The B.C. government sometimes seems to suffer from attention deficit disorder.
Take the case of B.C.’s nurse practitioners. The province began regulating these health-care professionals in 2005. The goal was to increase patient access to health care in an affordable, effective manner.
Many studies show this happens when nurse practitioners are included in the health-care mix.
The government invested in the profession. It supported development of training programs at three B.C. universities. It provided provincial health authorities with money for new nurse-practitioner positions, then salary money for a limited number of new positions until this year.
And then it walked away.
After nine years, almost 300 nurse practitioners practise in B.C. They diagnose and treat illnesses, order tests, prescribe medications and refer patients to specialists. They often work in tandem with doctors, midwives, physiotherapists and other health-care providers, complementing the expertise provided by other team members and freeing up physicians to focus on more complex diagnoses and treatments.
Sometimes, however, they serve as primary-care providers, working with communities where few — sometimes no — family doctors practise. In some rural communities and on many First Nations reserves, nurse practitioners are residents’ primary source of health care.
In larger urban centres, nurse practitioners often tend many of the illnesses, injuries and afflictions of the elderly, the addicted, the homeless and those with chronic disease or mental illness — members of the community who rarely appear in doctors’ waiting rooms.
Besides providing primary care for acute and chronic illness and conditions, nurse practitioners also teach and counsel patients — for instance, about nutrition or diabetes management. They arrange support for some of the most marginalized and disenfranchised people.
Yet, despite raising their voices on behalf of patients, they themselves risk being marginalized in the province’s health-care system.
Although some B.C. nurse practitioners work within health-care teams, many work in isolation and with little support. The province pays some of their salaries, and has left it to the cash-strapped health authorities to find funds to rent clinic space, purchase computers and provide office support. Often, nurse practitioners must negotiate for clinic space and computers themselves. Often, they must prepare all the required paperwork themselves and run samples to local medical labs for testing.
A most telling gaffe on the government’s part was to assign responsibility for the Nurse Practitioner Scope of Practice to the B.C. College of Physicians and Surgeons in this year’s budget and the corresponding Ministry of Health Service Plan. The scope of practice sets out the requirements and standards nurse practitioners must meet to practise their profession here, and is rigorously enforced by the College of Registered Nurses of B.C.
Although the department apologized and amended the documents last month, the error indicates the government’s lack of awareness of and attention to the profession and systems it invested in in 2005.
It also shows a lack of inclusiveness. The Ministry of Health hadn’t included nurse practitioners in its strategic consultations about the future of health care in this province — despite having formalized the profession in 2005 in order to solve some of the very same, very pressing problems the service plan is supposed to address.
If the government were a patient, a nurse practitioner might prescribe medication, suggest more attention to diet and nutrition and help it access the resources it needs to function more effectively.
But, alas, nurse practitioners must consider their own profession as a patient in need of support and services. How sad that these hard-working professionals need to divide the attention they give to patients to ensure those same patients — including the most marginalized — continue to have the access to care promised in 2005.