A recent impact study shows nurse practitioner-managed nursing stations offer a safe, accessible and sustainable model for rural health care.
Parry Sound nurse practitioner Donna Kearney, co-ordinator of the study, is a strong proponent of the nurse practitioner-led model in her region.
When she had concerns about Canada's health-care system, Kearney took matters into her own hands and launched a study to evaluate the region's six rural nursing stations, a model she knew worked, but could never prove because she lacked the scientific data.
"I'm keen on this model," she said. "It's been around for more than 35 years, but it has never been studied. I wanted the model to get some exposure, but I needed to prove what I was saying."
The study
Kearney set up a one-year study from March 1, 2009 to Feb 28, 2010 and collected data to learn more about the use and effectiveness of the nursing stations, compared with the West Parry Sound Health Centre's Emergency Room (ER).
She also tracked the number of patients without a family physician, the number of new patients and the type of care provided: preventative, diagnostic, supportive and curative.
The nursing stations are open 7.5 hours per day from Monday to Friday. The practice focuses on prevention and wellness management. Each NP collaborates with a family physician according to a negotiated contract. All six stations are affiliated with the hospital, a cost-saving measure that provides access to a multidisciplinary team of experts and hospital services.
"If I need a dietitian, mental health expertise or a physiotherapist, we can set up video conferences with our patients," Kearney said. "When I hire my staff, they become employees of the hospital. Electronic records are being extended out to the nursing stations from the hospital, which helps the flow of patients from the community to the hospital and back again."
Each station is run by one nurse practitioner and one administrative assistant, funded directly through the Ministry of Health and Long-Term Care. Kearney said it requires approximately $1.3 million annually to run the nursing stations from which a percentage is paid to the hospital for services extended to the nurse practitioners, including diagnostic privileges, human resources and information technology.
Results
During the 12-month period, 19,240 patients were seen at the nursing stations, amounting to approximately 85 per cent of the volume of patients seen in the ER during the same time period. Less than one per cent of the rural patients were referred to the ER and only five per cent were referred for diagnostic imaging. More than 90 per cent of the patients seen had all of their presenting health-care needs met by the NP at the nursing station.
The hospital's ER is open 24/7 and has an operating budget of $3.3 million. The Town of Parry Sound does not have an after-hours clinic.
Emergency Room triage data indicated that 60 per cent of the patients seen were at comparable acuity levels to 98 per cent of the patients seen in the nursing stations. Therefore, a majority of the patients who visited the ER during the research period could have been managed by an NP.
A patient visit at a nursing station costs $70, whereas the cost per patient visit at the hospital's ER starts at $150 and may increase depending on patient acuity.
"I didn't think the volumes of people visiting the six nursing stations would come that close to the volumes seen in the ER," said Kearney. "It speaks to how busy we are, considering it is a one-person practice in each of the six nursing stations."
As well, she noted that the acuity and triage scores (of patients) in the ER that could have been seen by an NP also speak to the scope and role of the nurse practitioner.
Recommendations
Seven recommendations were made for the Parry Sound area, some of which are now being considered by the hospital. Among them are a permanent NP position in the hospital's ER, and an NP-led after hours health-care option within the town to reduce inappropriate use of the ER.
Other recommendations are to hire more staff to perform venipunctures, provide relief during vacations and absences related to professional development and illness, and manage increasing volumes of patients.
"We are putting an application in for extra funding so we can get another NP at each of the sites, even for part time or to mentor them," Kearney said. Because the stations are in rural areas, it is very difficult to provide accommodation for a temporary replacement. Due to the seasonal nature of the region's population, the workload during the summer months can be very demanding for a new graduate or someone who is used to working in a team setting, she said.
Another recommendation is to remove barriers to an NP's practice so they can work to their full scope. Bill 179, the Regulated Health Professions Statue Law Amendment Act, 2009, will allow nurse practitioners and other health professionals to deliver more services than they are now qualified to provide.
"I think the study showed that rural health care services have been at a disadvantage for a long time," Kearney said. "The model is collaborative, safe and accessible. It is sustainable because it is affordable."
Kearney hopes that governments across Canada will look at this model because the challenges associated with rural health care are not specific to Ontario.
