Verberne Nurse Practitioner


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Verberne Nurse Practitioner

  1. 3. <ul><li>RN(EC) is the protected credential in Ontario; Nurse Practitioner ( NP) is the commonly used term </li></ul>
  2. 4. <ul><li>Primary Health Care. </li></ul><ul><li>We work in community settings and manage most common illnesses, and provide preventative care and education for healthy living. </li></ul>
  3. 5. <ul><li>2. & 3. Adult and Paediatric </li></ul><ul><li>We work as part of a health care team in hospitals and home health care agencies, where we manage complex patient conditions. </li></ul>
  4. 6. <ul><li>4. Anaesthesia. </li></ul><ul><li>This role will be introduced into Ontario’s health care system in the future. </li></ul>
  5. 7. <ul><li>1965 - first NP program established at the University of Colorado </li></ul><ul><li>1967 - first education program for NPs working in northern nursing stations began at Dalhousie University, Halifax, Nova Scotia </li></ul>
  6. 8. <ul><li>1971 - first university program in Ontario to prepare expanded role RNs </li></ul><ul><li>1973 - NPAO established as an affiliated Interest Group of the Registered Nurses Association of Ontario with the mandate to lobby for the PHCNP role </li></ul>
  7. 9. <ul><li>1973 - CNA/CMA Joint Committee releases joint policy statement on the role of the NP </li></ul><ul><li>1975 - Ontario Council of Health releases The Nurse Practitioner in Primary Care with recommendations about necessary legislative changes and remuneration issues </li></ul>
  8. 10. <ul><li>Early 1980s - first NP initiative ends because of: </li></ul><ul><ul><li>perceived physician oversupply, </li></ul></ul><ul><ul><li>lack of remuneration mechanisms, </li></ul></ul><ul><ul><li>lack of legislation, </li></ul></ul><ul><ul><li>lack of public awareness regarding the role </li></ul></ul><ul><ul><li>lack of support from both medicine and nursing </li></ul></ul>
  9. 11. <ul><li>1983 - last NP education program closes at McMaster University, Hamilton, Ontario </li></ul><ul><li>1988 - CNS-NP role implemented in Level 3 NICUs following reduction in number of Pediatric Residents </li></ul>
  10. 12. <ul><li>In spite of failure of the first initiative, NP role consistently cited in the recommendations of many provincial health care commissions and task forces </li></ul><ul><li>NPAO continues to actively lobby to re-establish educational programs in Ontario and for the recognition of the NP role as a viable member of the Ontario health care system. </li></ul>
  11. 13. <ul><li>1993 - Minister of Health and NDP government announce a new Nurse Practitioner Initiative as part of improving access to primary health care. </li></ul><ul><li>December 1994 - &quot;Nurse Practitioners in Ontario: A Plan for their Education and Employment of NPs&quot; is released with specific steps for implementation. </li></ul>
  12. 15. <ul><li>1994 - Council of Ontario University Programs in Nursing (COUPN) involving a consortium of 10 nursing faculties develops the new PHCNP Program </li></ul><ul><li>1995 (September) - the PHCNP education program begins </li></ul><ul><li>1996 - first graduates of the PHCNP program. </li></ul>
  13. 16. <ul><li>1997 (September) - University of Toronto, Masters of Nursing offers two program streams: Acute Care NP Adult Health and Acute Care NP Child Health </li></ul><ul><li>1998 Bill 127, the Expanded Nursing Services for Patients Act proclaimed </li></ul>
  14. 17. <ul><li>1998 – CNO accepts first registrants </li></ul><ul><li>1999 Minister of Health announces investment of $375 million in nursing, including 106 PHCNP positions: </li></ul><ul><li>80 in Underserviced Areas </li></ul><ul><li>20 positions in long term care homes </li></ul>
  15. 18. <ul><li>Experienced registered nurses with advanced university education who provide personalized, quality health care to patients. </li></ul>
