August 11, 2021- Nurse practitioners play a critical role in the delivery of health care in Ontario. At the 25th anniversary celebration of the Primary Health Care Nurse Practitioners (PHCNP) program, Cynthia Kitson shared her experiences and challenges as the first full-time PHCNP student at the University of Ottawa, her career highlights working with some of Ontario’s most vulnerable populations and her hopes for future graduates of the program.
Through postsecondary education and clinical experience, Cynthia has made valuable and lasting contributions to the health and well-being of communities and Ontarians across the province. Read below for a full transcript of Cynthia’s speech to new graduates:
“In what seems a lifetime ago I went to a meeting about a new and upcoming nurse practitioner program- one that would re-ignite the Nurse Practitioner role in Ontario’s health care system. I carefully completed the required application and was surprised to find myself accepted for a full time position starting in the fall of 1995.
Little did I know when I accepted the offer to start the NP program that I was the lone full time student- but joining me part time was Pat Topp who many of you know in the role of AHAD and IP tutor of many years and Janet Helmer who was, for some time, the site co-ordinator for the University of Ottawa. When I started however, we were led then by a dynamic duo at the University of Ottawa Jenny Humbert- Anglophone program and Suzanne Doucette- Francophone program who have subsequently retired after serving the program so well for many years.
The Nurse Practitioner (NP) program was in its infancy – full of expectations and learning. I travelled to Queens’ to join their students for AHAD seminars and joined remotely for Therapeutics- and remotely in those days was by telephone! The total clinical hours for these two courses included quite a few days with both a pharmacist and a complementary/alternative therapist therefore reducing the number of hours spent a nurse practitioner preceptor. This meant our clinical experience hours were quite limited as we entered IP and, although there was much to learn from these alternative health care practices, I was certainly happy to see an increase in the hours dedicated exclusively to time in more traditional clinical settings.
Initially there was no formal NP designation with the CNO and on graduation from the NP program we waited nearly 18 months to have the role officially established and to write our registration examination. In the meantime I worked in Sioux Lookout zone and Moosonee, taught the post RN health assessment course in Ottawa and Pembroke and started teaching therapeutics in the NP program.
Working multiple contracts is exciting and dynamic work but also exhausting as one changes environments and hopes that there is another contract coming after the current ones conclude. I was subsequently hired at Pinecrest-Queensway full time as an NP. Here I enjoyed the experience of providing health care to those in a shelter for homeless families, a high school clinic and seeing clients in the CHC walk in. My experience with newly arrived Canadians and those living in poverty was rewarding and carried forward valuable lessons about working with people truly challenged in the area of social determinants of health.
More recently my clinical career path has taken me further into working with homeless populations in shelters and those in transitional housing. Safe consumption sites, opioid substitutes and safer supply have all evolved around me, along with better care for those at risk of or having Hepatitis C and HIV. One quickly learns that clinical practice is never stagnant and is always moving forward in new directions.
Currently, in my full time position with Ottawa inner city health I work with 4 dedicated and talented NPs. We work collaboratively with the nurses and peer support teams at other OICH sites while providing PHC in a downtown setting for people who are homeless. We have a doctor one ½ day a week and operate like an undesignated NP led clinic.
Additionally, I completed a PhD in nursing in 2019 with my thesis focusing on health care for women who are homeless and using intravenous drugs. Thus I was truly able to combine academia and clinical practice.
Working as a nurse practitioner has also opened many other opportunities- such as working with the College of Nurses of Ontario in the days where the NP medication list was quite restricted and one needed to submit an application for a drug to be considered for addition to the NP scope of practice.
I also work for Ottawa Public Health – not as an NP but rather as a Public Health Nurse on the Needle Exchange mobile van and in the safer consumption site. I also am a member of the provincial emergency medical assistance team- EMAT. I joined at a time when team was developing primary health care capacity to complement critical care skills and more nurse practitioners were asked to join the team. In 2015, my first deployment, we greeted the Syrian refugees at a small terminal at Pearson and provided health care as they disembarked from their long journey. Since this time NPs have become an integral member of the EMAT clinical deployments.
In my 25 years as an NP- wow 25 years is crazy long and it has gone so fast- I have seen the NP practice grow from a restricted role that was intensely scrutinized, to a wholesome contributor to PHC and acute care in the Ontario health care system. We still have work to do- as we know ordering MRIs and CTs, doing POC testing and other restrictions on practice remain barriers to accessible health care for our clients. Independently practicing NP numbers are growing but there are still areas of practice that need to be explored and promoted.
And in conclusion, as the NP role continues to expand, it is you, the new graduates, who will carry on and expand the work that others have done before you. Thank you for taking on the challenge of this relatively new and exciting role, and I hope that you will thrive in your chosen career path and be proud to further contribute to the NP health care provider acceptance and role expansion as it continues to be integrated into the Ontario health care system providing excellence in evidence based care.
I hope, also, that when you look back on your own 25 years of NP practice, that you will feel as rewarded and satisfied in your professional life as I do.”
Cynthia Kitson NP PHC, PhD
Therapeutics 1 and 2; Integrative Practicum
Primary Health Care Nurse Practitioner Program
University of Ottawa