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Primary care for all

Region supports innovative role for nurse practitioners

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Nurse practitioners are playing a larger role in providing primary care to patients in hospital and community settings under a pilot project launched recently by the Winnipeg Health Region.

As part of the project, three nurse practitioners are rotating through the Grace Hospital and St. James Clinic, providing primary care services that patients might otherwise receive from a family physician.

The project - one of the first of its kind in Winnipeg - is designed to increase the number of primary care providers in the city, according to Pat Younger, Community Area Director for the Winnipeg Health Region in St. James and Assiniboine South.

The province has pledged to ensure all Manitobans will have access to a primary care provider by 2015.

It is estimated the nurse practitioners have provided primary care to over 90 patients at the St. James Clinic since they began their training in the fall of 2011.

"Now, many more people have the care and support of a primary health provider," says Younger. "That's very positive."

At the Grace, nurse practitioners are providing care at the newly-established, 10-bed short-stay unit (SSU) for patients who have been treated in the Emergency Department and are stable but not yet ready to go home.

Noreen Shirtliff, Emergency Program Director at the Grace, says by moving patients to the care of nurse practitioners in the SSU, the hospital is able to provide them with non-acute care until they are ready to go home. This improves patient flow by freeing up beds in Emergency.

In addition, nurse practitioners are providing primary care to patients visiting the St. James Clinic. They see patients much as a family physician would, and make referrals to specialists as required.

The trio - Angela Thable, Patty Sudermann and Dianne Fitch - will relocate to the new ACCESS St. James when it opens on the grounds of the Grace Hospital in the near future.

Historically, the role of primary care provider has been filled by physicians. In recent years, however, many jurisdictions throughout North America have been using nurse practitioners to provide some of the services normally provided by physicians.

Essentially, nurse practitioners are registered nurses with an advanced practical designation that requires a master's degree, significant clinical practice experience, and active registration through the College of Registered Nurses of Manitoba. They practise autonomously and carry their own patient loads, referring clients to other specialists as required. The nurse practitioner's scope of practice includes requesting diagnostic tests, diagnosing illness, prescribing medicine, performing some procedures and ordering interventions.

The Grace Hospital project started with the nurse practitioners completing an orientation in both the hospital and community last spring. The short-stay unit at Grace opened in July 2012.

Nurse practitioner Angela Thable starts her day at the Grace doing rounds on the SSU. She then consults the Emergency Department physician to determine which patients should be transferred to the unit. Every day she meets with occupational therapists and physiotherapists, the charge nurse, social worker and geriatric rehabilitation clinician to make a plan for patients on the SSU. Thable spends her afternoon in community practice at St. James Clinic, where she sees patients from the Grace and other community clients. She ends her day doing follow-up at the hospital.

Thable says nurse practitioners have an important role to play in enhancing access to care.

"Nurse practitioners have flexible schedules and can try and deal with all of (a patient's) issues in one visit. We offer patients alternatives and encourage them to be their own advocates," says Thable, who has a background in Emergency care.

A major challenge is educating members of the public about the role of nurse practitioners and their scope of practice. "We are pioneering a new role at the hospital," says Thable. "We have to clarify it. We are not doctors' assistants. We don't do bedside care like the nurses."

Thable takes pride in her work. For example, she met one man who had not seen a doctor in a decade and came to Emergency because he was feeling dizzy. Since that time, he has had a number of issues. "We diagnosed him with heart failure, put him on medication and referred him to a cardiologist. He's doing fabulously. We're so glad he came to us."

The nurse practitioners are a great addition to the hospital team, adds Shirtliff. "There has been a lot of interest in our model. An integrated model of acute and community care is an attractive option. It's a very exciting initiative and it's great to be a part of it."

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