organise a meeting.
We will continue to provide further updates as this progresses.
In the meantime if you have any questions or concerns please contact your Together Health Team at firstname.lastname@example.org.