Nursing the system forward: Canada’s evolving model of care

Not even a decade ago, Canada’s nurse practitioners were neither regulated nor registered and barely numbered 100.

Flash forward to 2018, and we now boast over 5,000 regulated nurse practitioners across all provinces and territories.

It’s a good example of how our health care system is moving in the right direction, says Canadian Nurses Association CEO Michael Villeneuve.

“We’re pleased by the shift at the federal level from discussion of hospitals and acute care, to the less costly, more convenient community-based care,” says Villeneuve, who heads an organization representing 139,000 members in all 13 provinces and territories.

“Recent negotiations with the provinces and territories finally put the rubber to the road, dedicating $6 billion to home care over 10 years.”

The passing of two 2017 budget implementation bills – C-44 and C-63 – which aim to improve care for patients whose primary health-care provider is a nurse practitioner, also takes down barriers facing nurse practitioners.

“Historically, legislation has been built around the language of physicians,” says Villeneuve. “Governments are now taking the time to enable legislation for other health care providers, which helps improve integration and frees up the precious resource of a doctor.”

However, the system is still being held back by regulations that haven’t kept up with changing times.

“There’s no reason someone like me – a nurse with decades of experience and a master’s degree in neuro-nursing – can’t order an X-ray or get you the Gravol that your children can buy across the counter in Shoppers Drug Mart. That’s the part we have yet to fix.

“The incremental approaches we’ve seen so far have not been very successful. We’re just tinkering at the edges. Although we created nurse practitioners, they’re not fully licensed in everything they could do. We might have a great program in one hospital in Toronto, but you may not see the same in Saskatoon.”

Then there’s the issue of patient care technology, he adds. “You might see a MRI that looks like something out of Star Trek and, perversely, fax machines, pens and paper right beside it. We still don’t allow people to use the technology that they hold in their hands every day, like an iPhone.”

Add to that our sheer size, with multiple levels of government across six time zones, and standardization becomes a logistical nightmare.

“Every province’s formula is different. You might get 50 different answers on the cost of care in 50 jurisdictions, because it’s such a tough industry to find the trail for where the money goes and what services are actually purchased,” says Villeneuve.

Still, the end goal is worth the growing pains: Numerous studies have shown nurse-led clinics divert a significant number of hospital visits, cut down wait times and deliver better clinical outcomes with less costs.

“Two-thirds of our members work in acute health care and we’re all caught up in that engine. We cost about 13 per cent of all the money we spend in the country – so how can we deliver that health care in a more efficient way?

“We share that struggle with all our counterparts. We’re on the way there, but we almost need a reset button.”