Despite the fact that nurse practitioners are becoming increasingly important in the Canadian health care landscape, the graduation numbers don’t reflect this.
By Trevor Graumann
Nurse practitioners are becoming an ever more important, yet still largely invisible, development in Canadian medical care. Their advent opens up new dimensions in nursing careers for those who have an interest in expanding their nursing options
The purpose of nurse practitioners is to relieve doctors of some of the more routine aspects of their work, but nurse practitioners have a surprising number of responsibilities and duties. They can treat and even diagnose under the supervision of a doctor. They can prescribe all but narcotic drugs. They can even perform minor surgeries.
Judith Scanlan, Associate Dean of Nursing at the University of Manitoba, says, “We used to work directly under a doctor, and administer treatment the way that doctor saw fit. But now we’re working on interdisciplinary teams, and we are having a key role in the diagnosis and treatment of patients.”
Although Nurse Practioners have worked in Ontario hospitals since the 1980s, the country’s first nurse practitioner-run clinic opened in Sudbury in 2007. On the very the first day the clinic opened it had patients lined up around the block.
Since the opening of the Sudbury clinic, no less than 25 such clinics were slated to be opened in Ontario. There are also clinics in Alberta and British Columbia and nurse practitioners are becoming more evident in Manitoba practices.
Despite the fact that nurse practitioners are becoming increasingly important in the Canadian health care landscape, the graduation numbers don’t reflect this. The University of Manitoba rarely graduates more than 15 nurse practitioners in any given year. In total, there are currently about 100 working nurse practitioners in the province.
Though universities throughout Canada offer training in acute care – which involves emergency and intensive care work – the University of Manitoba’s focus is on primary care, also known as family care.
Sandra Kehler, who graduated from the University of Manitoba’s program in 2008, works primarily with mental health patients. A typical day for Kehler goes something like this: in the morning she works in the addictions unit of the Health Sciences Centre, doing the admitting paperwork – such as patient history and physical exams – for new patients on the ward. This is in addition to doing the rounds for existing patients. Kehler works closely with the doctor on the addictions unit.
For her afternoons, Kehler works on the outpatient psychiatry unit, monitoring the physical effects of meds and screening patients who are on some form of anti-psychotic, because diabetes and weight gain are common side effects of such medications. She independently sees, treats and prescribes to patients, though there is a psychiatrist as well as a house medical officer on shift at the same time. Sandra is the first nurse practitioner to have this role at the Health Sciences Centre.
Janell Plouffe, director of nursing education at the Health Sciences centre, was among the first to focus on acute care, working with children. Over the course of her career, Plouffe has seen public appreciation of nurse practitioners grow. “In the past we were seen as little more than assistants to the physician, whereas today we are seen more as physicians.
“It takes courage to be a nurse practitioner,” she says. “Sometimes the decision for a terminally ill patient’s treatment belongs to you and no one else.” Still, she explains, there is a clear difference between the physician’s role and that of the nurse practitioner. “Physicians tend to focus on the patient and the treatment needed to combat a particular ailment,” she says. “But nurse practitioners have a more all-encompassing approach to treatment, involving the patient’s family, diet and illness trajectory.”
Research is also a key part of a nurse practitioner’s career. As Janelle notes, “Our research always has a practical end to it, with the goal of improving a particular medical practice.” This is in contrast to the research conducted by physicians, which is often for a more distant application that is not always visible.
In terms of the future of the nurse practitioner profession, both Scanlan and Plouffe have hopes that nurse practitioners will be more widely used in the future as part of medical teams. “My hope,” says Scanlan, “is that hospitals will bring in more streamlined processes, which will see nurse practitioners serving more people.”