Shelburne councillors lobby for changes to role of nurse practitioners

The Municipality of the District of Shelburne is asking people in the health-care system to get behind an idea they believe could ease some pressures in rural emergency rooms.

Local councillors want to give nurse practitioners the authority to admit patients to hospital. To do that, the provincial government would have to change regulations under the Hospital Act.

In 2015, the province gave nurse practitioners the authority to discharge patients from hospital, but not to admit them.

Warden Penny Smith says their idea came about after councillors had a chance to talk with a nurse practitioner who recently started working at the Shelburne health clinic by the Roseway Hospital. That nurse practitioner had worked in Ontario, which has different regulations.

"Perhaps if we could get this amended it could be a real game-changer for the province," Smith said. "It's not about replacing doctors with NPs. It's about fully utilizing them in Nova Scotia just as they are in other jurisdictions." 

Nurse practitioners can admit and discharge patients in Ontario, British Columbia, Manitoba and Alberta. 

The council has written to several other organizations to suggest the idea, including Doctors Nova Scotia and the Nova Scotia Nurses' Union.

David Levy, the deputy warden, said the municipality is concerned about the number of ER closures at the Roseway Hospital, many of which happened due to lack of physician coverage. The Roseway's emergency department is yet again closed until 8 o'clock Wednesday evening.

"It's fairly serious for many people," he said.

Smith said the council's understanding from talking to health-care workers is that if a nurse practitioner was on hand to admit patients, the emergency department could stay open even if there was no physician available.

Role of nurse practitioners scrutinized

The Nova Scotia Nurses' Union has been calling for changes in the way the province uses nurse practitioners. Janet Hazelton, the union's president, said it doesn't make sense that they can discharge patients but not admit them. 

"There's more risk to discharge a patient than to admit a patient," she said Tuesday. "Because if you admit a patient and they ought not to be admitted, then it's simple. There's no concern." 

Hazelton said she thinks it may be time to re-examine the Hospital Act.

Dr. Tim Holland, the president of Doctors Nova Scotia, said it's a good idea for the people in Shelburne to talk to their local health-care workers to come up with a solution that works for the Roseway. 

"It's great to see communities try to find innovative solutions to the crises they're facing, however, it's really important to keep in mind the potential unintended consequences of those solutions," he said. 

"If you're putting a nurse practitioner in an emergency department who hasn't had the appropriate training in emergency services, you could face a situation where a real trauma comes in or some sort of major case that that nurse practitioner isn't ready for."

He said the reality is "if you're ever bleeding into a collapsed lung, you really want an emergency physician in that emergency department."

Holland said there is a role for nurse practitioners in ERs, but he thinks it should be in a team setting.

Growth in numbers

There are about 200 nurse practitioners in Nova Scotia, and the Department of Health and Wellness says the number of nurse practitioners has grown by more than 70 per cent since 2010. 

"One of the goals of Nova Scotia's Nursing Strategy is to remove barriers that prevent nurses from doing the work they are educated and licensed to perform, and allowing NPs to admit is one of the items we're looking at," wrote the Health Department's Andrew Preeper.

Preeper said at the time the province modified the regulations to allow nurse practitioners to discharge, it was expecting their role to evolve over time.

"The most pressing need at the time was discharge and the nurses were ready to assume that role," he wrote.