The integral role nurses play within the Canadian heathcare system is rapidly evolving. Their responsibilities are expanding and their roles are becoming more and more varied. As McGill’s School of Nursing gets ready to play host to a major conference to explore the obstacles and successes in implementing role change and expanding the scope of nursing, the Reporter sat down with Dr. Hélène Ezer who explained some of the changes and how the School of Nursing is charting new directions.
Nursing has moved with the changes right from the very beginning and has been a major player in charting new directions – nurses have had to roll with the punches.
Their work has become much more complex with much pressure on the system to provide care. The number of patients nurses can handle on a daily basis has decreased because patients leave hospitals earlier and the ones who remain are the very ill. There is a limit to the caseload of seriously ill patients that nurses can safely carry. As a result, there aren’t enough nurses to handle those numbers.
The shortage of nurses has been a big factor in actually stopping things from being done sooner. Many of the delays in providing care in hospitals are related to the lack of nurses able to look after the patients.
Nurses need a comprehensive education to handle the complexity of patients who are gravely ill and to help them and their families find ways of managing with their disease. No matter what kind of training any health professional has, there will be a period in which you need concentrated, hands-on experience to develop the clinical judgement needed to provide safe care. This means that nurses cannot simply be “parachuted” from one unit to another, and staffing becomes a big issue.
There is a broad range of nursing roles and responsibilities, both in hospitals and community- based institutions. Nursing roles have multiplied and the scope of nursing practice has increased. Many of these new roles have a particular focus – for example with parents and newborn babies, in mental health or home dialysis – and nurses become highly skilled in working with special populations.
In Quebec, one of the more recent and best known roles is that of the “infirmières pivot,” nurses who have an expanded scope of practice in helping cancer patients, not only at the time when they’re receiving treatments in hospital, but afterwards when they go home. This is a coordination and follow-up role that has been invaluable to these patients, to their anxious family members and to the other practitioners who are also working with them.
These programs are relatively new for Quebec. They were first created in specialty areas – neonatology, cardiology and nephrology – to alleviate the demands for specialized care. The newest of the NP program is in Primary Care. It is an attempt to meet the population needs for front-line health care as well as the management of chronic illness. The NP role has been a long time coming in Quebec. There is now a growing understanding of the potential of this role in improving care. The intention of the Minister of Health is to have 500 or more Primary Care NPs across the province in the next five years.