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The changing landscape of health care in Nova Scotia

When we’re recruiting and looking at physicians and health care providers, we’re not just recruiting them for their work. We’re recruiting their families, we’re recruiting their kids-Nicole LeBlanc Project Navigator with Citizens for a Healthy Pictou County.
The collaborative care model, combining the expertise of doctors, nurses (including nurse practitioners) and other medical specialists, is a support model meant to help address shortcomings in the provision of health care in Nova Scotia.

The role of nurse practitioners and the collaborative care model

There is no doubt that Nova Scotia is facing a health care crisis.

According to data released by the Nova Scotia Health Authority on Feb. 1 there were 4,268 people that hadn’t been placed with a family doctor in the Eastern Zone which includes Antigonish County. Provincially there are 51,485 on the wait list.

With an inadequate number of doctors, and many of its practicing doctors planning to retire in coming years, the province is looking to fill gaps where it can in health care provision.

One of the prongs of this plan is the nurse practitioner (NP) – nurses with advanced education and an expanded scope of practice.
In order to become a nurse practitioner, a registered nurse must complete a specific education program, meet entry-level competency requirements, pass an examination specific to where they want to focus in their practice, and fulfill all College of Registered Nurses of Nova Scotia [CRNNS] registration and licensing requirements.

According to information from the Nova Scotia Health Authority, these highly trained nurses are typically part of collaborative family practice teams.

“What we hear every day is how people don’t have GPs (general practitioners),” said Janet Hazelton, president of the Nova Scotia Nurses’ Union. “The government has expressed an interest in utilizing more NPs. The NPs are taking the burden of general practitioners, and taking the burden off communities struggling to attract healthcare professionals”

The rise in the number of NPs in the province is still a new phenomenon; “just starting to ramp up in the last couple of years,” Hazelton said.

When considering the role NPs play in Nova Scotia, the difference between being able to provide primary and emergency care is an important distinction to think about, Hazelton noted.
“Emergency care would be going to St. Martha’s with a sore ear, getting discharged and going home. Primary care is a relationship with a care practitioner – a family doctor that you see every six months or six weeks,” she said. “You see them over a period of time, so they know what you require.”
The role of the NP, Hazelton said, is to fill the gaps that exist between health care practitioners who work in primary care.

“What’s happening now is the role of the NP is to look after patients independently, so they can see – assess your blood pressure, prescribe meds if necessary, talk to you about what you should or shouldn’t be eating, what you need to do to control blood pressure – they are able to do all that, right up to prescribing medication.”
NPs can also order X-rays and blood work, interpret the results of those tests and treat patients accordingly.

“They are not doctors, but they are very important. We relieve the strain that is in primary healthcare,” Hazelton said. “Some people need forms filled out by a professional, for example, and if they don’t have a family doctor, they’re stuck.”

From Hazelton’s perspective, communities where NPs are being introduced to fill the gaps in primary care have responded mostly with positivity.
“I think the role of the NP is going to expand. They’re hiring as many as they can find, all over Nova Scotia. I think it’s going to do nothing but improve healthcare, especially in rural Nova Scotia,” Hazelton said. “In some places, they might have one or two GPs for the whole community. That’s not fair to the GPs, and it’s not the best care for the patients, because you have to wait so long to see them, because they’re so busy.”

According to Dr. Tim Holland, Doctors Nova Scotia is supportive of the collaborative care model, but he added, “everyone in Nova Scotia deserves access to a family physician.”

“That doesn’t mean all the other care providers don’t have their role. One day a patient may see a nurse practitioner about a common health problem, but sometimes when a certain problem presents itself, it’s better suited to a physician.”

Being able to discern between those problems and the appropriate level of response to them, is an example of the collaborative care model working the right way, Holland noted.

When done right, Holland said the collaborative care model is an efficient form of health care delivery.

“We recognize the changing landscape and increasing role of collaborative care across Nova Scotia,” Holland said. “Every team member has an important role on their team. Different providers are different, and no one is better than anyone else.”
However, Holland stressed the necessity of everyone involved knowing who plays what role in a collaborative care mode for it to work functionally.

“It has to be done right for it to be a good thing. When it’s done right, collaborative care has been shown to improve patient outcomes and improve satisfaction for patients and practitioners,” he said.

Without the appropriate planning, however, Holland noted things can go wrong. When the team isn’t on the same page, and communication breaks down, things go awry.
“A lot of physicians hesitate when they see it go wrong, but when goes right it goes fantastically,” he said.

Holland alluded to a collaborative care unit he works with, in Indian Brook First Nation as an example of the best-case scenario.

“I work closely with the nurse practitioner, and the RNs, as well as the dentists, addictions services and mental health counselors,” Holland said. “We leverage the strengths of everyone on the team, and it’s amazing how well it works.”

One of the biggest anxieties around collaborative teams stems from uncertainty around the role of the NP.

“As a family physician, I am trained to make difficult medical decisions, dealing with uncertainty, and taking calculated risks with patients,” Holland said.

Holland noted work as a primary care physician is very specialized, requiring training in integrating multiple sources of information.

“Physicians have an incredible skill set in diagnostics, and a depth of medical knowledge and skillset that puts them in the ideal position with patients with complex medical needs,” Holland said. “When a patient comes into a primary care provider, they’re coming in undifferentiated, and you have to be able to diagnose across all spectrums of illness. Family physicians have the skill and knowledge to work out the more sinister conditions that may lurk behind common complaints.”

Community Group Perspective
As far as Gordon MacDonald sees it, having nurse practitioners around will help ease the pressure on doctors in the province. MacDonald, a member of Capers 4 Healthcare, a Cape Breton-based health care advocacy group, said NPs will specifically have a positive impact where he lives. Cape Breton, in particular, is a region infamous across the province for its egregious shortages and strains on its ability to provide healthcare, on account of a lack of family doctors and overcrowded hospitals.

“What I know about nurse practitioners is that they’re going to assist people that don’t have critical conditions, write prescriptions with some limitations,” MacDonald said.
With the strain many emergency rooms are facing throughout the province, MacDonald sees promise in the potential NPs practicing in Nova Scotia have to ease some of that pressure.

“There are a lot of times when people get into emergency, it’s for maybe a bad cold or the flu – things that doctors maybe wouldn’t be tied up with, if they were to go to a nurse practitioner first,” MacDonald said.

MacDonald said nurse practitioners can “alleviate situations” in emergency rooms, freeing up time for doctors to deal with people who are critically ill.

“I don’t see it as a bad thing,” MacDonald said. “Certainly, they shouldn’t be used to replace doctors, but their ability to help move things along faster will be beneficial.”



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