Nurse practitioners make a difference

By Wendy Elliott

The Advertiser/NovaNewsNow.ca

Five Nurse Practitioners (NPs) are working in south-west Nova Scotia to create a new model of health care.

Dianne Corbett travels throughout three counties, Yarmouth, Shelburne and Digby to see patients in their own homes, while Dara Lee MacDonald has been practicing on Digby Neck. She sometimes has to send her patients onto a ferry for a drive two hours away.

“Access is an issue for many,” says Wolfville-based NP Sheila McGray. “We’re hoping we can improve that.”

She practices in collaboration with Dr. Roger Hamilton, but out of the EKM Health Centre. Dana McNamara-Morse is another NP in the region who works in a collaborative practice with two physicians in Middleton.

McGray said the scope of her job is larger than that of a traditional nurse. Each NP has an advanced set of medical skills. “It’s exciting when we’re asked to offer our assistance,” she noted, “as nurses we have experience to offer.”

Each NP has an additional 18-24 months of clinical and academic study on top of her registered nursing degree. “It’s really quite intensive,” Corbett said.

Some, like Corbett, work in primary health care and others in more acute settings. Nurse practitioners can order tests and x-rays, write prescriptions, and conduct annual physical examinations.

Thorough examinations

Corbett said that NPs are known for their thorough examinations because they can take the time to ask questions and listen. She also noted that studies at Dalhousie University have proven that when an NP is working in the system, a large percentage of patients don’t have to visit emergency rooms.

Jacinta Harvey, who works in Annapolis County with four doctors, says NPs help to manage chronic disease. Harvey’s areas of specialization include women’s health, youth, wound management and immunization.

Many NPs like having more autonomous situations or independence within the medical hierarchy, but they also enjoy collaborative practice. Since there are so few, the NPs in this region enjoy getting together a couple of times a year to compare notes.

“We refer back and forth,” she said, referring to local and regional collaboration. “This district is very open. It’s a wonderful job. It’s very rewarding. I think people appreciate what we do and we do see a difference.

“We work across the life span of patients from birth to palliative care, McGray said. “We’ve developed more of a team approach that is interdisciplinary and professional. The idea is to utilize those professional to maximum of their capabilities.”

With more than a decade as an NP, she’s witnessed a lot of change. Medicine today, and nursing in particular, McGray suggests, has a more wholistic focus.

For Corbett, whose patients are largely seniors, complex cases require a multidisciplinary approach. “Younger physicians coming out of med school today are educated about how we work,” she added.

“In fact, we are often a training centre for medical students,” Harvey said.

NPs often have an educational or health promotion role. Harvey said she is frequently asked to speak about weight loss or angina or menopause at schools or fire halls or Women’s Institute meetings. “I think because we're nurses people are less uncomfortable talking to us. Everybody knows doctors are so busy.”

Earlier this decade

Nurse practitioners began practicing in a Nova Scotia pilot in 2000. It was so successful that in 2002 eight more were added, including Wolfville and Annapolis Royal.

At the time, then health minister Jamie Muir said, “this is great news for the people in these communities who won't have to wait as long or travel as far to get the care they need.”

The team approach was launched five years ago. “Adding nurse practitioners to our complement of health-care professionals allows us to be more creative in how we meet the health-care needs of people in these unique areas of our province,” Muir said. “Some communities may not have the population to support a full-time family doctor, but people can still have access to primary health-care services on a full-time basis.”

Last week, NDP health critic Dave Wilson said the province should further expand the number of nurse practitioners, who can divert up to 80 per cent of patients from needing to see a doctor.

“I think if we create an environment for a physician to work in, especially in rural communities, that isn’t as pressured as it is today, then I think you’ll have more success in recruitment and retention of these doctors to rural communities," Wilson said.