The number of licensed
nurse practitioners across Canada, as indicated
by the provincial nurse colleges and associations
*The data for NWT/NU are
based on the Canadian Institute for Health Information
2006 report on nurse practitioners |
At the Weeneebayko General Hospital
in Moose Factory, northern Ontario, Dr Robert Gabor
has many reasons to be grateful for the presence of
nurse practitioners (NPs). "It's another hand on deck
and, with the huge lack of doctors and lack of services
up here, they've made our case loads much easier and
healthcare more accessible to the public," says the
FP.
Judging by our NRM Survey
of Medical Practice 2007 results, Dr Gabor isn't the
only one to feel this way — other docs are clueing
in on the benefits of bringing NPs into their practices.
The number of physicians working with NPs shot up by
over 30% in the past year. Nearly 10% of surveyed GPs
were working with them as of 2007, up from six percent
in 2006, while six percent of specialists are relying
on their assistance, compared to a mere four percent
the year before.
The numbers may seem small, but
given that some provinces had no NP legislation to allow
them to work as late as 2006 (PEI was the last), the
quick rise is significant.
"Doctors are getting more used
to working with NPs," says North Bay General Hospital
NP Sue LeBeau. Ms LeBeau spoke to NRM back in
2004 of the scepticism she encountered in doctors when
she first started working as an NP. "Initially they
were afraid that we're going to put their patients at
risk, that we wouldn't know the limits of our knowledge,"
she recalls. "Now, they're aware that we work within
a set scope of practice and we consult appropriately."
NO
DOC'S AN ISLAND
Whether you're working in a hospital or in community
clinic, there's much these ubiquitous health providers
can do for you. They can take a history, order some
tests, diagnose and even prescribe some meds (a list
of drugs NPs are allowed to prescribe is issued by provincial
nurse colleges and associations). "They can be the first
connector [between doctors and patients]," says acute
care NP Cynthia Struthers, president of the Canadian
Association of Advanced Practice Nurses.
Patients like them too. NPs spend
more time with patients than FPs (almost certainly because
they're salaried) and explain things better, according
to a 2005 article in the Canadian Journal of Rural
Medicine. The result was higher patient satisfaction.
Having someone on the team who can take the time to
answer patients' questions can lighten your work and
stress burden.
Continuity of care and patient
follow-up can also get a boost when NPs are on board
the health team. "If there's a patient that's stable
with an illness, the NP can carry out the treatment
plan, do alterations and counselling," says Ms Struthers.
Some do home visits, adds Ms LeBeau, which might contribute
to the diagnosis.
GPs flying solo have also discovered
that NPs bring a different perspective to patient management,
according to Jane Sanders, executive director of the
Nurse Practitioner Association of Ontario. "They sometimes
have more knowledge as to what services are available
in the community and can help develop chronic illness
management program." And it can't hurt to have another
health professional to consult on hand, she points out.
LINGERING
HICCUPS
Rosy as the picture seems, the course of NP incorporation
into practice hasn't run entirely smoothly. Confusion
over their titles — Extended Practice Nurse in
Manitoba or Advanced Practice Nurse in BC — and
differing qualifications from province to province is
enough to deter some docs from choosing to work with
them.
The scope of practice is not uniform
across the country, leaving it largely up to the doc
to gauge what the NP can do on an individual basis.
Dr Gabor resolved the issue by helping train the NPs,
so there's both trust and awareness of what each is
capable of.
But even if the doctor knew exactly
what to expect, other professionals in the practice
don't. "I've heard stories from NPs where the receptionist
would take a call from a patient and not know who it
should go to," says Ms Sanders. "It's not easy and whether
you're working in a clinic, a hospital or in the tar
fields of Fort McMurray, you need to understand the
role of the team you work with."
Liability is another real concern.
Most NPs are covered under the Canadian Nurses Protective
Society (CNPS), which works much like the CMPA —
except those in BC and Quebec. However, NPs in those
provinces can now join the CNPS through a broker not
affiliated with the society itself, under the label
CNPS Plus. But since that's optional, the CMA encourages
docs to make sure all members of their team are well
covered.
A
LOOK AHEAD
There's still a lot of work to be done, admits Ms Struthers,
but changes are happening across the country. "The CNA
is working with the College of Family Physicians to
produce a document about the role of NPs and family
physicians, and provincial health ministries are trying
to create synergies for their roles," she says. Their
joint efforts, according to an October 2007 statement,
should lead to at least a 10% improvement in access
to healthcare for Canadians by 2012.
What's more, a new pan-Canadian
exam is now available for NPs and the CNA is actively
working to make their qualifications and training more
uniform across the country, says Ms Struthers. "The
education, the training and role familiarity —
it's an ongoing dialogue," she adds. Until more changes
make their way to the healthcare world, "we just need
to put the right NP with the right client."
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