Where is My Neighbourhood Nursing Station?
Often I hear the difficulty of people finding family physicians or how provincial health authority's reduce services, because our doctors are retiring or taking a short leave for a much desired rest. I argue remote populations maintain great access to primary care services because of Registered Nurses. We have been successfully providing primary care services in isolated communities for decades. Perhaps rural communities and those health executives making decisions to reduce services need a better understanding of the Nursing Station. I would like to discuss how my idea of a Neighbourhood Nursing Station will help communities.
Primary care is traditionally the domain of physicians and doubtlessly most solutions are therefore focused on physicians leading the care. New solutions to our current health care crisis requires a paradigm shift in thinking. Physicians are not the only discipline with an invested interest in resolving the crisis facing Canadians. The Canadian Nurses Association promotes the Interprofessional Collaborative Teams model, as we believe problem solving is managed best through partnerships. In my opinion, the Nursing Station is an excellent example of partnership in action; nurses, physiotherapist, dentists, pharmacists, and family doctors are only a few of the medical professionals working in nursing stations. Implementing nurse-led primary care programs, what I like to call "My Neighbourhood Nursing Station," should not be regarded as an alternative solution -- this multidisciplinary approach to primary care is actually the proper solution.
What is a nursing station? The concept, popularized in the 1990’s CBC television show North of 60, should not be new to Canadians. Essentially, it is a building where residents come for all their medical (and traumatic) needs. Nurses complete prenatal visits, baby immunization, prescription refills, while doing health promotions, disease prevention, and illness management, including mental health; it is the place where all regular primary care assessment, including acute care, emergency care, and chronic care, takes place. Although appointments are encouraged, same day visits typically occur and travel is no more than a few kilometres. This is not a fee-for-service system; nurses take the lead spending as much time needed for each patient visit. Unfortunately, this high level of access is not a reality for most Canadians. It is distressing how health executives continue to close existing infrastructure -- with four-season road access and reliable communication systems -- when nurses are available to provide primary care services to their communities.
Some say my idea of a Neighbourhood Nursing Station is providing Canadians lesser services; nurses are not doctors. Canada has more than 75 remote or isolated nursing stations where nurses are primarily the first contact. In these stations, nurses attend to thousands of patient visits; 24 hours a day, seven days a week, 52 weeks a year. Nursing stations have a high percentage of successful outcomes, (yet we seem to focus on those rare, sometimes horrific, occurrences, which are often intensified because the event takes place in an isolated community.) Nursing stations receive such poor media coverage I believe many view it as a lesser model of care when it is not. We need to be celebrating the day-to-day successes of the many positive (daily) outcomes occurring in these stations. Better publicity will assist with the understanding of how this viable and available model of care will benefit our communities especially when the current crop of young doctors are demanding a better work-life balance than the generation I grow up with. Simply said, if the Nursing Station model of care was not working, it would not continue to thrive in the most remote isolated regions of our country.
Primary care Registered Nursing services come highly regulated, ensuring knowledge and skills are appropriate to the nurses’ practice. As with newly graduated family doctors starting their first primary care practice, proper preparation and education is paramount to ensure safe patient care. The same is expected when nurses start their practice within a nursing station; appropriate education and mentorship must occur.
Health Canada has developed expanded practice guidelines directing the practice of primary care Registered Nurses. These evidence-based, best-practice guidelines are well researched and proven. Most important, the guidelines are easily adaptable to all practice environments. Nurses, regulated by their provincial professional College, follow a scope of practice allowing us to provide primary care services and have a continuing education program ensuring safe practices. It must be emphasized properly prepared nurses are working in partnership with doctors and other medical disciplines; the key to the nursing station model of care is these other professionals do not need to be physically present for the service to occur. If or when a doctor leaves a community, we do not loss a primary care provider nor do we reduce services. With the necessary supports every community should have access to a Neighbourhood Nursing Station.
So, let us change our thinking. Think how a building, employing a multidisciplinary team of health professionals, becomes your Neighbourhood Nursing Station. A shortage of family doctors need not be such a problem. Your access to emergency services is always present because it never closes. This model also keeps existing infrastructures open maintaining jobs. My Neighbourhood Nursing Station is not an alternative idea, it is the right idea.
KN