+ Moving a Step Forward in Advanced Practice– Preparation for the Formation of the Academy of Nursing 向前迈进了一步

2nd Nursing Conference on Advanced Practice 21st to 22nd November, 2008

Dr. Susie Lum Chairperson, Hong Kong Academy of Nursing Preparatory Committee + + Hong Kong Nurses Wish, Want, & Will to move forward in Advanced Practice 香港护士许愿，希望，意志和推进 + HK Nurses want recognition & legitimate power for specialization

要承认和合法的 专科化 + 讓激情來燃燒激情 Change can happen

„ 他讓激情來燃燒激情，

„ 讓希望來推动希望，

„ 喚醒冬眠巳久的理想主義，

„ 展現巨大的穿透力。 + 太空一小步創新一大步 + Background

„ Expanded scope of nursing practice

„ Rapid proliferation of nursing specialties

„ International development in advanced practice nursing

„ career progression model „ 190 nurse specialists (38 specialties) „ 530 advanced practice nurses + Hong Kong Academy of Nursing Preparatory Committee established 2006 under (Societies Ordinance Section 5A[1], Chapter 151)

Membership

„ Nursing & Midwifery Councils chairmen

„ Department of Health

„ Hospital Authority

„ 19 Professional Associations / Colleges / Societies

„ 4 Universities

website: http://www.hkan.hk P.O. Box 91601 Tsim Sha Tsui Post Office + Nurse leaders coming together to create our own preferred future 护士的领导人走到一起创造 我们自己的未来 + Advisors

„ Mr. Anthony WU, Chairman, Hospital Authority

„ Dr Hon CH LEONG, Executive Council member, Chairman, Elderly Commission, and Former President of the Hong Kong Academy of Medicine

„ Prof Grace TANG, President, Hong Kong Academy of Medicine

„ Dr The Hon Joseph LEE, Legislative Council Member (Health Services)

„ Dr PY LAM, Director of Health, Department of Health

„ Prof Thomas KS WONG, Health and Medical Development Advisory Committee member

„ Dr William HO, Chief Executive, Tung Wah Group of Hospitals + Oversea Advisors

„ Prof Frances HUGHES, Former Chief Advisor Nursing, Ministry of Health, currently Professor of Faculty of Medical and Health Sciences and Director of Centre for Mental Health Research, Policy and Service Development, University of Auckland

„ Dr Karen MACDONALD, Chair, American Nurses Credentialing Center Commission on Certification, USA.

„ Dr Angela MCBRIDE, Distinguished Professor and University Dean Emeritus of the School of Indiana University and former Scholar- in-Residence of the Institute of Medicine of the National Academies, USA

„ Dr Mary SMOLENSKI, Director, American Nurses Credentialing Center Certification Program, USA + Honorary Legal Advisors

ƒ Mr Lester HUANG

ƒ Mr Mark LAM

Honorary Auditor

ƒ Mr William Wai Hei CHAN + The Hong Kong Academy of Nursing

„ Key functions

Regulating the practice and promoting the professional development of advanced practicing nurses in specialty areas. + Advanced Practice Nurses

„ Nurses who work both independently and in collaboration with other professionals to provide a wide range of advanced assessment and specialized interventions in response to the actual and potential health needs of the individual, group or family.

„ Their practice encompasses the continuum of health promotion and maintenance, disease prevention and management. + The Hong Kong Academy of Nursing

„ An independent institution with the statutory power to organize, monitor, assess and accredit all nursing specialist training and to oversee the provision of continuing nursing specialist education.

„ Explore the feasibility to establish a Specialty Register under the amended Nurses Registration Ordinance Chapter 164 + TheThe objectivesobjectives ofof thethe HKANHKAN are:are: (1)(1) ForFor thethe publicpublic

„toto protectprotect thethe publicpublic byby regulatingregulating standardsstandards ofof advancedadvanced nursingnursing practice;practice;

„toto educateeducate thethe publicpublic regardingregarding thethe valuevalue ofof professionalprofessional nursingnursing specialization;specialization; andand

„toto promotepromote thethe improvementimprovement ofof healthhealth carecare forfor HongHong KongKong citizenscitizens.. +TheThe objectivesobjectives ofof thethe HKANHKAN are:are: (2)(2)

ForFor nursingnursing professionalprofessional developmentdevelopment

„ to promote the advancement of the art and science of nursing;

„ to promote integrity, ethical conduct and standards in the practice of advanced nursing and its specialties;

„ to foster the development of advanced practice nursing education in specialty areas; and

„ to facilitate the exchange of information and ideas in nursing and matters concerning the nursing profession. + Major functions of HKAN

„ set, monitor and enforce the standards of study and practice of specialty nursing in Hong Kong;

„ accredit advanced-practice programmes and education institutions in reference to the set standards;

„ certify and re-certify individuals who have graduated from the accredited programmes (and comparable others) for advanced practice;

„ sponsor and conduct educational activities that enable advanced practice nurses to maintain currency in areas of expertise;

