Role of Clinical Nurse Specialists in
WRHA Palliative Care Program
Lori Embleton, Program Director
WRHA Palliative Care Program
November 21, 2008
WRHA Palliative Care Program
• Provides care to patients and families living
with life limiting illness
– Patients of all ages
– Spans the continuum of care settings
• Palliative Care Program settings – community,
inpatient units and hospices
• Need to provide support to practitioners in other
care settings -acute care facilities, PCHs, outpatient
clinics
CNS Role in Palliative Care Program
Created in 2001 to:
• Build capacity for quality end-of-life care
throughout the continuum of care within the
WRHA
• Promote evidence-based palliative care
nursing practice through education and
program development activities
CNS Role in Palliative Care Program
Initially – 3 EFT with 2 EFT located in acute
care facilities, 1 EFT in community
Currently funded for 5 EFT
– 3 EFT for community and community hospitals
– 1 EFT – Pediatric Palliative Care
– 1 EFT – HSC
* 1 EFT at SBGH
Successes
Consultation service utilized widely:
2006/2007 - ~ 600 consults
2007-2008 - ~ 900 consults
*(excludes SBGH and HSC)
Successes
• Development of a number of program
specific initiatives to support care
– Medication kits
– Nursing procedures / guidelines / protocols
• Educational initiatives aimed at building
capacity and including all members of the
health care team
– Within Palliative Care Program
– Within sites and programs across WRHA
Challenges
Increasing focus on consultation leaving
less time available for other domains of
CNS role
• Practice has evolved to meet Program demands
SCOPE OF NURSING PRACTICE: OVERLAP OF CNS/ NP ROLES
CLINICAL NURSE SPECIALIST
Direct Patient Care
Education
PC CNS
Research
Professional Development
Promote excellence in nursing practice
Direct Patient Care
Education
Research
Professional Development
Overlap with
role of physician
NURSE PRACTITIONER
Bryant-Lukosius, D. (2003). Continuum of advanced practice nursing roles.
Unpublished document. School of Nursing, McMaster University.
Strategies to Support CNS Role
• Program actively developing plans to
expand “team” approach to support care
outside of program settings
– Model developed for consultative service to
include MD/CNS and psychosocial support
Strategies to Support
• Meetings to support CNS in practice
• Consultation review with PC physician and Program
Director
• Open discussions regarding scope of practice and CNS
role
• Continue to evaluate evolving role
• Continue to explore opportunities for APN
roles in Program