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Nurse practitioners: health care for rural communities

By Jill M. Caines
Roncalli Central High
Port Saunders, Newfoundland

 People living in rural communities near Port Saunders on Newfoundland's northern peninsula now have access to a new kind of health care professional -- nurse practitioners.


Tracy House and Paulette
Critchley describe the
view clip

 In September, Paulette Critchley and Tracy House graduated from the nurse practitioner course which they began in October 1997 at the Centre for Nursing Studies in St. John's. Along with 12 other classmates, they have completed a year-long Advanced Nursing Course.

Critchley and House had both worked as staff nurses at the center before they went back to school. They completed six months of theory (the actual class work) in St. John's. This segment included subjects such as: pharmacology, health assessment, rules and issues class, pathology, physiology, community health course, primary health course and advanced clinical decision making. The students also completed six months of clinical, which is much like on the job training.

Through this program, they became Nurse Practitioners in Primary Health Care (NP-PHC), professionals who care for patients from birth until death. Their main job is to maintain optimal primary health care at the Rufus Guinchard Health Center in Port Saunders and ensure that the health care offered in the community is accessible to the public.

Over the last two years, the center has not been accessible to the public primarily due to the lack of doctors. During August, 80% of the time patients could not schedule an appointment with a physician at the facility and doctors were available for urgent cases only.

Both Critchley and House hope to solve this problem through making the hospital more stable. When patients request an appointment, they will have the option of being seen by either a physician or nurse practitioner. Nurse Practitioners will also do triage, which means they will assess the patients condition and either treat them or refer them to the physician.

These practitioners will encourage the public to participate in the planning and the organization of their health care. They will encourage health promotion and illness prevention through health education, immunizations, and lifestyle counselling. And they will work with the community health nurse to provide better services.

They will also try to maintain adequate technology in the Port Saunders facility such as lab and x-ray services and effective Nurse Practitioner assistance.

"We are hoping that in this technology, we will be able to provide a better service that has not been able to be accessed in this facility over the past two years," says Critchley.

As nurses, House and Critchley could do an assessment of a patient and a physical exam. However, they were not authorized to notify the patients of their illness, order any diagnostic tests, or to treat your illness by prescription or any other means. As Nurse Practitioners they are now authorized to do so.

However, they do have guidelines and rules that they must follow. They can treat only minor illness including; sore throat, arthritis, chest infection. Chronic conditions must be treated by a doctor. However, they may follow up and prescribe medication as long as the original assessment and prescription was done by a physician within a year.

Under the new system, chronic care patients would be required to only consult with only one person, the Nurse Practitioner instead of a number of changing doctors. The pactitioners will act as a link between the physicians and the patients

"I think this is what makes it so hard on people trying to watch out their health care because they think that nobody cares because nobody is following them up," says House.

The practitioners plan to begin seven-day a week service on a trial basis, with each of them working shifts at the center.

"If it meets the people's needs, it will continue that way, if not it will be changed around it about two months time," says Critchley. They will also be on support call, which means that if there is no physician on call, the practitioners will provide that service.

The nurse practitioners are also responsible for the 22 long-term care patients at the facility. They will complete the patients' annual physical exams, tend to them when they are sick and re-order their medication.

The nurse practitioners say they will be updating their knowledge regularly since the are always new procedures, new drugs and new therapies that with have to be learned to keep up with their clinical skills. 


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