Why isn't province using prescription for collaboarative health care?

By Nadine Armstrong

The Hants Journal/NovaNewsNow.com

It’s apparent to anyone who has had to wait hours in an emergency room to be treated for a simple cold or injury that something is wrong with the health care system. In the days of doctor shortages and emergency room closures, it may be time to look at other options; and nurse practitioners may just fit the bill.

Yet Nova Scotia appears to be hesitant to write the prescription for more accessible health care by delaying the funding process for nurse practitioners, says NDP leader Darrell Dexter.

The Opposition leader has been touring the province of late and visiting practices in an attempt to figure out what the hold up is.

“There is obviously a shortage of decision-making by the Department of Health,” Dexter told The Hants Journal during a recent interview. “We are losing nurse practitioners in this province and it doesn't make any sense. This is sadly typical of the delays in our Health Care system.”

There was a big push during a 2000 pilot project to introduce nurse practitioners as a collaborative approach to family medicine in Nova Scotia. But since then, interest appears to have dwindled and most NPs are now forced to go outside of the province to find employment, or wait the three to five years for funding.

Such is the case for Dawn Lowe, a trained nurse practitioner currently working out of a Hantsport practice. Lowe worked as a registered nurse for 10 years before upgrading her education to NP. After serving her practicum with Dr. Iona Wile in Hantsport, the offer was on the table to continue the partnership -- which would save Wile time and better serve her ever-growing patient list.

Can see different patients

Wile said the advantages of having Lowe on board includes an increase in the number of new patients she could take on and provide better heath care education.

In fact, unless a patient is critically ill, an NP can see to just about any condition, Wile said. Nurse practitioners not only test blood pressure but can also screen for diabetes and cholesterol. They conduct general health monitoring and administer immunizations and vaccinations.

In addition, NPs are able to write prescriptions and file requisitions for blood tests and other diagnostics. They are also licensed to make referrals to specialists. This collaborative approach means family doctors such as Wile can get down to the serious business of doctoring. “There are patients that need much more from me, and having Dawn here gives me the opportunity to really focus on them,” she said.

But that’s all dust in the wind if Lowe doesn’t soon get the necessary funding to stay. Lowe has student loans to repay and her remuneration at Dr. Wile’s office can’t take her retraining into consideration until the province gives the go ahead, nor can she legally practice her trade.

The funding application process for Lowe began last June, but there has been no confirmation that it has been considered. So far, between Yarmouth and Cape Breton, only 19 NPs have been funded since the 2000 initiative.

Lowe said the 2000 pilot was set up to implement a collaborative practice approach, and although those initial teams are still up and running new practices are a different story. “The efficiency of this kind of practice is already proven, but it's become almost impossible for new practices to get the funding,” she said.

Time at a premium

And time is of the essence for Lowe. If she doesn't begin to practice within a specific time frame, she could loose her certification. She said that in her class of seven at Dalhousie University, only two are employed as nurse practitioners in Nova Scotia.

Dexter said that although province has invested in education for nurse practitioners it does not provide them the opportunity to practice. “What is clear is that we are losing nurse practitioners in this province. We just know people are leaving to go to other jurisdictions,” Dexter said.

Although wait times for health care was one of the priorities identified in the government throne speech, he noted, there has been no recognition for a program already shown to make a tangible difference. “There are funding considerations, but really this is an efficient way to spend Health Care money. It will result in shorter wait times, which will keep people out of emergency rooms. It makes way more sense to have an expanded collaborative network across the province.”

During his tour, Dexter said doctors are claiming they want and need the collaborative practice approach too keep up with patients. “I’ve been all around the province talking to physicians to identify the road blocks they are feeling and nurse practitioners have been identified as a way to make health care delivery as effective as possible. This is something Nova Scotia needs.”

Dexter said that having only 19 NP funded since 2000 is a shame and a tax on the entire Health Care system.

“The collaborative practice has already been identified as a way to increase access to primary care and takes some of the burden of practitioners. Its efficiency is already proven,” Dexter said. “We see it as a positive, effective answer to one of the major Health Care problems in this province.”