When Karen Oldford, a registered
nurse from Labrador City, decided to go back to school
16 months ago to upgrade her skills in a nurse practitioner
program, she and her 15 classmates were pretty confident
there would be a job waiting for them at the end.
That's because the Newfoundland
government was planning a number of primary care reforms
aimed at making services more accessible to the population.
Among the initiatives was a plan to establish a number
of regional multi-disciplinary healthcare centres, especially
in rural settings, to be staffed by nurse practitioners
(NPs). But at recent graduation ceremonies, only four
of the 16 grads were celebrating landing new NP jobs.
So what went wrong?
FIRST
THINGS FIRST
The primary care reforms were the brainchild of the
former Liberal government. While the Tories under Danny
Williams, who came to power last fall, say they're committed
to carrying out their predecessors' reforms, they're
putting them on hold while they sort out what they call
a bloated health authority structure.
Dr Lydia Hatcher, a family physician
and former president of the Newfoundland and Labrador
Medical Association, isn't mourning the halt. Dr Hatcher
works regularly with NPs in her Mount Pearl clinic,
where they do work terms to gain experience during their
training. Dr Hatcher is happy with the results and is
all for nurses and doctors working in a collaborative
manner. But Dr Hatcher says before the province hires
more NPs it needs to deal with its physician
human resource problem. There simply aren't enough physicians
to work alongside NPs — which makes the idea of
collaboration a bit moot.
"It's more cost effective to have
a doctor at a more expensive up-front cost," she argues,
"who will be able to do more and see more patients and
therefore keep the system out of the terrible backlogs
we're seeing."
With millions of Canadians currently
without family physicians, Dr Hatcher says, the care
gap can't be filled by NPs who work in set hours under
very specific circumstances.
GREAT
IN THEORY
Not that doctors are against having NPs in their practices.
Far from it, says Dr Hatcher. "There are lots of doctors
who will say, 'bring on the primary care reforms' —
but who can afford it?" she wonders. "I think that's
why primary care has been so slow because government
recognizes, especially in a province like Newfoundland,
we can't afford it. It's great in theory, but very expensive."
As for Karen Oldford, she and her
fellow graduates are feeling let down by the system.
"I could go back to my staff nursing position but certainly
I would lose my skills very quickly," she says, adding
that she plans to take NP locum jobs wherever she can
get them, even outside the province, until a full-time
job becomes available.
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