  16. 19. <ul><li>provide a full range of health care services to individuals, families and communities. </li></ul><ul><li>provide comprehensive primary health care with a focus on health promotion and disease prevention . </li></ul><ul><li>practice in urban, rural and remote communities and in a wide variety of settings </li></ul>
  17. 20. <ul><li>Nurse Practitioners are not physician assistants or mini doctors, but are expert nurses functioning at an advanced practice level. </li></ul>
  18. 21. <ul><li>Are governed by the College of Nurses of Ontario </li></ul><ul><li>Are regulated by many different Acts </li></ul><ul><li>Have registration requirements including: </li></ul><ul><ul><li>graduation from an accredited program </li></ul></ul><ul><ul><li>passing the provincial exam </li></ul></ul><ul><ul><li>review at 1800 hours or 1 year full time practice </li></ul></ul>
  19. 22. <ul><li>NP’s: </li></ul><ul><li>provide comprehensive primary health care to a diverse population of patients </li></ul><ul><li>work in complementary and collaborative role with physicians </li></ul><ul><li>are authorized to communicate a diagnosis of disease or disorder </li></ul>
  20. 23. <ul><li>NP’s : </li></ul><ul><li>are able to prescribe a limited range of drugs (open prescribing) </li></ul><ul><li>Provide wellness care and health screening (e.g., pap smears, infant growth & development) </li></ul>
  21. 24. <ul><li>NP's: </li></ul><ul><li>Diagnose and treat minor illnesses & injuries (e.g., strep throat, bladder infections, sprains, ear infections) </li></ul><ul><li>Screen for presence of chronic illness and monitor stable chronic illnesses (e.g., diabetes, asthma) </li></ul>
  22. 25. <ul><li>Collaboration is a cornerstone of NP practice </li></ul><ul><li>Interdisciplinary teams benefit patient care </li></ul><ul><li>each brings unique knowledge and skills </li></ul><ul><li>decreases duplication and fragmentation </li></ul><ul><li>increases patient access to medical care </li></ul><ul><li>NP led clinics – several NPs with fewer doctors – NPs see most patients, Doctor sees complicated cases and is available for consultation when needed </li></ul>
  23. 26. <ul><li>According to recent statistics, there were 800 primary health care NPs registered in the extended class and working in nursing in Ontario in 2007. </li></ul>
  24. 27. <ul><li>Nurse Practitioners work in a variety of settings such as </li></ul><ul><li>community health centers </li></ul><ul><li>clinics </li></ul><ul><li>urgent care centers </li></ul><ul><li>public health units </li></ul><ul><li>long-term care facilities </li></ul><ul><li>hospital in-patient and outpatient units </li></ul><ul><li>family practices </li></ul><ul><li>FHNs </li></ul><ul><li>hospital clinics </li></ul><ul><li>ER’s </li></ul><ul><li>CCAC’s </li></ul><ul><li>community mental health programs </li></ul><ul><li>social service agencies </li></ul><ul><li>aboriginal healing and wellness centers </li></ul>
  25. 28. <ul><li>NP’s provide high quality, comprehensive care </li></ul><ul><li>Collaborative models enhance delivery of care, increasing caseload by 25-50% </li></ul><ul><li>NP’s provide effective patient care coordination </li></ul><ul><li>NP’s provide patient choice and are demonstrated to have high patient satisfaction </li></ul><ul><li>NP’s are the most researched and evaluated health professional in Canada </li></ul>
  26. 29. <ul><li>NP’s decrease use and relieve burden for hospital emergency rooms </li></ul><ul><li>NP’s focus on health promotion and prevention with increased rates of: </li></ul><ul><li>-Immunizations </li></ul><ul><li>-Mammography </li></ul><ul><li>-Pap Screens </li></ul><ul><ul><ul><li>-Risk factor screening </li></ul></ul></ul>
  27. 30. <ul><li>Healthy Patients = Less Utilization & Lower Costs </li></ul>
