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‘This is the time’

Nurse practitioners can shape present and future of health care

By Marcia Porter

Earlier this fall, a group of registered nurses in the second year of the master of nursing, nurse practitioner, option at the Faculty of Nursing put on their nurse practitioner “hats” and spent the week together in labs and classes.

They assessed standardized patients, focused on examination techniques and learned how to suture, building on their advanced practice nursing skills and learning about the nurse practitioner’s scope of practice.

These experienced registered nurses, mainly from across Newfoundland and Labrador, come to the program with expertise in a wide variety of practice areas, including intensive care, emergency, cardiology, oncology, pediatrics, obstetrics, long-term care and others.

That depth and breadth of knowledge — about three years’ worth of clinical experience — is a requirement for admission into the three- or four-year nurse practitioner option of the master’s program.

You can learn more about nurse practitioners, and what they do, in a MUNalum 101 session on Tuesday, Nov. 15, from 1-2 p.m.

“The difference between registered nurses (RNs) and nurse practitioners (NPs) is the level of responsibility and accountability that comes with the added role of assessing, prescribing, ordering diagnostics and tests, and following up with patients and their families, and caregivers using a holistic approach,” said Dr. Jill Bruneau, co-ordinator of the nurse practitioner option, who is also a RN, NP and an assistant professor in the faculty.

‘This is the time’

She speaks passionately about the role of nurse practitioners and their potential to help shape the present and future of health care in the province.

“This is the time for nursing and nurse practitioners,” said Dr. Bruneau, whose PhD research in the area of cardiovascular risk, prevention and management of risk factors addresses a gap in health care that she’d like to help bridge. “We are all about promoting the health of the population, looking at where they are and getting them to a better place.”

Nurse practitioner education at Memorial focuses on two streams: family and all ages, where NPs see people from birth to senior years; managing chronic illnesses, such as hypertension and diabetes, chronic obstructive pulmonary disease and mental health; and adult, which focuses mainly on acute care and specialty areas.

“Being a nurse practitioner is about the relationships that you are able to build with patients and their families.” — Dr. Jill Bruneau

But the program is taking a more generalist approach in the future, to more effectively prepare NPs to work in all health-care settings.

At the heart of nurse practitioner education is the emphasis on the importance of the social determinants of health. It’s foundational and critical to consider the socio-economic and environmental factors influencing a person’s health, Dr. Bruneau says.

“Being a nurse practitioner is about the relationships that you are able to build with patients and their families, taking care of them over time, and having that depth of knowledge. Being their constant support is an incredibly rewarding experience.”

Nurse practitioners are also important advocates and facilitators, serving as a resource for inter-professional team members, including specialist physicians. They’re relied on for sharing critical information about the patient’s status, working both independently, and within the team.

With more than 250 nurse practitioners practising in hospitals, clinics and in rural and remote communities across the province, up from 170 just a few years ago, Dr. Bruneau is seeing an increased demand for their advanced knowledge and specialized skills.

And that’s a good thing, she says, pointing out that Newfoundland and Labrador’s Health Accord recognizes nurse practitioners as key to helping transform a health-care system where high levels of spending — the highest per capita in the country — have not translated into a healthier province.

What are the barriers?

But there are significant barriers on the path to a healthier place.

One of the biggest is billing and the fee-for-service model for physicians.

“We’ve got to find a better model for all primary health-care providers, such as NPs and family physicians, that remunerates quality of care rather than time spent in a fee-for-service model,” she said. “It’s costing the province so much. We have to find a better way to enable primary health-care providers and to empower the people of our province through supporting them to improve their health.”


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