Nurse Practitioners

“I have GOT to move upstream….”

Debra Bathgate RN (NP), currently Primary Care Nurse Practitioner at the Family Medicine Unit of the Regina General Hospital outlines why she decided to become a nurse practitioner and the process she went through.

My decision to become a nurse practitioner was a nebulous idea for years! It started in 1995 at 2:30 in the morning when I was checking one of my CCU patients. As I looked at the man sleeping in the bed I couldn’t help but reflect on the fact that his grandfather was one of my first CCU patients, and was in this bed. Since then his father had also been in that CCU bed in my care! Three generations I had cared for in that bed!

Two thoughts occurred to me: I have been doing this job LONG ENOUGH, and I have GOT to move upstream, to try to prevent heart disease hitting each successive generation 10 years earlier than the previous generation.  Try to keep these people out of hospital.

After some reflection and research, I began a long journey as a "mature Student" in Saskatchewan Institute of Applied Science and Technology’s Advanced Clinical Nursing program. This is now the Primary Care Nurse Practitioner program, which is the only Saskatchewan Registered Nurses Association-approved Nurse Practioner program in Saskatchewan.

“Over My Dead Body”

I had worked for over 20 years in a small hospital in Weyburn. My employer provided moral and financial support, and unpaid leave for clinical rotations through my Advanced Clinical Nursing program. The management was moving towards alternate services in the health district and often reassured me that positions would be opening for me and other NPs.  These reassurances encouraged me to persevere through the long and difficult program. The month I finished my program, with still no sign of a Nurse Practitioner position in the community, a physician in Weyburn told my friend, "Over my dead body will a nurse practitioner ever work here!”

I finished the program in October of 2000, one month after my oldest son entered university! I was lucky to obtain the position of Primary Care Nurse in the Family Medicine Unit-Regina in February 2001 when Nurse Practitioners were still not a legal title in Saskatchewan.

I am actually very grateful that doctor had shared his sentiments with my friend, because it gave me the incentive  to apply for my current position in Regina. After almost six years working in Regina as a Primary Care Nurse Practitioner, the "Over My Dead Body" physician is still hail and hearty, and there is still no hint of a nurse practitioner position in the community.

In 2001, after much consultation and input from all stakeholders including many nurses like me, Amendments to the RN ACT, 1988, Section 24, enabled the regulation of the RN(NP) role within Saskatchewan. The most important phrases even included some of my wording.  But we were still quite aways from formal recognition.

In 2003, the Canadian Nurses Association was granted a portion of the federal primary health transition fund to facilitate integration of the NP into the health care system and to create mechanisms and processes to support the integration and to sustain the NP role. The Canadian Nurse Practitioner Initiative  (CNPI) was formed. Many of Saskatchewan’s RN’s and NP’s participated in the CNPI interviews, focus groups, stakeholder meetings. I was interviewed five times.

(I was privileged to participate in a multi-stakeholder CNPI meeting in Ottawa in June 2005. The CNPI report, "Nurse Practitioners, the time is now- A solution to Improving Access and Reducing Wait Times in Canada" was released June 20, 2006 in Saskatoon during the CNA Biennium. Of course I had to be there!)

In September of 2003 I and other potential NP’s working in primary care nurse roles received letters from SRNA outlining an extensive application processes. This was one of several changes and lengthy forms nurses like me submitted in the NP licensing process.

On March 25, 2004, I received a letter from the SRNA acknowledging receipt of all the necessary documentation in my application for an RN(NP) license, with only one final form to complete and return to SRNA!

Finally on April 30, 2004 at about 10 am, all the required bylaws were proclaimed law in the Legislature with key SRNA personnel in attendance! An hour later SRNA staff phoned me with the GREAT NEWS that I was now officially an RN(NP). I was the 4th NP of of 9 who were licensed in the province that day!

My collegue physicians, nurses, social worker and staff had a celebration with me!

Now, a nurse can become licensed as an RN(NP) by applying after successfully completing an approved NP program, meeting SRNA RN requirements, and practice hours, successfully passing a national primary care NP (all ages) exam, and paying the fee. As of 2006 there are 85 NP’s in Saskatchewan and 6 nurses with pending NP licenses.

I really enjoyed participating on the Canadian Nurses Association NP exam committee for two sessions, December, 2003 and December, 2004. What a great learning experience, and introduction to networking with NPs across Canada.”

What a Nurse Practioner’s practice looks like…

My current role is still evolving. I am in a busy family practice teaching unit. I love the environment! I see patients by appointment at least 4 days per week. My scope is minor common illnesses and injuries, and management of stable chronic conditions. Every day is different: sore throats, earaches, periodic health exams, sprained ankle, pneumonia, contraception counseling and follow up, PAP’s, well baby checks, child health and prenatal checkups, etc.

In chronic diseases, the Family Medicine Unit-Regina is becoming proactive in managing the care of people with diabetes and heart disease. This has involved “collaborative” meetings and program planning/recalls in quality improvement cycles. At least half a day a week is related to this.

 Because Outreach is historically part of the NP role, and because being a resource to the community is a Department of Family Medicine value, I do half a day per week at the Al Ritchie Health action center. This center has a team that is non-medical, who’s goal is to improve health by addressing the determinants of health. While there I do much the same work, plus foot-care for a few residents. If the need arises, I will make home visits.

*The best thing about family practice is the relationships I build. For example, a young woman came to me for a periodic health exam which included contraception and health teaching, in preparation for her marriage. Soon her mother began to see me. After some time the young woman brought her husband with her after trying unsuccessfully to conceive. Soon I was sharing with her, the husband, and her mother at a family visit the results of a positive pregnancy test! I did her first prenatal checkup. At this time we collaborated with her physician to plan the prenatal care and delivery, and I did prenatal checks when the family physician was away. We rode the bumpy and emotional journey together, now with her husband and mother, while the pregnancy survived a threatened miscarriage. Now one of my joys is to watch her beautiful daughter grow when I see them for well baby checks and minor problems like and earache. And I continue to see the babe’s Mom and Grandma for their well women health care. Life is truly rewarding when my work builds relationships like these that encompass both the tears and the joys the blessings of life bring! I have often said, and continue to feel that I am the luckiest nurse in Saskatchewan.