ICCN 17

Educational programmes for oncology nurses

Professor Mary Jane Esplen – University Health Network, Toronto, Canada




Can you tell us about your presentation?

I think most people know now that nurses don’t come out of school now, regardless of their degree, with any kind of qualifications or education that prepares them life-long for dealing with the complexities of cancer. No single degree any more really prepares any health professional for a life-long application of their knowledge because the knowledge keeps changing, there’s new evidence all the time, new technology coming down the pipe around cancer. So what we’re trying to do is raise the bar for oncology nursing and really promote excellence in oncology care. What the institute does is we cover the whole range from prevention all the way through to palliative and end of life care, preparing programmes that really take the latest evidence and the latest practices and applies them in a knowledge translation way that makes it really palatable for the frontline clinician so that they very quickly have the latest evidence and are able to apply it to their practice. So it’s very clinically practice oriented and we’re about 80% continuing education and about 20% graduate education. We have, in fact, launched something in Canada called the De Souza Nurse Designation; this is the new designation that represents excellence in oncology care and it’s a really a nurse who has had advanced excellent training, greater training and greater clinical fellowship, again to have the latest evidence and to improve her practice. So this has been launched, we’re trying to reach out actually beyond Ontario to the rest of Canada. The education is free to any nurse working anywhere in the continuum of care, so she or he could be a specialist in a cancer hospital, they could also be… the nurses could be a generalist working in community or a general hospital or in surgery. Regardless of where the nurse works and regardless geographically, we’re trying to reach everybody in the province delivering cancer care. So, Beyond the Borders really is about trying to meet the challenges and aegis of nurses who are different generations; trying to reach nurses no matter where they practice along the spectrum of care and trying to reach them no matter what level of practice. Obviously for the graduate nurse as well as the undergraduate nurse we have programmes. So we have e-learning, we use a lot of e-learning, about 70% e-learning. We use face to face modalities; we have mobile learning now, we use avatars in our programmes and the latest technologies, trying to be quite innovative because we have to have a lot of access across the province.

Can modules be selected?

Each of the designations, we have four designations: the De Souza Associate would be for the generalist; the De Souza Nurse would be a speciality nurse who has written a certification exam in Canada for oncology or palliative care and she or he would take their courses from a selection, from a menu of courses across four particular domains. These domains are areas of practice so, for example, treatment and symptom delivery: managing treatments and the symptoms from the disease; professional development courses; therapeutic relationship type courses, so communication, psychosocial, managing psychosocial distress; patient education and teaching. So they are quite different but each nurse can select his or her courses according to their area of practice, we certainly have palliative care nurses. And then we have the De Souza APN levels, so those nurses do a clinical fellowship or research fellowship and might take courses in leadership, a research institute or advanced practice issues. We even have a PhD level, the De Souza Scholar which those are nurses in a PhD programme who are doing advanced training and research and we’re hoping will stay with us and teach. Because we’re really trying to engage nurses into a lifelong system so that the novices come early after graduation but our average age of nurses is 48 or so, so we’re actually hitting a lot of mid-level career nurses as well as nurses in the field 25, 30 years who really are going back writing exams and actually trying to advance their practice.

Are nurses proactive in taking courses?

Some are and some aren’t. What we do is all of the courses at this point are at no cost, so that’s a big help. We’re working with leaders to help get them to support their nurses to come to us and we go out all over, I mean, they don’t come necessarily to a learning institute, they may, some of the times we do a face to face course where they attend and we pay the way. But we reach out, we have incentives that are not necessarily monetary rewards but I know that we’re doing a public campaign so my sense is that over time patients will start to ask, “Are you a De Souza Nurse?” We’re starting to see a little bit of evidence where leaders are now hiring individuals who have either engaged in De Souza programmes or have actually reached the De Souza designation. However, there are nurses not motivated; we’re trying to do a lot of education outreach around the need, why they would need to still enhance their practice, that they couldn’t possibly have kept up with the literature. A lot of nurses at the front line are not reading journal articles on a regular basis so we make that fairly easy. We have a virtual library that is of no charge and all of the courses are evaluated and all of the courses involve some reading material ahead of time or during the course. We show them and make it quite easy for them to go in and get the articles. It’s a credit based system, they can’t get their credits for the courses unless they’ve completed all aspects. It’s not always easy, there are nurses who, unless they’re paid for their time off their clinical units, are not as interested but we’re trying to work on that and have other types of incentives. I’m sure we won’t reach everybody, not everybody is going to become a De Souza Nurse, so it has to be clinically meaningful and it should represent a nurse that has gone beyond the typical education and done extra to achieve a special designation.

So I think, all in all, there will be motivations through the leadership, the public, not wanting to be left behind, certainly the novices and the mid-level career are probably going to get on board. Making it free has been a big plus, it’s funded by the Ontario Ministry of Health and Long-Term Care. That’s a big deal to nurses, to have that kind of funding behind them and that was discussed earlier in the plenary in the question period around not every country has that kind of funding. We are trying to reach out, we’re actually working a little bit with Brazil and we’re delivering programmes in Kuwait. So we’re just primed now to go beyond Canada and actually expand across Canada and we’re looking at various funding models. Some countries can, for example, we’re going work with proposal writing, we’ll write their proposal, they can translate, we’ll work together and actually try to go to their government to obtain some money where possible. Perhaps in developing countries we’ll have to use any money we’ve generated or some other avenue through a foundation to help them get the courses at a very small cost, cost recovery. Other countries that are more established or wealthier could probably pay a small amount. We haven’t gotten too much into charging, we’ve helped other countries develop proposals so that they got money from their cancer agencies because we made the case, the strong case, that the certification really helps in the care. It’s better practice, it’s better medical outcomes as well as nursing outcomes and psychosocial outcomes, quality of life. We also have a foundation that we just developed this year and so now I’m in a position where I can reach out and do some fund-raising and that will give me more flexibility to go to other countries or provinces and say, “I have $1 million, we’ll match it if we can go to your government and get matched funds to go forward and develop your own De Souza institute or model, based on our techniques.” But they’ll still have to contextualise, everything we do still has to be contextualised in order to be successful for a local context or culture.