„ support and foster development of advanced nursing practice e.g. through recognition of excellence, through analyses of future needs; and

„ educate the public regarding the roles and benefits of specialization in nursing. + Proposed structure of the HKAN (1)

„ Council „ President „ 2 Vice-presidents „ Secretary „ Treasurer „ Representatives from nursing specialties „ Six elected members „ Two co-opted members + Proposed structure of the HKAN (2)

„ Committees „ Registration Committee „ Education and Accreditation Committee „ Professional Development Committee

„ Secretariat + Education and accreditation of advanced nursing practice + Term of Reference

„ To derive a generic competence framework for advanced practice nurses (APN)*通用能力框架

„ To specify key elements that need to be present in curriculum that prepares APNs

„ To propose strategies for accreditation of APNs for new comers and those who are already in practicing APN positions.

„ *APN is used here as an umbrella term to include nurses who practice at advanced / specialty level. It is not used here to present a title for position nor a title of membership that will be granted by the Hong Kong Academy of Nursing. + Key questions to ask

„ Are our APNs fit for practice?

„ How do we know?

„ How do we let others know?

„ What is fit for practice?

„ What are the measures indicating ‘fit for practice’?

„ What is the purpose of making the measures explicit? +

Hong Kong

International + APN Curriculum

„At postgraduate level 研究生

„Theoretical component

„Practical component + Theoretical curriculum

„ Converging (common core, generic to postgraduate students and all APNs)

„ 会聚（共同的核心，一般以研究生和所有APNs ）

„ Diverging (subjects addressing specific specialty content)

„ 发散（科目处理具体的专业内容） + Reference to American Association of Colleges of Nursing + ModelModel ofof MasterMaster’’ss NursingNursing CurriculumCurriculum

Graduate Nursing Core (All master’s degree nursing students)

Administration APN Clinical Core Community Health (All master’s degree (All master’s degree nursing students nursing students prepared to provide prepared to provide direct client care) population-based care)

Speciality Curricula CNM CRNA NP CNS

Primary Care NP Acute Care NP + American Association of Colleges of Nurse (1996) The essentials of master education for advanced practice nursing. Washington, DC: AACN.

Graduate core (e.g. research, health policy, leadership, ethical / legal issues and heath care delivery system)

Advanced practice core (e.g. advanced assessment, pharmacology, pathophysiology, decision making, advanced nursing therapeutics and health promotion)

Specialty core (content not been specified in the AACN documents)

+ Specialty core

National Association of Clinical Nurse Specialist (NACNS) 3 key spheres of influence

„ patient/client

„ nurse/nursing

„ system/organization

Gouldreau K.A., Clark A., Lyon B. & Rust J.E. (2007) + NACNS Essential core content areas for developing CNS competencies

1. Theoretical foundation for CNS practice

2. Phenomenon of concern 现象的关注

3. Design and development of innovative nursing interventions

4. Clinical inquiry/critical thinking using 床 批判性思 advanced knowledge 临 调查/ 维

Gouldreau K.A., Clark A., Lyon B. & Rust J.E. (2007) + NACNS Essential core content areas for developing CNS competencies

5. Technology, products and devices

6. Teaching and coaching

7. Influencing change

8. Systems thinking

9. Leadership for transprofessional collaboration

Gouldreau K.A., Clark A., Lyon B. & Rust J.E. (2007) + NACNS Essential core content areas for developing CNS competencies

10. Consultation theory

11. Measurement

12. Outcome evaluation methods

13. Evidence-based practice and translation of research

14. Developing content areas

Gouldreau K.A., Clark A., Lyon B. & Rust J.E. (2007) + Basic Requirement

A mean number of 416.2 clinical hours

A range of 41.4 to 52.2 theoretical credit hours

57 clinical nurse specialist programmes in 139 different schools surveyed in the United States by Walker et al. (2003) + Mechanism of approval to practice 审批机制的实践

„ Nursing practice acts护理实践行为

„ professional regulations专业法规

„ certification认证

„institutional guidelines (approval)体制准则 （批准）

„ standards标准 + http://www.nursingworld.org/ancc/cert/index.html + APN – local and global trend

A generic competence framework for advanced practice nurses + Six domains of the competence framework for advanced practice nurses (A total of 54 statements) 六个领域

Domain 1 Managing clients with complex health conditions

Domain 2 Enhancing therapeutic nurse-client relationship

Domain 3 Demonstrating effective leadership and team work

Domain 4 Enhancing quality assurance and improvement

Domain 5 Managing and negotiating innovative and effective approaches to care delivery

Domain 6 Enhancing professional attributes of general and advanced practice

Domain 7 Enhancing personal attributes

+ Accreditation 认证

„ For New comers „ Fulfills requirements set by the Academy to be considered as a member „ Has graduated from a Master program recognized by the Academy „ Passes an exit assessment for qualifying APNs recognized by the Academy

„ For Existing APNs „ Grandfathering those who are currently appointed as APNs „ The applicant needs to meet the requirements that are equivalent to the exit assessment for qualifying APNs recognized by the Academy

„ For re-certification „ Provides evidence of continued education as specified by the Academy + Academy Colleges + Academy College

„ Each nursing specialty will form its own Academy College.

