Nurse practitioners lead a quiet revolution in Ontario hospitals

Posted on May 8, 2014 in Health Delivery System – Life/Nursing Week – To reduce waiting times, NPs can now admit and discharge patients, order tests and prescribe drugs.
May 08 2013.   By: Paul Dalby

CAMPBELLFORD—Thirty years ago, when Beth Van Dusen started her nursing career at Trenton Hospital, nurses were mostly seen, not heard, and doctors called all the shots.

Times have certainly changed.

In March, Van Dusen arrived at Campbellford Memorial Hospital as a nurse practitioner, equipped with the authority to admit and discharge patients, order diagnostic tests and prescribe certain drugs.

Ontario is the first province to give nurse practitioners this much authority.

Van Dusen’s role at this 32-bed country hospital? To help speed up treatment and reduce wait times in the busy emergency room, which has only one doctor on duty, but operates 24/7 and treats 22,000 patients per year.

“This is acute care versus family practice,” says Van Dusen, who has worked the past decade as an NP in community clinics.

“Now, I’m getting to treat the people that I used to send to emerg. The upside of this is that these people are going to get in and out quicker.

“(For example) folks who may have diabetic issues can be sitting there in the waiting room for four or five hours,” he says. “They skipped breakfast, and likely need to have food. So, if we can get them in and out in two hours overall, it’s best for everyone.”

Van Dusen is considered more of an equal partner to ER chief Dr. Norm Bartlett. And he couldn’t be happier about the shifting landscape.

“People used to ask me, are you the only doctor working in here, because there are 10 beds,” he says. “So I’m always moving around, it’s like being the only waiter in a 10-table restaurant.”

“Before Beth came, if I had to take a break for a meal, everything stopped,” says Bartlett. “Now, Beth sees people and gets things rolling while I’m on break, and they’re all teed up when I get back.”

Bartlett, a 16-year ER veteran, had been lobbying for an NP for more than a decade, but his pleas were always outweighed by budgetary constraints. All that had changed with the province’s new emphasis on reducing ER wait times.

“Traditionally, in an emergency department, the sicker patient is seen first and that’s how it needs to be,” says ER manager Sue Robinson. “With this new initiative, the less-urgent people are getting seen as well in a decent amount of time. That’s why we just love having Beth.

“In just the short time she’s been here, we have lowered our average wait time from 4.9 hours to 4.5 hours, and our target is to get that down further still, to 4.3 hours on average.”

The new doctor-NP teamwork is based on a triage system that divides patients into five categories. Doctors handle categories 1 (resuscitation, cardiac arrest) and 2 (emergent chest pains, cardiac in nature). Category 3 (urgent abdominal pain or extreme pain) is shared between the doctor and nurse practitioner, while the NP handles categories 4 (less urgent, such as sore ears, lacerations) and 5 (non-urgent, such as prescription renewals). The Campbellford ER treats about 60 patients per day, admitting an average of five for further treatment. Many have no family doctor.

“Just last week, a fellow came in with a terribly infected toe, and I took one look at him, and I knew he had vascular issues going on,” Van Dusen says. “He had no family doctor, so I referred him to a surgeon for vascular studies.

“The specialist saw the patient just two days later, and the guy has had a full set of tests done. That guy would have just fallen right through the cracks, and likely would have had to have that foot amputated if he had just toughed it out the way some people do.”

The transition has presented a few challenges, she notes.

“In a way, ER has sped up, because the pace of this place is unbelievable for a small town, so you’re changing gears quicker,” she says.

“I’ve had to do a fine-tuning on myself. I’m 30 years graduated as a nurse, so I’m dusting off some books, I can tell you.”

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