Taking nursing to the next level: the expanded role of nurse practitioners

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With the ability to diagnose, prescribe, order and interpret results, initiate referrals and provide direct care to patients, nurse practitioners (NPs) play a major role in health care delivery across Canada both outside, and inside, the hospital.

“Much of the public would know about the primary care role of nurse practitioners, but we’re really fortunate to have them in our hospitals too,” says Tricia Lane. Lane is a nurse practitioner in the Orthopedics department at the IWK, one of three pediatric NPs, one NP in mental health & addictions and nine neonatal NPs at the IWK.

In her role as a NP in orthopedics, Lane is able to see patients independently in clinic which provides improved access to care for many patients. “I’ll see patients in my clinic that don’t necessarily require the services of an orthopedic surgeon,” Lane says. “Surgeons are also in the operating room a lot so I’m available to go to see patients when a physician isn’t available.”

The College of Registered Nurses of Nova Scotia describes NPs as registered nurses (RNs) with advanced education and an expanded scope of practice. After completing an additional master’s degree, registered nurses can practice as NPs, allowing them to:

  • diagnose and treat acute and chronic illness;
  • prescribe medications;
  • order and interpret laboratory and diagnostic tests;
  • perform procedures;
  • refer to, as well as accept, client consultations from other health care providers.

Training for NPs in Canada began formalizing in the late 1980s with their introduction into neonatal intensive care units. Only in 1993 did University of Toronto start the first graduate-level program outside the specialty of neonatology. In Nova Scotia, Dalhousie started their NP program in 2000 with provincial legislation passing in 2002. Today, there are 163 NPs in Nova Scotia, 24 in Prince Edward Island and 125 in New Brunswick with the IWK’s specialty NPs in pediatrics and neonatology making up a small, but very mighty, portion of those NPs serving the Maritimes.

This expanded role of nursing offers a new challenge and career opportunity for aspiring, or practicing, nurses. “Nursing is a great career in that there are so many different ways you can work as a nurse. This is taking nursing to a different level. You have an expanded scope and that can be really important to someone to have that feeling of autonomy,” says Lane. “I know it was for me. I worked as an RN for several years, but I wanted a new challenge and this provided that to me and it was fabulous.”

One of the strengths of NPs is their contribution to collaboration and interdisciplinary care, a model that is practiced widely across the IWK. “In the pediatric care setting, NPs compliment the team in terms of providing comprehensive care to patients. We work alongside our physician colleagues to care for patients both in the inpatient hospital setting, as well as in clinic settings,” says Lane.

Support from physicians and nursing staff on inpatient units, as well as their own teams, is a cornerstone of the IWK’s NPs’ success. “We have huge physician support,” says Lane. “Our nurse practitioner roles are very collaborative in the acute care hospital setting and that enhances patient care. So it’s not an NP that’s replacing a physician, but it’s additional care providers that are ensuring the right person sees the right patient.”

Passionate about pediatrics, nursing and her role, Lane has high hopes for the future of the role of nurse practitioners. “I really think NPs enhance patient care so I really want to see more NP roles in the future,” Lane says. “I absolutely love my job. I love that I get to work with all the interdisciplinary team and I think that’s a big part of what I do.”

Nurse Practitioner Week is November 11-17, 2018. To learn more, visit npac-aiipc.org or crnns.ca.