  28. 31. <ul><li>Funding: </li></ul><ul><li>Lack of financial incentives for remote & rural placement </li></ul><ul><li>Salary inequities across different funding programs </li></ul><ul><li>Inconsistent funding for capital and operating costs across different funding programs </li></ul><ul><li>MD fee for service remuneration discourages effective role utilization </li></ul>
  29. 32. <ul><li>In order to support full utilization of the resources NP’s provide we need: </li></ul><ul><li>Primary health care reform that promotes interdisciplinary collaborative teams & comprehensive care </li></ul><ul><li>NP involvement in planning and delivery of primary health care services </li></ul><ul><li>Legislative and policy changes to remove barriers </li></ul>
  30. 33. <ul><li>Long term NP funding strategy as part of well thought through health human resource plan </li></ul><ul><ul><li>flexible and supportive to a wide variety of settings </li></ul></ul><ul><ul><li>comprehensive and equitable </li></ul></ul><ul><ul><li>separate from MD funding </li></ul></ul><ul><li>Changes in MD funding </li></ul><ul><ul><li>alternate payment plans </li></ul></ul><ul><ul><li>compensation for consultation </li></ul></ul><ul><ul><li>change in specialist referral funding </li></ul></ul>
  31. 34. <ul><li>Retention and recruitment strategies for remote and rural areas, under serviced populations </li></ul><ul><li>Introduce interdisciplinary collaborative education programs & education on collaborative practice for health professions </li></ul><ul><li>Broad based public education program to increase understanding and acceptance of the role </li></ul>
  32. 35. <ul><li>Full integration into primary health care delivery </li></ul><ul><li>Practice in interdisciplinary teams wherever primary health care is provided </li></ul><ul><li>Assist Canadians as individuals, families, groups and communities to attain and maintain optimal health </li></ul>
  33. 36. <ul><li>FHT’s provide a comprehensive range of primary care services </li></ul><ul><li>Care is provided by an interdisciplinary team of family doctors, NP’s, nurses, pharmacists, social workers, physiotherapists, psychologists, and dieticians </li></ul>
  34. 37. <ul><li>To help increase access to primary care and to be instrumental in providing preventative care which helps the community to be as healthy as possible. Through better access to care the NP aids in the prevention of illness and early detection and treatment of disease </li></ul>
  35. 38. <ul><li>Provides well baby/child assessments </li></ul><ul><li>Gives immunizations </li></ul><ul><li>Monitor clients with stable chronic illness (HTN, DM, asthma) </li></ul><ul><li>Does prenatal check ups (low risk pregnancies) </li></ul><ul><li>Just by performing annual physicals the NP can include health promotion, promote wellness and do appropriate screening for disease </li></ul>
  36. 40. <ul><li>New diagnosis diabetic – consult physician re med starts, referral to diabetes educators </li></ul><ul><li>Well baby exam (development, safety, immun) </li></ul><ul><li>Prescription renewal – check for screening </li></ul><ul><li>Physical woman >50 </li></ul><ul><li>90 year old “feeling tired” </li></ul><ul><li>Elderly woman with “wobbles”, known TIAs </li></ul><ul><li>Child with ear infection </li></ul><ul><li>Review lab and test results </li></ul><ul><li>Arrange U/S, x ray appts </li></ul><ul><li>Do referral letters to specialists </li></ul><ul><li>Call pts re test results and follow ups </li></ul>
  37. 41. xxx
  38. 42. <ul><li>Eat a healthy diet </li></ul><ul><li>Exercise </li></ul><ul><li>Be nice to your family </li></ul><ul><li>Wash your hands </li></ul><ul><li>Get a flu shot </li></ul>
  39. 43. <ul><li>Get Screened </li></ul><ul><li>Mammogram </li></ul><ul><li>PAP </li></ul><ul><li>Diabetes </li></ul><ul><li>Heart disease </li></ul><ul><li>Colon Cancer Check </li></ul>
  40. 44. <ul><li> </li></ul><ul><li>NPAO website </li></ul><ul><li>Thank you </li></ul>