A hybrid model for modern health care
Nurse practitioners are becoming increasingly crucial in bridging health-care gaps
Decades ago, there were doctors and nurses. One prescribed the pills and the other brought them to the patient with a cup of water. Today, a new, hybrid model is making the rounds and they’re proving their worth with each passing year.
The nurse practitioner — part doctor, part nurse — has increasingly become the first point of contact for those seeking primary care. There are currently 185 in Newfoundland and Labrador, and the number keeps growing.
“Even though that’s a 40 per cent increase over the past five years, we really feel that there is much more room for growth in the role of the nurse practitioner, and a much bigger role in the community, in primary health care clinics,” Yvette Coffey, president of the Registered Nurses’ Union of Newfoundland and Labrador, said this week.
“Nurse practitioners are alleviating the strain on the system, where we have such a huge shortage of primary health care providers.”
Nowhere is that more evident than in rural areas of the province and community centres like Bonavista, where Mark Aylward has been a nurse practitioner (NP) for the past six years.
Aylward, who grew up in the nearby town of Knight’s Cove, practised there as a registered nurse before earning the extra credentials for his current role, so he’s completely homegrown.
“We’ve always had a really good team in this area, so I’ve been very fortunate.”
WHAT’S INVOLVED
Aylward explains that an NP is still a nurse, but one with more autonomy.
“A nurse practitioner, in a broad sense, is considered a broad-practice nurse, so our foundation is registered nursing,” he said.
“We are all registered nurses, but with additional education and qualifications.”
Aylward spends half his time seeing patients in a family practice clinic, much like a general physician would, and half his time in the emergency department seeing patients who are lower down the triage scale.
“That certainly helps out the physicians that are working in emergency to devote most of their time to the more emergent, urgent type of patient.”
Aylward says there’s not much an NP can’t do. They can diagnose and treat most health conditions and prescribe drugs.
“The roles and responsibilities and the scope of practice of nurse practitioners have certainly advanced over the years, and even with the short period of time of six years that I’ve been practising, there’s been an increased scope,” he said.
That doesn’t mean there’s any kind of turf war, however.
“Evidence shows that the best outcomes for patients, and even community and population health, would point more to a more collaborative approach, and that includes all disciplines in the health-care system,” he said. “This is not about we vs. they or a turf war of any kind. There is a huge need for family physicians, emergency physicians, nurse practitioners, registered nurses that work in varying fields and other disciplines.”
Focusing on a team-based, community approach — even if that involves virtual consultation among some of its members — has been a focus of health-care advocates for the past several years, and is a central theme emerging from the recently formed Health Accord task force.
And it’s an approach the Newfoundland and Labrador Medical Association is on board with.
In January, the doctors’ group asked campaigning party leaders to, among other things, support a system “where nurse practitioners, registered nurses and other providers can be connected and integrated with family doctors in team structures.”
THE FUTURE
Julia Macdonald of St. John’s certainly sees the potential for NPS in the province.
She just got accepted to the NP program at Memorial University, which is essentially a master’s in nursing combined with extra training and clinical rotations.
You have to have at least two years’ work experience as a registered nurse to apply, and Macdonald says she’ll keep her current post
as a nurse in a private clinic while she pursues her studies part-time.
“I’m going in with an open mind,” she said in an interview Thursday. “I’m not sure where I want to end up at the end of this program, but I always loved the primary and acute care settings, being able to work with the interdisciplinary team, being able to provide holistic care, especially to women, children and families. That’s kind of where my heart is.”
Like the others, Macdonald sees an increasingly important role for NPS.
“I really think that nurse practitioners are almost the future of health care, the future of primary care. In many areas, especially in Newfoundland, they will end up taking the place of GPS because there’s such a shortage of family physicians here right now. Even I don’t have a family doctor.”
And she’s not apprehensive about the economic realities.
“Obviously, it’s at the forefront of everyone’s mind right now, but at the core of me, I just want to help with whatever I can,” she said. “If there were cuts, I would still be there, helping.”