Air Date: Jun 16, 2016 1:00 AM AT
As health care officials search desperately for a way to ease the doctor shortage in Cape Breton, nurse practitioners are frantically waving their hands… “we can help”. We re-visit the role nurse practitioners can play, Carolyn Mitchell co-chairs the Nurse Practitioner Association of Nova Scotia.
Health and Wellness
Fourteen thousand more Nova Scotians will have access to primary care, thanks to the addition of 22 new nursing positions across the province.
Government is giving Nova Scotia Health Authority an extra $3.6 million to hire 13 more nurse practitioners and nine family practice nurses. The mix of professionals may change, depending on community needs and the recruitment process.
These health professionals will join collaborative care practices where they will complement the work of doctors and other practitioners. Together under one roof, they will deliver high quality, appropriate care, when patients need it most.
“Government believes collaborative care is the future of health care in this province. We want Nova Scotians to be able to get the care they need, when they need it,” said Premier Stephen McNeil.
In the province’s central health zone, seven new professionals will serve patients in the communities identified as most in need, throughout Halifax Regional Municipality, the Sheet Harbour area and West Hants (Windsor and area).
Adding nurse practitioners and family practice nurses means more than 4,800 more people in the central health zone will be able to join a collaborative health care practice.
“Today’s announcement is just one more step toward that vision, and it won’t be the last,” said Premier McNeil.
Physician recruitment remains a priority, and work is ongoing. Expanding collaborative care teams enhances Nova Scotia’s ability to attract new physicians.
In the coming weeks the health authority will issue an expression of interest in some communities, for family practices interested in hosting nurse practitioners or family practice nurses. Once that is complete, it will post the new positions.
“A strong primary health-care system is the foundation of our health-care system. Having regular access to a health home is important for our health and wellness and that’s why today’s announcement for more nurse practitioners and family practice nurses is very welcome news,” said Tricia Cochrane, vice-president of primary health care, Nova Scotia Health Authority. “This is an important investment for the health and wellness of Nova Scotians.”
Nurse practitioners take advanced training that prepares them to diagnose and manage illnesses, order and interpret tests, and prescribe medications, among other things.
Family practice nurses are registered nurses who can independently assess, plan and co-ordinate care, make referrals, and evaluate how people are responding to treatment.
“Adding nurse practitioners to health-care teams allows them to accept new patients and shortens wait times. Nurse practitioners can also help patients manage chronic disease, learn to live healthier and avoid injury,” said Carolyn Mitchell, a nurse practitioner working at the Community Health and Wellness Centre in North Preston.
“It allows practices to offer a broader range of services, which is better for patients and for team members – a win-win all around.”
New patients will be added to the clinics as the nurse practitioners and family practice nurses are hired.
If you are expecting to find a quiet sewing circle at the North Preston Seniors’ Club, the burst of colour and energy that hit you when you walk through the doors is enough stop you in your tracks. The conversation is nothing short of boisterous as a dozen or so sets of nimble fingers dance across fabric and wool. Among them is an honorary member: nurse practitioner Carolyn Mitchell.
The growing pile of tiny purple knit hats will find a home atop newborns at the IWK soon. It was Mitchell’s idea. Ivory Provo is the president of the North Preston Community Health and Wellness Centre’s Senior Citizens’ Club and remembers how it started. “She came in to our seniors room one day and she was sitting down talking to me and I was knitting, and she came up with this idea that we should do it for the children’s hospital.”
“She just comes in and talks with us.” says Norma Downey, another member of the club who has a growing appreciation for what Mitchell brings to the group. “She’s really nice. Friendly. Any questions that you ask her she’ll find the answers.”
Mitchell leverages the relationship to get a better understanding of what the health needs are in the community she serves. “A simple knitting project has built up a relationship with the seniors. They feel comfortable around me and I can identify some needs that they have.”
It’s this type of unusual interaction from a primary health care provider that is becoming more familiar in Nova Scotia, but for many it’s still something new
“A nurse practitioner is a nurse who has advanced education and training that allows us to prescribe medications, to order tests, to diagnose certain conditions and to manage chronic health conditions so we do a lot of the same things that a family doctor does,” says Mitchell. “But we’re still nurses so we still come to the patient encounter from a nursing perspective…You could be seeing patients in the office then running out to do a home visit for someone who can’t make it to the office, or then meeting group in the evening but having the freedom to be able to meet the needs of the community, and meet them where they are.”
A few days later, the group is assembled in a much more formal setting in an IWK boardroom in Halifax, but the energy level is just as high as it was back in North Preston. The group is enjoying a small thank you tea from the IWK before heading off for a tour. Mitchell is there too, sharing in the satisfaction of donating boxes of handmade hats and blankets that will surely go to good use.
Just as important for Mitchell is the satisfaction of knowing that behind every stitch in the impressive pile there was conversation. Sometimes they talked about what they’e eating, how they’re struggling with mobility, or just musing about how much candy is too much before bedtime for their grandkids. Mitchell has woven herself inside of those conversations and the hours of chatting about the things that colour their lives, quietly building a better understanding of how to deliver the healthcare they need. “I spend some part of my day cutting blankets and knitting, and I don’t think a lot of places would allow me to do that as a nurse practitioner but it’s something that invests in building the relationships with the community members, and we build a trust.
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.”
Kathleen MacMillan is director of the school of Nursing at Dalhousie University. Cindy Cruickshank is the acting executive director of the Health System workforce branch of the department of health and wellness.
INFORMATION MORNING – NS | Jul 25, 2014 | 11:14
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