By Melanie Jollymore
At a time when more and more people in Nova Scotia are searching for a family doctor, nurse practitioners (NPs) are proving their ability not only to help fill the gap, but to bring new value to patients.
Nurse practitioners must hold at least a master’s degree and are qualified to perform many of the same tasks as a physician. “We are able to suture, cast broken bones, order and interpret x-rays, prescribe various medications, and refer to specialists,” notes Kim Lamarche, a nurse practitioner in Cape Breton who holds a doctorate in nursing practice (DNP). “It is not within our scope, however, to admit patients to a hospital, wield a scalpel for surgery, or prescribe medical marijuana.”
There are over 180 NPs licensed with the College of Registered Nurses of Nova Scotia, most of whom are working throughout the province’s health care system—in hospitals, outpatient clinics, nursing homes and, increasingly, in team-based primary care settings. Their impact is being felt in a positive way.
“Our research shows that nurse practitioners are improving access to high-quality primary care all across Nova Scotia,” says Ruth Martin-Misener, PhD, one of Canada’s leading researchers in nursing roles and a professor in Dalhousie’s School of Nursing who works closely with Nova Scotia Health Authority (NSHA). “For example, we’ve found that if you add a nurse practitioner to a group of clinicians, that group can take on 800 more patients.”
The reason, in part, is the slightly different focus of the NP role.
“Nurse practitioners cover the same breadth as physicians, but come at it from a different angle—a more holistic view on average,” says Rick Gibson, MD, NSHA’s senior medical director of Primary Health Care and the Department of Family Practice. As he explains, NPs are geared to spending more time with patients—to gather an in-depth history, discuss how other aspects of life are affecting their health, and teach them how to better manage their symptoms and maintain their health.
“With physician shortages, it is a good time to consider what NPs bring to a team,” adds Gibson, who is helping to lead the shift to team-based collaborative primary health care in Nova Scotia. “It’s apparent that an NP could do a number of tasks equally well or better than I could and free me up to do other things and add more value for the patient.”
Among her many roles—as a clinician, a teacher and a researcher—Lamarche heads to Eskasoni First Nations Reserve one day a week. Here she applies her understanding of Indigenous health needs to walk-in patients, collaborating with three full-time physicians and an RN.
Coughs, colds, medication refills and lab work-ups are routine. More in-depth discussions are required for those patients who are coping with chronic conditions—diabetes is a particular challenge—or who may be struggling with an addiction. “It’s the same with whatever population you’re working with,” Lamarche emphasizes. “You need to understand their circumstances and particular concerns.”
Working in teams provides the members with the opportunity to focus on their strengths so that, together, they provide the best, most efficient care to patients.
“The beauty behind collaboration is that it allows the most appropriate professional to provide the best care at the right time,” notes Lamarche. Sometimes this care takes the form of completing and signing forms—such as death certificates and insurance, CPP, disability and other forms. “Administrative tasks like these can take up a lot of a physician’s time, unnecessarily, but this is something NPs are certified to do.”
NPs are particularly skilled at helping patients with chronic diseases learn how to manage their symptoms and risks. This equips them to play an important role in group visits, an innovative approach to health service delivery that NSHA is exploring.
“Group visits may offer an efficient and effective alternative to one-on-one doctor visits,” notes Tara Sampalli, PhD, NSHA’s director of research and innovation in primary health care. “We’re investigating this possibility—not only as a means of connecting ‘unattached patients’ to care, but as a potentially better way to empower people to manage their own health.”
NSHA, Dalhousie University and the Nova Scotia Department of Health and Wellness are working closely together to explore, test and implement new ways of improving Nova Scotians’ access to quality health care. Growing the role of nurse practitioners in primary care is one of the proven strategies they’ve embraced.
Nurse practitioner plays multi-faceted roles
In addition to her work as a nurse practitioner in primary health care, Kim Lamarche is an educator and a researcher. The DNP (Doctorate in Nursing Practice) spends a third of her time as tenured associate faculty member with Athabasca University – touted as a leader in undergraduate and graduate education in Canada—teaching NPs via online courses.
She spends another third of time on research, which revolves in part around the technology that’s used for teaching health professionals online. “I study how we can best use MOOCS – Massive Open Online Courses – for NPs’ continuing education,” she says, noting that Athabasca University teaches exclusively online.
The online world is a big part of professional practice too, but, as Lamarche explains: “A health care professional may have 17 different online systems to use in the run of a day, but little or no training in using them. Some heath care providers are business owners too, which is challenging. We need to teach people how to use all these systems appropriately.”
Also on Lamarche’s radar is a look at job satisfaction among health care professionals. Add to that her role in community service: past president of the College of Registered Nurses, International Council of Nurses board member and professional practice chair for NSHA’s Eastern Zone. Oh—and she just happens to have nursed for Canada’s Navy, Army and Coast Guard and continues in the Army Reserves. Seems like there isn’t much this DNP doesn’t do.