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Quebec has only 59 Nurse Practitioners thanks to government fund fast

As reported yesterday, Sam Solomon, has left the blog to continue his studies in law school. Reports of the death of Canadian Medicine News were greatly exaggerated. It continues with regular contributions from David Elkins and other medical and health policy writers.

Ten years ago the idea of nurse practitioners was controversial, five years ago it was lauded as a solution to access to primary care and now, in most provinces, NPs are considered essential.

Nurse practitioners prescribe medication, order diagnostic tests follow patients and take the load off practitioners -- and the health care system. Canada needs more them, not fewer except, apparently, in Quebec where there are only 59. Ontario employs 1,900 up from about 1,400 three years ago.

In 2007, McGill's School of Nursing began a nurse practitioner program but so far it's been funded by the Faculty of Medicine with little help from the provincial government, says the Director of the School of Nursing, Dr Helene Ezer.

On March 10, Abbott Labs stepped up to support the program with a donation of $100,000. Said Jeff Devlin, General Manager, Abbott International, Canada: “Nurses and nurse practitioners comprise an essential component of our health care system. They play an extremely important role in the lives of Canadian patients. We must support their development to improve health care delivery.”

Quebec Health Minister Yves Bolduc was not as generous. His only comment: "(The government) remains committed to hiring 500 nurse practitioners over the next five years." Quebec teaching universities contend that there will be few to hire unless the government meets another commitment -- to put more money into NP training.

Bolduc maintains, "It's a new program that we're going to put in place in Quebec, and we have to develop the teachers. We have discussions with the universities and we're going to have a program in the next few years."

The first Quebec NPs will be graduating in June.

In a related item, yesterday Quebec's medical specialists joined general practitioners in support of the province's largest nurses' union, the 58,000 member Fédération interprofessionnelle de la santé du Québec. representing 58,000 nurses.

The doctors blamed the government for the severe nursing shortage -- estimated at 2,500 --that is crippling overcrowded ERs and causing operating room delays.



RE: Nurse Practitioners #1

In the late 1960's there was a movement to educate ? registered nurses in Ontario beyond their basic course.
It was proposed that nurses who followed a model of nursing that promoted " independence" in the patient( not yet known as "client")could apply for a two-year course and receive the title Nurse Practitioner. These types of nurses were working in Public Health in the community and in "critical care" hospital departments.
Their future was short-lived and their new credentials meant little to employers.

RE; Nurse Practitioner #2

Subsequent to the emergence of "Health Science " centers there was a genuine absence of " tacit" ( hands-on ) knowledge in baccalaureate prepared nurses . This birthed a new perspective in creating a type of Nurse Clinician/ Nurse Practitioner aligned with a GP staff commitment focussed on training this ?type of NP to replace their assessment duties in hospital settings. These credentials afforded the nurse little recognition or job opportunities beyond " critical care" employment in hospitals with no wage advantage.
There was more emphasis on replacing other staff ( lab technicians, I.V. team, ) and easing the assessment duties of the ?on call/ locum/ GP



RE: Nurse Practitioner # 3

In the recent past there was a "fast-tracking" of NP's to ? complement/?replace the work of physicians in both clinical and hospital settings.
There were three types with dramatically different perspectives:

1. the direct alliance with a GP or Family Health Center where little more than " parroting skills" are required. Hasty B.ScN credentials were arranged and locums representing their expected employment arena were vied for. A closer look at their scholastic offerings in a "group learning" arena allowed the "many" to jump on the backs of the "few". A closer look at their skillbase would give "aghast" new meaning.
They now complement the GP teams in Family Health centers making very high wages under "gravy" contracts.... and certain patient classifications have been "streamed" in a different direction.

2. the pychosocial model of community care normally occupied soley under the mantle of Public Health attracts entrants to the current NP programs to embrace the workload of types of ? clients ( formerly known as patients) who would not necessarily be accepted as patients by GP's in private practice).
With their past exposure to baccalaureate prepared nursing standards their skillbase and perspectives on health are dramatically different.
Their income is dramatically less than category 1.

3. the entrepreneural NP with an eye to independent practice and nurse-managed clinics ( already in long-time practice in the USA supported by " foundations" easing the physician workload in eldercare settings
The current threat/opportunity for this category in the USA is the push to have the NP status expanded to a "Doctor of Nursing Practice" legislated to be in place for 2015.

...now of those three categories which would you choose?




A "little learning is a dangerous thing".... not just for the practitioner......but also for the patient.

Have you ever looked on the wall of your Mechanic's workplace where a type of diploma contains stickers demonstrating someone has determined " currency" of skillbase for their current work setting.
We have learned a lot from that same workplace setting:
1.how to " cost" a task differently than according to " time" spent
2. how to segment and differentiate the nature of the task
3. how to cost the segments and present them "menu-style" to the client
4. how to insist that the role of "diagnostics" be paid as a seperate event
5. how to insure per "part" instead of per client or whole client vehicle

For healthcare settings operating with an entrepreneural model ( occupied by NP #2, categories 1.and 3.) I would like to see " annual stickers" on that NP diploma distributed by some regulating body that "actually" examines the skillbase of the individual.




( occupied by NP #2, categories 1.and 3.) in Summary

...should read as ( occupied by NP #3, categories 1.and 3.)



......this is what happens when you have erosion "from above" and "from below" of anything that is " dammed up"


Kudos to quebec for making sure they have properly trained " teachers" first :)

Kate: BScN MN NP said...

Nurse Practitioners are the most researched health care professionals to date. Studies consistently show that care provided by NP's is equal to or better than care provided by MD's. There is no evidence of increase in morbidity, mortality or malpractice associated with care provided by NP's.
At one time taking a blood pressure was the domain of the physician, we moved on. It is now time to move on again and to realize that the future of Canadian health care depends on an interprofessional model of care with increased responsibilities given to nurse practitioners, pharmacists, respiratory therapists and other health care providers. There are Nurse Practitioner programs available in universities across Canada. Let's use them to educate nurses to an advanced level of nursing practice until Quebec is able to establish accredited programs within its own facilities.
There is plenty of work for all of us. Let's not restrict Canadians access to health care because of antiquated beliefs and turf wars.