The Isolated Nurse-led Clinic
If you run a nurse-led clinic within a hectic team, spare a thought for Canadian nurse practitioner Aaron Medd.
Every other week he leaves his Canadian home in Thunder Bay, Ontario, to travel the 155 miles (250kms) to the town of Armstrong, where he works as the only primary care provider in a satellite community health centre. Aaron stays in town for five days in a duplex shared by police and forest fire fighters and provided by the healthcare facility. He job shares a full-time position with one other nurse practitioner.
He graduated as a registered nurse from the University of Western Ontario in the mid-1990s and worked in a federal nursing station in First Nations communities in Canada’s north which are only accessible by airplane. The term ‘First Nations’ refers to Canada’s native indigenous populations. Aaron describes these facilities as nursing stations staffed by registered nurses who provide all regular and emergency health care in the community, including diagnosis, prescribing and ordering laboratory tests. He consults with on-call physicians, when necessary, via telephone.
He says ‘It was this experience working in the expanded registered nurse role up north where my original passion for the nurse practitioner role was established. I subsequently went back to university in 1999 and obtained my primary care nurse practitioner certificate. In 2000, I moved from my home in London, Ontario to Thunder Bay to start my nurse practitioner career at Norwest Community Health Centres – the same organization I work for now.’
‘Since this time I have worked in community health centres, Aboriginal health centres and emergency room fast track clinics which has led me to my current role working as the lone nurse practitioner, and only primary care provider, at a satellite community health centre site in Armstrong, Ontario.’
He describes a typical day encompassing a full scope of primary care services, including chronic disease management, illness and urgent care, addressing wellness issues such as prenatal, well woman/man & child assessments, and immunizations. In addition, Aaron provides necessary therapies including pharmaceuticals, referrals to other health care professionals as needed, diagnostic testing and has access to a collaborative team of health care providers including physicians, nurse practitioners, dieticians, pharmacists and counsellors. Collaboration is undertaken through telephone or secure video conferencing.
‘In Ontario our provincial government has committed to twenty-six nurse practitioner-led clinics in the province. These are clinics that have nurse practitioners as the primary care providers for people that are unattached to a physician or nurse practitioner in their location. For example, in my home town of Thunder Bay, with a population of 110,000, it is estimated that 30,000 people do not have a regular physician or nurse practitioner, due to a severe shortage of primary care providers, and rely on walk-in clinics or emergency rooms. Similar statistics are found across many cities in the province, especially rural and isolated communities. The nurse practitioner-led clinics have been advocated by the nurse practitioners themselves and cautiously accepted as part of the solution to our province’s high number of unattached patients. This nurse-led model of care has been a truly ground breaking step for nurse practitioner integration in Ontario. Ontario has just over 2,000 licensed nurse practitioners working in healthcare sectors, well over half of all of those in Canada.’
Aaron says that almost all of the twenty-six funded nurse practitioner-led clinics are operational now and are starting to demonstrate a positive impact on the health of community residents who have for so long been without a regular provider. He adds that nurse practitioners have been slow to be recognized in the collective conscious of the average person; many of whom have no idea what a nurse practitioner is.
‘However, this is changing, due to fairly frequent media coverage and an improving recognition of the contributions that nurse practitioners can make in health care by government bureaucrats and decision makers. Over the last ten years, nurse practitioners have become a recognized and key health care provider in Canada’s health care strategy through the delivery of cost-effective, accessible, quality care while improving the health outcomes of Canadians,’ he says.
‘Many Canadian health care politicians are keeping an eye on the progress of nurse practitioner-led clinics and I believe we will see the model progress eventually across Canada once nurse practitioners grow in number in other provinces.’
‘Our registered nurse association has called for fifty nurse practitioner-led clinics in Ontario, but I fear this will not happen in the immediate future due to severe government budget restraints at present.’
‘There are two nurse practitioner-led clinics in my home town of Thunder Bay and I am currently a board member of the Lakehead Nurse Practitioner Led Clinic but I don’t work for them. The clinic where I work is part of 101 community health centres across Ontario. Nurse practitioners are employees, but don’t manage the clinics in most cases, like nurse practitioner-led clinics.’
NB: In addition to his many other roles, Aaron also works as the communication specialist for the Nurse Practitioners’ Association of Ontario.
Photos courtesy of A.Medd.