„ The Academy Colleges will be contained within the Academy, all of which run their own structured training programs. + Suggested Academy Colleges

„ Medical/surgical care „ Men/women’s health „ Child and adolescent health „ Mental health „ Public/community health „ Critical care „ Gerontological health „ „ Complementary/alternative Medicine + AdmissionAdmission ofof membersmembers intointo thethe CollegeCollege (1)(1)

„IndividualIndividual CollegeCollege willwill setset itsits ownown requirementrequirement forfor admissionadmission asas fellowsfellows andand members.members. IndividualIndividual CollegeCollege willwill setset itsits standardsstandards ofof specialistspecialist training,training, includingincluding level,level, duration,duration, content,content, andand methodsmethods ofof assessment.assessment. + Admission of members into the College (2)

„ Trainees have to complete a nurse specialist education from an accredited nursing specialty programme;

„ have at least a master level education;

„ have at least five years of structured specialist training in the specialty area.

„ The Academy Board will hold certified assessment for their trainees. Passing the final assessment is a prerequisite to Fellowship and members of the Academy.

„ To apply for re-certification and maintain the name on the specialist registry, members have to fulfill mandatory continuing professional development requirement as stipulated by individual College. + Membership of the HKAN

„ Fellow

„ Member

„ Associate

„ Honorary Fellow + Membership of the Hong Kong Academy of Nursing

„ The members of the HKAN are members of an Academy College who recommended by that Academy College for admission to the membership of the Academy and approved by the Registration Committee. + Associate member

„ if a is engaged in postgraduate nursing education or in any study or other activity which is in the nature of continuing nursing education or if the HKAN is satisfied that he/she is interested in such study or activity. + Member

„ if a registered nurse has successfully completed such courses or periods of training and passed such examinations held, conducted or recognized by such Academy College in relation to the admission of members. + Fellow

„ if a registered nurse has successfully completed such courses or periods of training and passed such examinations held, conducted or recognized by such Academy College in relation to the admission of Fellows;

„ or if a registered nurse has specialised and practised in a branch of nursing for 15 years or more as at the commencement of the Amended Nurses Registration Ordinance, has significant contributions to specialty services development, and in the opinion of the Council, the conduct of his/her practice was consistently good throughout such years. + Honorary Fellow

„ Person of eminence or any person who has rendered outstanding service to the art or science of nursing or to the HKAN, may be admitted to the membership of the Academy as an Honorary Fellow. + Publicity & Communication 宣传和交流 + Strategies

„ Stakeholders Identification

„ Promotion & Publicity

„ Communication + Stakeholders Identified

1. Political Personnel (Leg Co / Ex Co / DC members / patient groups)

2. Nursing Groups

3. Target Populations in the Community:

3.1 Professional Bodies

3.2 Prestigious Groups

4. Mass Media

5. Patient groups

6. General Public + Promotion & Publicity

„Mass Media

„Newsletter

„Pamphlets, poster

„Website: http://www.hkan.hk + + Communication

„Meeting with stakeholders.

„Discussion & explanation through talks, open forum and e-mails (Website: http://www.hkan.hk). + Funding model 筹资模式

„ Self-financed in the long run. „ membership fees „ friends of nurses

„ Sources of funding: fund raising activities, membership fees, examination fees and course fees. + Support needed from the Government of the Hong Kong Special Administrative Region 需要政府支持

„ Facilitate the establishment of the Academy of Nursing Ordinance

„ Explore appropriateness of the adaptation of the extant Nurses Registration Ordinance or its subsidiary legislation to embody a specialist nurse accreditation and registration mechanism.

„ A venue

„ A start-up fund + What have we done so far?

„ Discussions with the Secretary and Deputy Secretary for Food and Health

„ Business Plan presented in March 2008 商业计划

„ Temporary office in former School of Nursing, Princess Margaret Hospital + Preparatory Committee for Hong Kong Academy of Nursing meeting with SF&H on 13/6/07 + 2nd2nd MeetingMeeting withwith FHBFHB inin AprilApril 0808 + + Kick-off Ceremony of HKANPC Office on 21 June 2008 + Kick-off Ceremony of HKANPC Office + Kick-off Ceremony of HKANPC Office Opening of the Hong Kong Academy of Nursing Office in June 2008

We need YOUR SUPPORT!! + Meeting with Nurses’ Union/Association Leaders, November 2008 + The next steps

„ Seek consensus and future links with the Nursing Council

„ Ｓeek further support from government on legislation and funding

„ Grant or conferment of specialist „ determine the qualifications and experience to be acquired, training to be undergone or research requirements to be undertaken or fulfilled „ Seek assistance from overseas expert consultant „ Assess, evaluate or examine the standards of specialist education

„ Step up communication with specialty groups

„ Set up Foundation to raise fund +

THANK YOU