The recently announced expansion of the nurse practitioner role in B.C. is good news for our health-care system.

However, in addition to expanding the scope of practice for nurse practitioners, new service delivery and funding models are needed to let them work with physicians and other health-care professionals and use their skills to deliver high-quality primary care.

For example, although they are very few in number, nurse practitioners are making a significant contribution to residential longterm care programs for the frail elderly. They could be doing so much more.

Nurse practitioners are registered nurses with additional education and experience who possess the legislated authority to autonomously diagnose disease, order and interpret diagnostic tests, prescribe medications and perform specific procedures.

The care requirements of people entering residential care are increasing and many are nearing end of life. People often have cognitive impairment and complex health conditions. They are often taking nine or 10 medications per day, and have multiple functional impairments likes limited mobility, incontinence, and many are experiencing chronic pain.

Yet, the older adults in these settings may be underserved in terms of primary health care.

For the past year, a nurse practitioner has been making a significant difference at The Lodge at Broadmead. She works with several physicians and the Lodge's staff on an interdisciplinary team to provide primary care to about 70 of our 225 residents.

We established this position for three years as a pilot program. To date, it has been unfunded by B.C.'s health care system and we have had to find savings in other areas to cover the costs.

The nurse practitioner's work includes doing health histories and physical exams; ordering lab tests, medications and treatments; sharing information with families; teaching and coaching nurses; and making referrals to physician partners.

We are evaluating the nurse practitioner role and have found that it is well accepted by staff. Family members feel comfortable with the care provided, and partner physicians are confident in her practice.

Having a nurse practitioner as part of our interdisciplinary care team means faster response times and more timely access to primary care for our residents.

The nurse practitioner supports other staff in their practice, and allows for greater collaboration between team and family.

Health Canada studies have concluded that if nurse practitioners were used to their full potential, the cost-savings to our health-care system could be significant. Nurse practitioners can help reduce costly transfers to emergency/hospital through early detection and treatment of episodic acute or chronic illnesses and can also help to reduce drug utilization and associated costs. For example, in one evaluation of the implementation of the nurse practitioner role in a Winnipeg nursing home, there was a 17 per cent reduction in overall drug cost.

There is a very high level of satisfaction with the nurse practitioner role at Broadmead, and strong support for continuing it, yet there is very limited dedicated funding for the role of the nurse practitioner in residential care in B.C.

We welcome the progress in the new legislation from Health Minister Mike de Jong.

However, we encourage all of the stakeholders involved in shaping the role of nurse practitioners to move quickly to introduce the structural and funding changes needed for nurse practitioners to contribute to quality care for the frail elderly living in B.C.'s residential care facilities.

David Cheperdak is CEO and Fiona Sudbury is director of care for Broadmead Care, which operates the Lodge at Broadmead.