Addition of Oncology Nurse Practitioner to Palliative Care Team

Addition of Oncology Nurse Practitioner to Palliative Care Team Karen Davis, RN, BSN, OCN GNUR 462 Business Plan Loyola University June 15, 2012

Addition of Oncology Nurse Practitioner to Palliative Care Team Executive Summary: Symptom management is a major obstacle for oncology patients. For many

patients, their symptoms arrive at or soon after their initial diagnosis. Palliative care provides patients relief from pain or discomfort, does not hasten or prolong death, reinforces life and death as a normal process, offers support to patients and their families, and integrates spiritual and psychological aspects into patient care. Many patients, doctors and family members are unaware of palliative care programs that are in place to help a patient manage their symptoms while continuing to undergo treatment. A majority of palliative care teams that are developed in hospitals only consist of a physician. Since palliative care teams are usually only one physician, not that many patients can be seen during the day. Each year more patients are diagnosed with a form of cancer, and many are admitted to the hospital for symptom management or for treatment. With the increase of patients being admitted to the hospital for symptom management, there is a greater need for bigger palliative care teams. The addition of a nurse practitioner to the palliative care team more patients will be able to be seen and treated. Currently the palliative care team at Lutheran General Hospital consists of one physician and an Oncology CNS nurse. The CNS nurse rounds on the patients on the palliative care service, however the physician still must round on them as well. By adding an Oncology Nurse Practitioner to the palliative care team, more patients will be able to be seen and treated. More patients will benefit from the palliative care and have an increase in quality of life. A time frame of six months would be needed to properly train the Oncology Nurse Practitioner. The addition of an Oncology Nurse Practitioner to the palliative care team would ultimately be cost efficient. Money must be spent to hire and train the nurse, along with addition of their salary. However, in the long term the additional costs would be returned along with a profit. More patients would be able to be seen, therefore billed. While the hospital is able to make a profit off of the addition of another Nurse Practitioner, the patients also benefit because more can be seen and have their symptoms better managed.

Addition of Oncology Nurse Practitioner to Palliative Care Team

Introduction: Each year more patients are being diagnosed with a form of cancer. Of those patients being diagnosed, many are admitted to the hospital for symptom management. There are specialized palliative care teams in hospitals to help oncologists and their patients better manage their symptoms. While palliative care teams are becoming more common, many do not employ nurse practitioners. A majority of palliative care teams consist only of a physician and a registered nurse. This causes their patient base to be quite limited due to only having one physician, The addition of an Oncology Nurse Practitioner to the palliative care team would be able to increase the amount of patients seen, and it would bring in more revenue for the hospital.

Description of the Business: Currently, the palliative care team at Lutheran General Hospital consists of one physician and one Oncology CNS nurse. The palliative care team is only able to see a limited number of patients per day due to the lack of personnel. The current practice is for the nurse to round on the patients, do an initial assessment and see how the current plan of care is working for the patient and family. Then the physician will round on the patient and make any changes to the current plan of care. The goal is to add the position of an Oncology nurse practitioner to the palliative care team at Lutheran General Hospital. By adding a nurse practitioner to

Addition of Oncology Nurse Practitioner to Palliative Care Team the palliative care team the number of patients seen a day will not be as limited. Having more than just one physician seeing patients a day will greatly increase the number of patients who can benefit from palliative care. By increasing the number

of patients seen each day, more patients will have better symptom management and increased quality of life. Not only will patients benefit from the addition of an Oncology Nurse Practitioner, but also so will the hospital. They will able to have increased revenue due to the increase in patients seen by the palliative care team.

Analysis of Market: The WHO (World Health Organization) defines palliative care as: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessments and treatment of pain and other problems, physical, psychosocial and spiritual (WHO, 2011). It is estimated that 1.6 million people will be diagnosed with cancer in 2012. Of those 1.6 million people diagnosed with cancer, many will be admitted to the hospital at some time during their illness. Of those admitted to the hospital, almost all of them will have some form of symptom i.e. pain, nausea, diarrhea, fatigue, constipation. Some may not be able to receive their chemotherapy or radiation treatments because their symptoms are too severe. The target customers are those patients with an oncology diagnosis admitted to the hospital that need help with symptom management. By adding palliative care to their care plan, many patients will have better symptom management, increased

Addition of Oncology Nurse Practitioner to Palliative Care Team

quality of life and may be able to receive treatment that they could not prior to using palliative care.

Product Description: Palliative care offers symptom management to patients with a life threatening illness. When in a palliative care program, a patient is still able to receive radiation treatment, chemotherapy etc. The point of palliative care is to treat the patients symptoms and keep them comfortable to enhance their quality of life. The palliative care team is in addition to the patients oncology physician. The oncology physician still treats the cancer and manages the treatments. The palliative care team assesses the symptoms the patient may have, and what treatment would work best to manage them. There are many advantages to using palliative care. First, the patient can continue to receive treatment. Second, members of the palliative care team specialize in symptom management. They have a better understanding of what medications and treatments help to manage symptoms. They are able to offer a better plan of care to treat a patients symptoms. Third, palliative care has been proven to enhance a patients quality of life. Fourth, palliative care involves not only the patient, but also their family. Fifth, palliative care offers individualized treatment. The palliative care team molds the treatment plan to the patient, using medications and treatments that best help that patient.

Addition of Oncology Nurse Practitioner to Palliative Care Team Operational Plan: The timeline for the addition of an Oncology Nurse Practitioner to the palliative care team is six months. The six months includes the orientation time to

the hospital, as well as to the palliative care team. The location of the training would be onsite at Lutheran General Hospital. The nurse practitioner would work with the palliative care team doctor, along with the nurse. They would round on the patients and the nurse practitioner would be oriented onsite to the palliative care team.

Cost/Benefit Analysis: There are two viable options for the palliative care team at Lutheran General Hospital. First, is to keep the team as it is currently practicing with only a physician and a nurse. The second option is to add an Oncology Nurse Practitioner to the team. If the palliative care team were to not make any changes their costs would remain the same. However, there would not be any increase in their revenue. If the palliative care team added a nurse practitioner, initially there would be increased costs. Costs would be spent on salary, and training the nurse. But in the long term the benefits would outweigh the costs. With the addition of another team member the number of patients being seen would increase. This causes an increase in revenue for the hospital, which would eventually make up for the initial costs of the nurses salary and training costs.

Addition of Oncology Nurse Practitioner to Palliative Care Team Development Schedule: The first action is to take the business proposal to the Chief Nurse Officer at

Lutheran General Hospital. The CNO makes the decisions on adding new positions at the hospital. The cost of adding a nurse practitioner will be the salary of one FTE nurse practitioner, including benefits. While creating a nurse practitioner position will add costs to the organization, there will be an increased benefit in the long run. More patients will be able to be seen and treated, which will bring in more revenue for the organization. In the end, more patients will be seen and treated, there will be an initial loss from the additional costs but ultimately the organization will benefit. The completion date will be within 6 months of the proposal being presented to the CNO.

Financial Plan: The revenue type will be from services provided, along with revenue from drugs and devices used. Revenue sources will be from self-pay patients, private insurance companies, Medicare and Medicaid. The amount received from each revenue source will be determined by the type of insurance each patient has, or if they do not have any insurance. The initial start up money will be taken from the new hire budget. The debt will be repaid over the course of a year once the nurse practitioner has completed the initial orientation.

Addition of Oncology Nurse Practitioner to Palliative Care Team