Why did you decide to become a nurse practitioner?
I was working in the North in an expanded RN role and I wanted more knowledge and autonomy. I recognized that I needed additional education to be able to apply the best care management plans for my clients. I had been working as an RN for 20 years when I decided to go back to school. I have been a nurse practitioner for 12 years now.
How do you feel you help patients the most?
I think NPs positively affect the individual, community and society. With the individual, the greatest benefit NPs provide is that we look at the whole person. We don’t just focus on a disease. I contextualize a patient’s management plans based on the entire situation. With the community, NPs work with its members and leaders to help them achieve a standard of living that the community wants to have. At a societal level, NPs work toward the triple aim philosophy — enhance the patient experience, improve the health of the population, and do it at a cost that society can afford. Research demonstrates that nurse practitioners achieve improved health outcomes on all three levels of care.
What is the most rewarding aspect of your job and what is the most challenging?
The most rewarding aspect is to be able to provide the type of health care I believe all Canadians deserve. I am an NP in long term care at Regina Lutheran Home, and I have kept very careful statistics over the years. With these statistics I have been able to prove the benefit of my NP role in long term care. Long term care is monitored nationally using quality indicators — I have been able to achieve far better results than the national or provincial average results. For example, the team I work with can prove we use less physical restraints, use less anti-psychotics, and our clients have fewer falls. We have improved pain control, less pressure ulcers, less bladder incontinence. We monitor closely for depression in the elderly and work toward relieving the three plagues of loneliness, helplessness and boredom. When I see the positive outcomes from the care being provided and I know it is quantitatively proven that my role can improve care — that is very rewarding.
There are challenges and frustration related to the world of NPs in general. I believe that NPs are frequently not able to practise to their full scope and are restricted by the goals of the employer rather than the goals of the patient. Sometimes it comes down to the situation in which the NP is employed, or what goals and outcomes they’re told they have to meet. For example, my goal is to provide primary care to the elders in the home. Another NP’s goal may be to avoid emergency department visits as much as possible. Those are two very different goals. The person looking at emergency visits will be looking at totally different outcomes and may not be providing the same holistic care as my goal of providing primary care.
Over the years I have realized that the root cause of this challenge/frustration is that nurse practitioners need to be funded differently than they are now. Our roles need to be funded directly from the provincial governments, not from the health authority. This would help ensure that NPs can practise to their full scope of practice providing primary care rather than limiting them to fulfilling the requirements of specific programs and goals (for example, decreasing hospital visits).
More about Maureen
Over the last 12 years I have worked in many areas that affect NP practice. I worked in regulation, where I was able to build some of the regulatory structures around the NP role in Saskatchewan. I have been a faculty member in the NP program, and now I am in clinical practice.
What I have learned through my experience is the high need to advocate for the role of the NP. Locally I was the president of the Nurse Practitioners of Saskatchewan and also the president of the Saskatchewan Association of Nurse Practitioners. Then I moved into the national body, the Canadian Association of Advanced Practice Nurses, serving as president and I am currently in the role as past-president.
Through all my different facets of being an NP, advocacy is number one. We have to remember as NPs that we need to be out there, demanding the changes that we know the people we serve need to have the health care they deserve. These changes will not happen if we are passive. We have to be actively involved. During my years of advocacy I have spoken to the media, regulatory bodies, politicians and health ministry officials. In the past 12 years, I have been directly involved in many changes to the NP role. Within the last year, I represented nurse practitioners before two federal committees in relation to medical assistance in dying and NPs are now included in the legislation. I am also currently involved in a national committee looking at medical marijuana and how Canada should legalize its use.
But the most important role I have yet to fulfil is mentoring new NPs to be involved in advocacy. I am willing to pass on everything I have learned in relation to advocacy. The type of NP-led care that is being offered to Canadians in small pockets across the country should be available to everyone. And it is up to NPs to advocate for that change.