NP Roles:A good fit for Public Health?

Primary Health Care System

What is Public Health Mandate?

• Promote health for the population

• Prevent Disease in the population

• Monitor communicable diseases/ take action in epidemics

• Population approaches/ Individual approaches

• NPs are skilled at health promotion/ disease prevention and at community development approaches

Primary Health Care Nurse Practitioner

• 1998 legislation was passed allowing NPs an autonomous scope of practice RN(EC)

• the legislation was passed without consideration for funding the role

• May 2000 was the first dedicated funding for new NP positions in Ontario

• COUPN graduates 75 to 100 new NPs annually but there has been no commitment to fund positions yet

NP Role

• The expanded aspects of the nursing role allow NPs to diagnose and treat common illnesses, monitor chronic stable illnesses, provide well person care such as annual health examinations

• The COUPN program prepares the PHCNP and the RN(EC) designation is specific to NPs specializing in Primary Health Care

CNO Expectations

• Competence statements for RN(EC)

• Expectations for consultation

• Standards for prescribing drugs

• Standards for ordering lab tests

• Standards for ordering x-ray and u/s

Primary Care

• Delivery of a complex set of services, which includes the first contact and maintenance care

• In the current health system primary care or that first point of contact into the health system is provided by the family physician role about 95%

Traditional Nursing

• Hospital acute care

• Long Term Care facilities

• Community Nursing

• Public Health Nursing

Primary Health Care

• emphasized well being as a fundamental right and a world wide social goal- WHO

• essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through their full participation and a cost that the community can afford

Principles of Primary Health Care

• Essentiality

• Community Participation

• Inter-sectoral collaboration

• Access

• Empowerment

• PHCNPs live and breath this philosophy and role model it for nursing and the other professions

Developing New Roles and Positions

• The NP role has great potential to improve patient care, increase access, emphasis on prevention and health promotion and a cost that the system can afford

• we need to engage in thinking outside the box for creative solutions

• Public Health Units with their focus on health have great potential

Implementing a New NP Role

• Involve all of the stakeholders in discussions

• Frequent communication to help them to understand the role

• Focus on the benefits to patient care and access

• Find a supportive physician to act as a leader for the physicians

Demonstrate the NP role

• there is no sales pitch as good as a success• to successfully implement the NP role in an

area that has not experienced NP care; you need a NP with superior communication skills

• you need a NP with great clinical skills; that is how she will be judged

• as you demonstrate the role you will create demand for the role

Public Health Sector

• Potential Roles:

• Sexual Health Clinics

• Well Women Clinics

• Well Baby Care and Immunization

• Outreach services to difficult to serve populations

Barriers in the Public Health Sector

• Administrative mindsets accustomed to traditional nursing roles

• Fee for service doctors/ fear loss of income

• Turf

• Fear about how it fits with the PHN role/ ONA

• Lack of leadership within the agency

• Funding

Public Health Positions

• Stepping Stones Resource Centre; sponsor VON; partnership with Brant County Health Unit

• Haldimand Norfolk Regional Health Unit; sexual health services; mainly 13 to 19 year olds, outreach clinic in Cayuga to reach high school students

• Algoma Health Unit, sexual health services

Other NP roles in Health Units

• 5 positions were announced for PHUs to improve cervical screening rates through Cancer Care Ontario; 1 or 2 may have hired

• Sudbury has received some additional money via Women’s Health Council

Community Roles that support Public Health mandate

• NPs in clinic settings such as Student services at a college, or in family practice where NP is offering women’s health services

• NP clinic: outreach to Indian Friendship Centre, Crisis Centre, Soup Kitchen

• Outreach roles: into high schools

• Focused populations

The Future Is Ours to Develop!

• The NP role gives us an incredible opportunity to create and improve patient care

• Many successes already

• We need the networking of NPs to build on the successes, not re-invent the wheel.