Where doctors are scarce, nurses and paramedics learn to work together

Nurses and paramedics are increasingly taking on more responsibility in Nova Scotia, especially in rural and remote areas where doctors are scarce.

While both professions are trained to deliver emergency health-care services, working together as a team takes some getting used to, say a paramedic and a nurse involved in a pilot project at the Buchanan Memorial Community Health Centre in the village of Neils Harbour.

"When we're called to assist in a team-based environment, there's often some confusion because we don't know exactly what the other person is capable of doing," said Ryan Brown, a paramedic for the past 11 years. 

"Sometimes we're stepping on toes."

The clinic, which has an emergency room, a 10-bed inpatient unit and a variety of outpatient clinics, serves about 4,200 residents north of Smokey Mountain.

The goal of the pilot project is to clear up any confusion when nurses and paramedics are called to assist in an emergency situation.

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It's important for nurses and paramedics to be able to work closely together, said Brown.

"Collaborative care is the way the system is going."

Practice overlap

Nurse Janice Hayden also participated in the program, which featured sophisticated computerized dolls with lips that turn blue when oxygen levels appear to drop and mimics seizures.

"It allowed us to put our skills to use, and afterwards, talk about it," she said.

Brown said the program showed how nurses and paramedics can use their skills most effectively.

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"It was quite interesting," said Brown. We learned there is a lot of overlap in the scope of practice. While as a collective team, we can really work together and do a lot of the same things, our time is better spent in certain areas."

Brown said processes like drawing blood and specimen collecting is "nurses' turf."

'Wall has really come down'

Buchanan Memorial has adopted a system where nurses phone Emergency Health Services for assistance when paramedic intervention is required. The health-care centre and the EHS building actually share a parking lot.

"We work together but there was a sense of uncertainty in terms of role clarity," Hayden said. "But it seems that since we've done these simulations, the wall has really come down."

Other collaborative health centres will be using the simulated learning program to improve patient care, said Cindy MacQuarrie, a practice and learning director with Nova Scotia Health Authority.

Mutual respect and collaboration

She said it's important to recognize that health providers work in really complex systems.

Ideally, all sides will "recognize and appreciate each other's strengths and value, and respect what we all have to contribute as a team," said MacQuarrie.

"It is about the shared knowledge of all members of the team ... including the people we serve every day."