The evolving role of nurse practitioners in ending hallway health care
February 21, 2019

Ontario’s universities and the Nurse Practitioners’ Association of Ontario (NPAO) recently brought together health-care leaders, employers, clinicians, students and government to collaborate and discuss the future of nurse practitioners, and nurse practitioner education, in Ontario.

A breakfast panel on the Evolving Role of Nurse Practitioners in Ending Hallway Health Care kicked off the event, moderated by Jennifer Medves, Director of the School of Nursing and Vice-Dean (Health Sciences) at Queen’s University.

During the panel, Ted Hannigan, alongside Marnee Wilson, President of the NPAO and Jennifer Clement, Executive Director of the Sudbury District Nurse Practitioner-Led Clinic, discussed a whole-of-community approach to health care.

In particular, the panelists identified the roles nurse practitioners play in the home, the community, long-term care, and the hospital, filling an important gap in Ontario’s health-care system and ensuring high-quality, cost-effective care.

They also discussed how nurse practitioners complement the role of family physicians and other health-care providers by providing primary, acute and specialty health-care services. They have the unique ability to work independently, perform physical exams, order tests, diagnose and treat illnesses, set and cast fractures, write prescriptions, admit and discharge patients from hospitals and provide referrals.

Filling an important gap in health care

For Hannigan, access to a nurse practitioner meant access to primary health care.

Hannigan moved from Toronto to Belleville 11 years ago. While he was able to find a dentist for his family and a veterinarian for his dog, he was unable to find a family doctor.

“We were introduced to the Belleville Nurse Practitioner Led Clinic (NPLC) and have been patients for 10 years now,” Hannigan said. “Without the NPLC, we would have no front door into the health-care system. There would be no access to check-ups, referrals or prescriptions.”

“It was through the NPLC that a nurse practitioner was able to diagnose and refer my wife to an oncologist who confirmed her Stage 4 cancer,” he added. “We would not have had access to that care otherwise, and she may not have gotten the attention that she needed.”

Innovative solutions to transform community health care

Stories such as Hannigan’s were shared by others who highlighted how nurse practitioners brought resources to the patients and the communities they served, helping those access primary care when they might otherwise have gone to the emergency department.

“The traditional referral process is very disruptive for me, as I cannot afford to miss days of work for appointments and then follow-ups,” said one participant. “I found it easier to go to the emergency department because then I’m at least just losing one day rather than multiple.”

Their flexibility gives nurse practitioners the unique ability to adapt and transform the health-care system in a way that puts patients’ needs first, while ensuring the system is cost-effective and efficient.

They follow up with patients and provide home care services that work with the patient’s schedule, while also creating a network around patients and their families – complete with recovery plans and linkages to other health care providers through phone calls, emails and online portals.

Panelist Perspective: Alleviating the burden of hallway medicine

“Being part of the Council of Ontario Universities’ panel provided me with an opportunity to reflect back to where I started as a nurse practitioner 10 years ago. From only being able to renew certain medications on an approved list to now being able to prescribe controlled substances, and to only being able to order a few investigations to now ordering most tests, this profession has grown by leaps and bounds.

With all the changes coming to health care, I believe nurse practitioners are in a unique position to help alleviate hallway medicine. We have the time to be able to spend with patients to address multiple health-care issues per visit, we are well-situated in communities allowing us to have a network of partners to help patients with their health-care needs and, for those of us working in primary care, we have the inter-professional teams that work together to provide comprehensive, patient-centred care.

What we need to see, however, is more nurse practitioners throughout all areas of health care – more nurse practitioners in the community to help prevent unnecessary visits to walk-in clinics or emergency departments, nurse practitioners in long-term care to provide care in a familiar environment and nurse practitioners in specialty clinics who are specialists in that field. Looking at the successes of nurse practitioners already in practice, the positive impact on the health of Ontarians and the positive feedback from patients; we are an untapped resource.

Universities are integral to these changes in that it is important that the new nurse practitioners are ready for the broad scope of the role and the potential changes we will see in the future.”

– Jennifer Clement, Executive Director, Sudbury District Nurse Practitioner-Led Clinic

Panelist Perspective: New models of patient care

“Ontario’s nurse practitioners play a key role in helping to integrate patient care to improve their health outcomes. It is, after all, integral to our very scope of practice.

Nurse practitioners provide primary care to hundreds of thousands of Ontarians. The expanded use of nurse practitioner-led teams must be considered as a timely, cost-effective and efficient wrap-around model of primary care. Secondly, nurse practitioners in acute care act as comprehensive care providers to treat patients and simultaneously move patients quickly and safely through their hospital journey, ensuring robust transfer of accountability to their community care provider.

Moreover, nurse practitioners are ideally prepared to provide timely care services to our most vulnerable population living in the long-term care environment. While across multiple settings, nurse practitioners influence the health of Ontarians in a positive way, ultimately reducing emergency room visits and post-discharge readmission.

And while we know the work of nurse practitioners, the workforce is under-utilized. Nurse practitioners work across all settings, in clients’ homes and in the hospital, care for all ages, and work with the most vulnerable people. It is time to consider strategic deployment of this workforce and allow us to do the work we do best. Nurse practitioners are ideally positioned to provide radically different care.”

– Marnee Wilson, President, Nurse Practitioners Association Ontario

Responding to the evolving role of the practitioner through education

Ontario’s universities, and the nurse practitioner programs they develop and teach, play a key role in ensuring students and new graduates develop the knowledge and skills they require for their evolving place in the health-care system.

Beyond learning the core competencies to provide communities with high-quality health care and services, teaching leadership, communications, interpersonal, conflict management and project management skills will allow nurse practitioners to better navigate and respond to the changing needs of the province.

They will continue to be able to meet patients where they are and find innovative solutions for communities across Ontario.