The introduction of Nurse Practitioners in B.C has just recently passed the 10 year mark. Throughout this past decade, we have had some notable successes in NP integration - some large, some small. We're finally starting to see general acknowledgment by the Ministry of Health, the health authorities, and even some of our medical colleagues, that nurses with advanced practice education and the appropriate resources to support them can be quite useful in keeping our population healthy.
Shortly after arriving in the rural community where I’ve been practicing the last couple of years, I remember seeing an unstable patient who needed to be evaluated at the local emergency department. Based on my training, as a provider sending someone to the emergency department, it is good practice to call and give a verbal report if the receiving provider is available. On this occasion, the receiving provider was an ER physician who, before I could explain the patient’s issues, cut me off and demanded to speak to my “attending physician.” I explained I was in solo practice, didn't have an “attending physician,” and was the patient’s primary care provider.
This was not the answer he was looking for. Further discussion culminated in me suggesting he keep me honest by calling the CRNBC to verify nurse practitioners could practice independently. I'm happy to report that a year later, this medical colleague was sending difficult patients with multiple co-morbidities to my practice for primary care in the community. This marks a small, but for me, vital example of the daily evolution of professional recognition.
The NP4BC funding initiative is an example of a larger success. Prior to this initiative, we were losing highly (and expensively) trained B.C. nurse practitioners to other provinces and the US. I was one of those NPs who was forced to seek licensure elsewhere because prior to NP4BC, there were very few NP jobs, despite a significant healthcare provider shortage. The funding helped to get NPs into the field. This in turn allowed communities and healthcare systems to experience advanced practice nursing with good results. Some health authorities are now beginning to fund some NP positions out of their operating budget. I see this as an extremely positive development and an acknowledgment of our value across diverse practice environments.
For a number of years NPs were footballs in a game of “funding chicken.” Health authorities wouldn't hire NPs unless funding was provided by the Ministry, and the Ministry suggested to the health authorities that if they wanted NPs they could use their multibillion-dollar (but fully utilized) budgets to hire as many NPs as they wanted. We seem to have moved past this logjam, at least for the time being, as an appreciation for the solutions that advanced practice nursing can bring to the table has become more apparent. The long-term solution to advanced practice nurse funding involves inclusion of NP funding in all current relevant streams of healthcare provider funding. I think at some point, NPs are going to have to participate in MSP.
Now I know some of my esteemed colleagues disagree, but if there's a provider funding stream, I believe nurse practitioners should be included in it.
We’re in a time of huge change in healthcare. I’ve always enjoyed the evolutionary concept of punctuated equilibrium. Yes, evolution can take place over long periods of time, but then there are those exceptional periods in the fossil record where change comes incredibly quickly. I don't know what the healthcare system will look like in 10 years, but I'm pretty sure it's going to look a lot different than it does now. I'm looking forward to being part of helping nursing unlock its inherent healing powers to meet the evolving demands of our patients, our medical colleagues, and our healthcare system. I enjoy being at the ground zero of change. I have come to believe that dealing gracefully with change is now a core competency for being a nurse.
I got a call the other day from a forward thinking nurse who is working with some forward thinking medical colleagues. She was wondering if they might be able to improve outcomes by including a nurse practitioner on their team in a role not traditionally performed by nurses. In thinking about the Triple Aim- improving population health, cost sustainability, and creating patient- centered care, advanced practice nursing has a lot to offer. These are the kind of discussions I love. I look forward to being part of nursing continuing to evolve towards new healthcare solutions.
ABOUT MARK SCHULTZ, NP
Mark has been practicing as a nurse since 2003. He received his Master of Nursing, Nurse Practitioner degree at the University of British Columbia in 2006. Since then, he has been an active member of the BC Nurse Practitioner Association, where he has developed a strong interest in health and nursing policy issues. Mark has practiced as a nurse practitioner in several areas including in-patient cardiology at Vancouver General Hospital, orthopedic reconstruction at UBC Hospital, primary care at the Comox Valley Nursing Center, and urgent/emergent care at Oceanside Health Center in Parksville and Alicia Roberts Medical Center in Klawock Alaska.
Well said, Mark! When the NP initiative began in BC, it was assumed by all concerned that the 'logjam' you mention with respect to MSP funding would be solved imminently and NPs would quckly become a marvelous new resource for primary care around the province. However, no one counted on how ferocious and political the protectionism would be. Primary care funding is almost exclusively through MSP in this province, and one profession has been granted relatively unfettered control over how it is managed. While Health Authorities were glad to find places to put NPs when funded to do so, few have had significant conventional primary care reach. We look forward to a day when there will be sufficient political will to do what is right and create rational reimbursement models in alignment with both primary care and the health authority structures. It is the same patient moving back and forth between these two misaligned 'systems.' So often, we know there is adequate funding within the system overall to provide the services that British Columbians need, but these frustratingly complex ideological and political barriers prevent sensible care coordination solutions. We must keep explaining this loudly and strongly to all who will listen. And eventually this structural barrier between primary and secondary/tertiary care will be a thing of the past.
Thanks for this powerful reminder!.
And thanks to all of the NPs of this province who have kept the vision alive despite these significant challenges.
Great blog Mark.
There needs to be openness within the nursing community to understand and appreciate the pros and cons of different funding models available. If we continue to reject the current funding options we will continue to be on the sidelines of health care in this province. Many NP positions are limited to very specific patient populations and as such we are excluding the majority of BC residents. It is rare in this province to be able to freely choose to receive your care from an NP. Until we integrate ourselves into the current primary care system of this province this will continue.