Lack of timely access to health care is a growing concern not only in remote and rural areas of the country but also in more urban centres. It's primarily for this reason that the number of nurse practitioners (NPs) – registered nurses with additional education in the diagnosis and management of illness and injuries – has grown by more than 40 per cent in only two years, increasing from 725 in 2003 to more than 1,000 at the end of 2005. Here's what you need to know about NPs.
1. An NP provides primary health-care services in collaboration with other health-care professionals.
An NP is trained to take medical histories, order and interpret screening tests, diagnose illnesses and prescribe some medications. In many regions, NPs can perform such procedures as a Pap smear, injections, suturing, cast application, biopsies and the removal of a wart, an ingrown toenail, a lesion or a foreign body from the eye. Offering such services helps to solve the problem of lengthy hospital and health-care waiting times.
2. As with other health professionals, health promotion and illness prevention are top priorities for NPs.
Ann Palamar, for example, an NP in Britt, Ont., near Parry Sound, regularly immunizes infants and children and provides health education in aboriginal communities that have alarming rates of type 2 diabetes, obesity and high blood pressure. And Brenda Dawyduk, an NP at the Burntwood Regional Health Authority in Thompson, Man., runs a high-school-based adolescent clinic where, among other things, she manages adolescent issues including birth control, sexually transmitted diseases and eating disorders.
3. Twelve Canadian provinces and territories have legislation governing the NP profession.
Ontario, for example, maintains a list of procedures NPs can perform and drugs they can prescribe. "A cardiac NP might be able to insert central lines, but if it is not on the list, she can't do it," says Donna Alden-Bugden, an NP who administers the Canadian Nurse Practitioner website, as well as the site for the Nurse Practitioner Association of Manitoba.
Manitoba, on the other hand, lists the diagnostics that NPs can't order and the prescriptions they can't prescribe. This last list generally includes narcotics (although in some provinces NPs can prescribe narcotics for specific conditions and in specific situations), experimental drugs and cancer treatment drugs, says Alden-Bugden.
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In general, NPs can't perform any invasive surgery that involves deep sedation or general anesthesia.
Patients appear to be happy with the care they receive from NPs. The results of a recent survey bear this out. "Canadians who responded to the survey indicated that they were very happy and very comfortable accessing services from a nurse practitioner," says Madge Applin, director of patient safety and risk management for the Northern Lights Health Region in Fort McMurray, Alta.
4. An NP can be your primary practitioner.
In a primary-care setting, an NP can be your primary caregiver, providing continuous general care. Ask your local clinic if it has an NP (there are no directories of NPs in any province or territory). You don't have to inform your doctor that you're seeing an NP, just as you wouldn't have to inform a doctor that you're seeing another doctor, says Alden-Bugden. Most clinics have consulting physicians, so if your NP found something that was out of her scope, she would either consult one of them or refer you to a specialist. During your first visit to an NP, she would take a thorough history (as would a physician) and send for records from your previous health-care provider.
NPs are usually salaried. Provincial or territorial governments provide funding for NP positions. In Canada, NPs do not generally directly bill health-care companies; however, some NPs may set up their own practice and bill clients directly.
For more information
For legislation governing nurse practitioners in Canada:
• Canadian Nurse Practitioner Initiative
• Canadian Nurses Association
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