Recruiting more physicians to Nova Scotia is one solution to a doctors shortage, but the province’s nurse practitioners say they’re ready to help close the province’s larger health care gap.
Nurse practitioner Carolyn Mitchell says this isn’t a battle between nurses and doctors — it’s about coming together as health care professionals.
“Take us because we are here,” said Mitchell, co-chair of the Nurse Practitioners’ Association of Nova Scotia on Thursday. “Don’t ignore us because you are waiting for something that is not.”
Mitchell says nurse practitioners are ready and willing to provide a long-term, sustainable option to the province’s health care needs.
She defines nurse practitioners as independent health professionals who can provide the same level of care that family doctors can. They can also enhance access to care by taking on their own patient case load.
Further, primary nurse practitioners are able to work in a hospital setting where they diagnose patients, prescribe and adjust medication, order tests and make referrals to specialists as needed.
After cabinet on Thursday, health minister Leo Glavine said nurse practitioners are “already playing a very strong role in the health care system.”
When it comes to expanding their role, Glavine says for the last two years he’s engaged in discussions in an attempt to give nurse practitioners more stand-alone capabilities.
He says these independent roles will be integrated into the collaborative work environment already in play.
Under this setup, Mitchell says if a patient’s needs go beyond what a nurse is able to provide, they will then refer the patient to a doctor.
“Having a team available to a patient ensures they are going to receive the most appropriate provider to meet their needs,” says Mitchell.
Mitchell says the province’s emergency rooms can sometimes be at a “choke point” filled with patients who are unable to access care. This most prevalent in rural communities, where emergency room care is often their only option.
Mitchell says health professionals, including herself, will often throw around terms like “collaborative care” and “collaborative emergency room centres” without knowing whether the public understands what they are saying.
“It takes so much work to make simple changes that we can forget that we aren’t communicating effectively to the communities we serve,” Mitchell said.
Collaborative care shouldn’t be a catch-all term either, because not every community is going to need a different level of care. “It’s going to look different in every community, and it needs to look different.”
Mitchell recognizes that the government and the health authority are doing everything they can to recruit physicians into practice. But nurse practitioners don’t have the same job support.
She says nurse practitioners first started out as a pilot project in Nova Scotia in about 2005. They have grown from a tiny group of five to a force of roughly 141.
But not all are able to work as a licensed nurse practitioners in the province. She says they don’t have contracts to help them find employment to keep them in the province when they graduate.
Many graduates who are unable to find work as a practitioner at home begin working as a registered nurse instead. But in order to keep their nurse practitioner licence in Canada they need to work an estimated 500 hours every two years in that role. Their hours working as a registered nurse don’t count toward that.
“We have nurse practitioners who are graduating from Dal and leaving the province,” Mitchell said.
Despite the abundance of practitioners, residents of rural communities are crying out for help.
Mitchell says there are nurse practitioners living in the community, who are ready to help when given the opportunity. And some drive four hours every day across the province to provide care.
“They are doing that because they believe in what they do, and they want to maintain their skills because they truly believe positions will be available,” said Mitchell. “But it’s not happening fast enough.”
Mitchell cited Ontario and Quebec as two provinces that run nurse practitioner-led clinics.
According to each of the province’s health websites, the clinics are publicly funded in Ontario and privately funded in Quebec.
On the Nurse Practitioners Association of Ontario website, they say the program was designed to “improve access to care” for those who do not have a primary health care provider.
In a story earlier this week about doctors leaving rural communities, Dr. Jeremy Hillyard talks about having nurse practitioners employed to work in hospital settings alongside emergency room specialists.
Mitchell says this is exactly the type of “outside the box” thinking that needs to be done. “Nurse practitioners provide an excellent support in speciality clinics,” she said.
She says a lot of the attention is on primary care, but the province’s needs far surpass that. Nurse practitioners also work as speciality practitioners in areas like neonatal, pediatrics, long-term care and speciality clinics.
Mitchell works in a community heath clinic where access to care is staggered depending on patients’ needs. She sees patients with a variety of illnesses and needs, some of which cannot be treated medically. At times like that, she and physicians will sit down with the patients and simply listen.
Moving forward, the association wants to lend this same listening ear to the government and doctors in an effort to reopen the lines of communication.
“This whole discussion is not about doctors or nurse practitioners,” Mitchell said. “It’s about having access to health care . . . no matter who you are.”
She says it’s not the time to regulate, nor is it the time to negotiate. “Now is the time to advocate.”