PALLIATIVE: CANCER CONTROL STRATEGY. Nurse Education Strategy

The College of Nurses Aotearoa wishes to provide some brief comment on this document.

Workforce

We believe that the level of workforce analysis proposed is potentially a waste of money as such an analysis implies that once a deficit is identified a planned number of nurses will be systematically identified, educated and deployed nationally. It simply doesn't happen like that and whilst many and frequent workforce analyses have been done very little, if any, planned realignment of the workforce occurs.

Rather, workforce development occurs as a result of recognition by services that they need development of workforce, that they have the resources or access to the resources to instigate that development, and that the education is available to support the development.

It would however certainly be useful as a research project to capture a snapshot of the nature and structures of employment of palliative care nurses and their professional development levels. As employees of hospices they have been somewhat marginalised from mainstream access to professional development and education and this is a serious issue for the quality of practice.

The workforce planning which does need to be done is; what is considered appropriate utilisation of differing roles, i.e. – NP; CNS; Primary Health Nurse in the palliative and oncology context. This work needs to be done by nursing across the spectrum of settings and not in one specialty area in isolation from the rest. We appreciate the frustration of nurses in specialty areas who have lived with employer driven role titles unrelated to education or experience and lacking any national cohesion or portability. In addition, nursing has been deficient in not acting powerfully to address this issue. This is long overdue.

Education

Palliative care knowledge and to a lesser extent oncology knowledge is needed across a wide spectrum of settings - primary, secondary and tertiary. It applies to practice nurses, district nurses, and nurses in acute settings and in residential care.

Clearly there is room for the development of specific oncology nursing roles in acute oncology centres but with the exception of very important palliative Nurse Practitioner roles there is a need for embedded knowledge of palliative care across the spectrum.

The most critical issue is to ensure availability of relevant education at both undergraduate and postgraduate level so that when services identify need for developing roles the education is available.

•  Undergraduate content

Do all undergrad degrees include sufficient attention to:

• Pain and symptom management
• Assessment physical and psycho-social
• Interpersonal communication skills
• Understanding the nature of ‘being palliative'
• Death and dying

The answer to this question is almost certainly no. However there is an ongoing dilemma that a three-year undergraduate nursing degree is too short to do justice to the depth and diversity of knowledge required. It is widely accepted within nursing that first year of practice programmes and postgraduate education are essential to develop specific practice components.

•  Postgraduate

It is expected that postgraduate education will be undertaken to support a nurse to:
Assume greater authority for care and management of people in oncology and palliative settings
Provide advanced symptom control
Manage the continuum of care for people with a range of cancer diagnoses
Provide specialty and generic oncology care
Lead palliative care services
Become a Nurse Practitioner (NP) in either setting

This education should not be considered in isolation from other postgraduate papers. NZ is slowly developing a reliable model where postgraduate degrees contain core papers – e.g. patho-physiology; research skills assessment and clinical decision making; pharmacology, etc. These are available in a number of tertiary settings.

The model allows completion of the whole Masters degree or exit with a postgraduate certificate or diploma as appropriate to the career goal.

Specialty papers such as palliative and oncology knowledge should be taken in conjunction with core papers as above to provide comprehensive education towards specialist nurse or NP role.

Decisions which really need to be made include just how many postgraduate centres can offer such papers and funding should be made available urgently for their design and development, including adequate consultation with relevant nursing clinicians.

Finally, it is important to note that whilst formal education is critical the presence of leadership, mentoring and access to ongoing professional development remain as critical components of quality practice in this important area.

Professor Jenny Carryer

RN, (PG Dip Oncology), PhD, FCNA(NZ), MNZM