'A different perspective': Nurse practitioners push to practise in community clinics

Nurse practitioners in Alberta say the province continues to trail other parts of Canada in allowing them to set up shop as an alternative to family doctors.

But one nurse practitioner heading up a community-based pilot project is hopeful the provincial government will take steps to allow her and others in the field to work to their full scope doing nearly everything a family physician can do.

Nurse practitioner Anne Summach runs a multidisciplinary health clinic at Sage Seniors Association in downtown Edmonton. It's one of four community-based clinics using nurse practitioners started as a pilot program under the former NDP government.

"We have all the medical pieces we can do prescriptions and order tests, etc. But we come at it from a different perspective," Summach said.

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Summach and her team offer a full complement of services to often-vulnerable seniors who seek out their help. She and other nurse practitioners work as a team with dietitians, recreational therapists andmental health professionals to help patients dealing with everything from mobility challenges to homelessness.

Because nurse practitioners are salaried instead of being paid on a fee-for-service model like Alberta's physicians, they are able to spend more time with patients and working with their teams, Summach said.

Primary providers

"Most nurse practitioners aren't interested in a fee-for-service model, they're just interested in the ability to open their own clinic and have it be viable and have people be able to choose them as their primary provider," she said.

"If you don't work through a [primary care network]right now,and you don't have special funding through a grant, you can't bill Alberta Health so you can't open your own clinic."

Many nurse practitioners work in Alberta's hospitals. But unlike in Ontario, they haven't been incorporated into community clinics yet.

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"Because nurse practitioners can't bill directly, it's prohibitive for a physician to bring an NP into their practice because they can't afford to pay the salary," Summach said.

Allowing nurse practitioners to broaden their scope of practice was highlighted in the United Conservative Party's platform during the campaign, and making better use of the profession was also recommended in a blue ribbon panel's report on Alberta's finances.

The report said allowing nurse practitioners to perform to their full capacity, with an average annual salary of $92,569, could create significant savings. Family physicians in Alberta earned an average $391,539 in 2016/17, according to the Canadian Institute for Health Information.

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This fall, the province announced 30 new nurse practitioner positions within primary care networks. A spokesperson for the minister of health said more positions may be announced next year, but that direct billing isn't on the table at present.

"We'll keep looking at it," said press secretary Steve Buick.

Restructuring

Limited job opportunities have also created challenges for universities.

"Our registration has dropped substantially over the years," said Diane Kunyk, associate dean of graduate programs in the University of Alberta's faculty of nursing.

The university didn't admit any nurse practitioner students for a fall 2019 start, opting to pausethe program for a year for a redesign that will shorten it by four months and make it more accessible to students who are already working as nurses or live a long distance from the university.

Kunyk said the school is doing what it can to make the program more successful, but even if interest in the program increases, its growth is also stymied by limited opportunities for students to get clinical experience in Alberta.

"Because the numbers of nurse practitioners have been restricted for a number of years, we don't have the clinical placements we could use," she said.

Family care clinics

This isn't the first time the university and the job market have been out of sync. Promises of increased use of nurse practitioners in family care clinics, piloted by the Progressive Conservative government of then-premier Alison Redford, prompted a spike in enrolments in the U of A's program, Kunyk said.

"By the time those students had finished the program, the family care clinics hadn't materialized, so many of those students had to go out of province to find employment," she said.

Kunyk said the UCP September announcement of 30 new positions may affect enrolment when it opens up again.

"Students are going to have to have a very clear pathway forward knowing that spending this number of months in school will result in a job that is what they anticipate," she said.

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Funding for the pilot at Sage and the other three sites was set to expire in March, but an Alberta Health spokesperson said Wednesdaythe government plans to continue to fund the nurse practitioner salaries through the primary care network model.

Funding for other related costs for the clinic overhead and other positions such as support staff, physiotherapyand mental health services remains under discussion.

Those decisions are expected to be made by April 1, 2020.