COMMUNITY CARE NURSE-LED CLINICS SPREAD
Easing a shortage of family doctors in Ontario,
BELLEVILLE— It’s 8:30 in the morning and a dozen people crowd into the tiny room, clutching coffee and clipboards. It’s time for The Huddle.
It’s a new idea for the staff of Belleville’s flourishing nurse-practitioner-led clinic, located in an abandoned doctors’ office downtown.
The team — four NPs, two registered nurses, a pharmacist, a social worker, a dietician and administrative support staff — make notes as they hear updates on patients they have referred to hospital for treatment. Ideas and suggestions are kicked around the room.
“It makes for better communications,” explains clinic administrator Ann Marie Baldwin. “Three times a week, we pick up the ER reports from the Belleville hospital — we have our own marked box at the hospital. Whoever decides to run the meeting goes over the schedule, and checks if we have any specific patients we should watch out for.”
The Huddle, launched at the start of April, is now a daily fixture. It is all about improving teamwork and that’s what makes NP-led clinics like this one tick.
“The nurse practitioners are a very tight group,” Baldwin says. “The group of NP-led clinics all tend to talk to each other all the time, there’s emails going out asking how do you do this, what do you do when this happens.”
The Belleville clinic was the first in a wave of 25 approved by the province and completed last year, after a trial nurse-led clinic in Sudbury was stamped a success. The NP-led clinics were seen as a quick solution to ease Ontario’s shortage of family doctors. The clinics now provide full health care for more than 20,000 patients. In the past decade, the number of NPs has tripled and new NPs are being trained at the rate of 200 per year. “I think the other difference is that NPs have a different approach,” Baldwin says. “They approach patients as nurses do, and they have longer appointments, typically 30 minutes, rather than 15 minutes with family doctors. There’s more time. They try to get to the core of the patient, and they have a whole conversation.” Belleville lived with a shortage of doctors for years. Even today, official estimates put the number of “orphaned” patients in the area as high as 11,000. The NP-led clinic already has 2,200 patients on its list and expects to top out at 3,200 by year end. It was the sheer number of orphaned patients — deprived of doctors and lining up for hours outside the hospital’s ER — that spurred nursing professors Tammy O’Rourke and Elizabeth Edwards to start a campaign to land an NPled clinic for Belleville. O’Rourke is now the chief NP of the clinic she helped create. She says a big part of their quality-improvement plan is to urge pa- tients to come to the clinic for preventative health care, instead of waiting until their condition deteriorates and they need to go to the hospital. The clinic has worked hard to earn the trust of its new patients, who, for the most part, did not have a family doctor when they enrolled. It’s open six days a week, including 12 hours on Mondays and Tuesdays, and an early opening on Wednesdays for blood tests.
The close-knit, multi-disciplinary nature of the clinic was a strong attraction for NP Rick Steeves, who moved here from Springhill, N.S.
“Obviously, the whole health-care system is moving to a more collaborative approach, where doctors, nurse practitioners, nurses, physiotherapists, dieticians, pharmacists, everyone, just works together as one,” he says. “And I think increasing our scope of practice in Ontario can only benefit the patients.”
Baldwin says the clinic is still trying to get the word out to the community. “I think people still do not understand, and think they are going to see a doctor when they come in here,” she says. “So it’s up to us to explain who we are, what we do, and that you won’t notice the difference between us and a doctor’s office.”