Reflections of a Nurse Practitioner, 10 years in
by Tanya ter Keurs, NP
PCN, CHC, ISC, CSC, UCC, PSP . . . . and the list goes on. Every major shift in health care should be accompanied by a dictionary, I have been blessed (or cursed) to have been in the midst of more than one of these major shifts. As BC heads into the next big shift in health care: Primary Care Networks, I find myself amazed that I have been a Nurse Practitioner for 10 years. I realize that those two things may not seem related, but for the first time in my life I have found myself a part of a major transition where I actually have some depth of experience to apply!!
In 2009 I started as a young, brand new Nurse Practitioner in a very small BC town. I was hired into, as many of us were back then, a position with little vision for the role, and even less understanding of the profession. The local health care morale was at an all-time low, many of the long time doctors and nurses had left leaving a sense of desperation which spiraled into a very toxic and poisonous culture. This in turn influenced the ability to further recruit and retain health care providers of every kind. My husband and I committed to one year, I cried my eyes out every night, left town every weekend and found a therapist. In the midst of this, my lifeline was a young South African physician who was just as lonely as I was terrified. We quickly became best friends but 12 months later she finished her return of service and left.
By this time nothing had changed in the context of my job (in fact the culture had further eroded), but everything had changed in the way I felt about my community and my patients. My husband and I bought a house literally 15 feet from the back door of the extended care center/hospital/clinic and I switched from tears to angry (at times irrational) determination. I fought. I fought for an EMR that worked, I fought against rules that made no sense, I fought against policies that interfered with my ability to care for my patients, I fought against unethical behaviour . . . and lost every single time! My one big win? Being able to care for my patients to the best of my ability. Despite the many hurdles and lack of support that I experienced, I worked hard to ensure that my community was given the best primary care that I could give.
And then a bit of a lifeline - the government announced incentives for physicians moving to underserved communities. We managed to recruit physicians who had a vision for what a health care team could be and the political clout to enact the changes I had been fighting for years. (I will save you the diatribe against the system that this inevitably conjures up in me). It wasn’t all sunshine and roses, far from it, but I found a champion and I learned how to influence a system that, until this time, I felt a victim of. I was able to take an active role in influencing the implementation of an EMR, creating a clinic agreement, hiring staff, transitioning from a health authority clinic to a private clinic and the list goes on.
These concrete changes have been indescribably important in shifting the level of care we are able to provide; they have also helped to shift the culture of our local health care team. This shift in culture has been the source of my fascination over the last year. But while our culture has shifted dramatically, burn out still exists, people are delaying personal goals to ensure the stability of our system, and the sustainability of these changes is fragile. This obsession with culture has led me to coaching.
I began working with a coach about a year ago. My one regret? I wish I had started working with her 10 years ago.
The exponential growth I have seen in my thought processes, intentionality and drive has manifested itself in more strategic use of time and resources, greater compassion and greater influence. Exactly what I needed over those first years of my career. What I wouldn’t have given to have had a safe place to think, process complex situations and problem solve. What I wouldn’t have given to have had a champion stationed in my corner, a champion that I felt safe being encouraged by and challenged by.
In this next stage of my career I want to be able to be this person for other nurses. As a board member of our local Divisions of Family Practice, I have had the opportunity to sit at both local and provincial tables as this next stage of primary care and NP implementation are discussed and planned.
As I listen to the Ministry of Health Executive Director for Strategic Priorities talk about how few BC NPs are in Primary Care, or I sit at a Divisions table and talk about how few templates there are for clinic agreements, or hear my bosses say that they don’t have a lot of experience working with private clinics, I realize how the last 10 years have left me uniquely positioned to support Nurse Practitioners in this shift to PCNs. While my early experiences may, or may not be, more extreme than most, I believe that every NP will experience these hurdles to some degree; we are pioneers in a young profession.
As a Coach I want to save other NPs some of the growing pains I went through. I want to help them not only navigate these changes, but thrive in this new environment. To this end, I completed my coaching program through the Coaches Training Institute and started Coaching for BC: Better Care of self, of others, of teams.
As I reflect on my last 10 years as a Nurse Practitioner, and look forward to my next 10 years, one thing is clear: regardless of the newest revolution in health care, the political promises, or how health care is configured, we all need someone to champion us, challenge us, and believe in us. I know that coaching can do this for nurses, I know that I can do this for my colleagues as an NP and as a coach. I will update you in 2029.
Tanya ter Keurs MN NP(F), Co-Active Coach