At the Weeneebayko General Hospital in Moose Factory, northern Ontario, Dr Robert Gabor has many reasons to be grateful for the presence of nurse practitioners (NPs). "It's another hand on deck and, with the huge lack of doctors and lack of services up here, they've made our case loads much easier and healthcare more accessible to the public," says the FP.

Judging by our NRM Survey of Medical Practice 2007 results, Dr Gabor isn't the only one to feel this way — other docs are clueing in on the benefits of bringing NPs into their practices. The number of physicians working with NPs shot up by over 30% in the past year. Nearly 10% of surveyed GPs were working with them as of 2007, up from six percent in 2006, while six percent of specialists are relying on their assistance, compared to a mere four percent the year before.

The numbers may seem small, but given that some provinces had no NP legislation to allow them to work as late as 2006 (PEI was the last), the quick rise is significant.

"Doctors are getting more used to working with NPs," says North Bay General Hospital NP Sue LeBeau. Ms LeBeau spoke to NRM back in 2004 of the scepticism she encountered in doctors when she first started working as an NP. "Initially they were afraid that we're going to put their patients at risk, that we wouldn't know the limits of our knowledge," she recalls. "Now, they're aware that we work within a set scope of practice and we consult appropriately."

NO DOC'S AN ISLAND
Whether you're working in a hospital or in community clinic, there's much these ubiquitous health providers can do for you. They can take a history, order some tests, diagnose and even prescribe some meds (a list of drugs NPs are allowed to prescribe is issued by provincial nurse colleges and associations). "They can be the first connector [between doctors and patients]," says acute care NP Cynthia Struthers, president of the Canadian Association of Advanced Practice Nurses.

Patients like them too. NPs spend more time with patients than FPs (almost certainly because they're salaried) and explain things better, according to a 2005 article in the Canadian Journal of Rural Medicine. The result was higher patient satisfaction. Having someone on the team who can take the time to answer patients' questions can lighten your work and stress burden.

Continuity of care and patient follow-up can also get a boost when NPs are on board the health team. "If there's a patient that's stable with an illness, the NP can carry out the treatment plan, do alterations and counselling," says Ms Struthers. Some do home visits, adds Ms LeBeau, which might contribute to the diagnosis.

GPs flying solo have also discovered that NPs bring a different perspective to patient management, according to Jane Sanders, executive director of the Nurse Practitioner Association of Ontario. "They sometimes have more knowledge as to what services are available in the community and can help develop chronic illness management program." And it can't hurt to have another health professional to consult on hand, she points out.

LINGERING HICCUPS
Rosy as the picture seems, the course of NP incorporation into practice hasn't run entirely smoothly. Confusion over their titles — Extended Practice Nurse in Manitoba or Advanced Practice Nurse in BC — and differing qualifications from province to province is enough to deter some docs from choosing to work with them.

The scope of practice is not uniform across the country, leaving it largely up to the doc to gauge what the NP can do on an individual basis. Dr Gabor resolved the issue by helping train the NPs, so there's both trust and awareness of what each is capable of.

But even if the doctor knew exactly what to expect, other professionals in the practice don't. "I've heard stories from NPs where the receptionist would take a call from a patient and not know who it should go to," says Ms Sanders. "It's not easy and whether you're working in a clinic, a hospital or in the tar fields of Fort McMurray, you need to understand the role of the team you work with."

Liability is another real concern. Most NPs are covered under the Canadian Nurses Protective Society (CNPS), which works much like the CMPA — except those in BC and Quebec. However, NPs in those provinces can now join the CNPS through a broker not affiliated with the society itself, under the label CNPS Plus. But since that's optional, the CMA encourages docs to make sure all members of their team are well covered.

A LOOK AHEAD
There's still a lot of work to be done, admits Ms Struthers, but changes are happening across the country. "The CNA is working with the College of Family Physicians to produce a document about the role of NPs and family physicians, and provincial health ministries are trying to create synergies for their roles," she says. Their joint efforts, according to an October 2007 statement, should lead to at least a 10% improvement in access to healthcare for Canadians by 2012.

What's more, a new pan-Canadian exam is now available for NPs and the CNA is actively working to make their qualifications and training more uniform across the country, says Ms Struthers. "The education, the training and role familiarity — it's an ongoing dialogue," she adds. Until more changes make their way to the healthcare world, "we just need to put the right NP with the right client."

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