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Douglas King, RN, MN, FNP

Alberta

Why did you decide to become a nurse practitioner?
By 2005 I had worked in many RN roles and was looking for a new challenge. I felt that becoming an NP would be a good way to add to my role and improve the care I can give to my patients. Quite often, in my role as a home care nurse, I felt it was hard for many patients to see their regular family physician. I wanted to help them access health-care services. Becoming an NP was a natural way to build on the skills I had and deliver the care I wanted patients to receive.

I studied at the University of Northern British Columbia in 2007 and I finished in 2011. It was distance learning with a number of mandatory on-site educational seminars in addition to three different clinical placements. I originally graduated from nursing school in 1997, so it was a full 10 years before I went back to do my NP degree.

How do you feel you help patients the most?
A common theme I hear from patients with chronic and multiple health issues is the perception that their needs are not being met or they are not feeling listened to; I think this frequently expressed opinion may be the result of the predominant “fee for service” billing system, where 5-to-10-minute appointments are the norm. I do 20-minute scheduled appointments, which allows for more time to explore a patient’s history and perform more comprehensive assessments.

What is the most rewarding aspect of your job and what is the most challenging?
At the end of the day, the most rewarding aspect is getting patients’ health needs addressed — performing thorough assessments, ordering the right tests, developing a treatment plan, and getting them sent to the right specialists when indicated. It’s all about having them feel that their health needs have been attended to and their concerns heard. Investing the time to effectively communicate with and educate patients about their health issues is a challenging component of my job. Reconciling patient expectations to more realistic health goals can be difficult.  For example, for many patients with chronic pain there is no magic bullet cure — there are definite limitation to what both medications and surgical options can achieve for them. Getting them to buy in to more nuanced and comprehensive long-term management plans takes time and plenty of patience.

One of the most challenging things is waiting for better integration of NPs into the system to be able to do our jobs to the full extent we can. For example, we do not have the ability to fill out workers compensation board paperwork. (I believe it is in the works to allow us to finally complete that.) Another example is that certain insurance companies or government agencies will not accept an NP’s signature on documents because the role is still new. That is a handicap for the patient too. You have been attending to the patient, taking care of their needs and now — simply because a particular agency will not accept your signature — you have to refer them out to a physician colleague who does not know them. This really decreases efficiency in a system that is already overburdened.

More about Douglas:
NPs are not new, but they are kind of the “new kids on the block” in terms of being established in the health-care system. I am fortunate to be practising where I am. One of the challenges NPs face is the lack of meaningful opportunities, at least in Alberta, for finding work in primary care, which is one of the biggest needs of the general public — especially in rural areas. I feel that in my role as a primary care practitioner, I am providing patients with access to quality health care. In Alberta, primary care is moving towards having providers manage patient panels, which is a set number of patients that you are identified as taking care of. My panel is presently around 600 and I hope to bring that number up to 1,000 in the next few years.

My colleagues and I are fortunate to work in a truly multidisciplinary clinic. What I mean by this is that patients are able to directly access a number of multidisciplinary providers who can best help them with their health issues — and all at one site. NPs, physicians and other health-care providers at the clinic are paid on salary models, so we are all working under the same umbrella. That has really changed the practice culture. When you have some providers paid on fee-for-service arrangements and some on salary, there can be some conflict because you are seen as taking away work from fee-for-service providers. This doesn’t happen when everyone is salaried and we are doing more or less the same job. The NPs (eight of us) carry most of the extended hours for the walk-in clinic, which is open seven days a week. The physicians are covering the the 24-hour emergency room. It is a nice division of workload.

In Alberta, NPs are ahead of the game as we have one of the biggest scopes of practice across Canada. NPs in Alberta have the ability to prescribe controlled substances, which as far as I know is unique to Alberta and B.C. We have to pass an accredited university course based on the McMaster guidelines for safe and controlled substance prescribing in order to have this ability. This means that if I have a patient who may benefit from opioids, I am able to provide a prescription. They don’t need to first be seen by a physician colleague, who likely does not know the patient.