Nurse practitioner Janice Robinson chats with Lodge at Broadmead resident Edmund “Ted” Semmens

Hard fight for nurse practitioner

Advanced nursing project proves value for seniors with Broadmead Care, but funding remains a struggle

Ted Semmens isn’t shy about giving Janice Robinson a friendly earful about his meals at Lodge at Broadmead.

Breaking into a smile, Robinson listens and asks a few probing questions of the 92-year-old Second World War veteran. He’s happy to talk and give a rundown on how he’s been feeling over the past few days.

Robinson is the Lodge’s nurse practitioner, a health care job that fits in the grey area between doctor and registered nurse. Within legislated limitations, she can prescribe medications, diagnose symptoms and order blood work – much of the work a doctor would otherwise do. If a Lodge nurse detects that a resident has a sudden change in consciousness or needs urgent care, they call Robinson.

“I can respond quite quickly, can be there in five minutes. I think having a nurse practitioner on site does help with timeliness of care,” she said. “I can get started on antibiotics, discuss a course of action with the family and get blood work going. It prevents people from going to emergency.”

As useful as the position is, a nurse practitioner at a residential care facility is extremely rare in B.C. and is effectively an experiment that is running out of time.

In 2009, publicly funded Broadmead Care managed to pay for a half-time NP position out of its $23 million budget, for a three-year pilot project. And only that was due to wiggle room afforded from extra funding from Veterans Affairs – about 30 of Broadmead residents are Korean War or Second World War veterans.

The centre needs to fundraise another $10,000 to afford the NP position through to next March. After that, it’s not clear what it’s going to do. David Cheperdak, CEO of Broadmead Care Society says once a nurse practitioner is on the team, it’s hard to step back.

“It will be very challenging for us. It’s hard to go back from such a substantial contribution to the quality of care,” he said.

“We are caring for people at the end of life, most with dementia. The average stay is 18 months, but for some it’s only three to six months,” Cheperdak said. “That care we provide can be intense. A nurse practitioner we believe is an essential role.

“Like most of the health care sector, we are under significant financial pressure.”

A dozen core doctors oversee most of the 225 residents at Lodge at Broadmead, which falls under the Broadmead Care Society, but all have their own busy family practice offices elsewhere in the city.

With the team of nurses, Robinson takes on that day-to-day role of monitoring residents, most who have multiple chronic diseases and take multiple medications.

“It’s a collaborative role. NPs aren’t replacing doctors, but they are complementary roles,” said Fiona Sudbury, director of care with Broadmead Care. “(NPs) will diagnose, order tests and get the ball rolling on medication changes, and communicate with the doctor and consult with them.”

Nurse practitioners are relatively new in B.C. health care, although its a position has long been used in Ontario, for instance. About 250 NPs are licenced to work in B.C. – compared to 36,000 registered nurses – and the Ministry of Health is funding 45 NP positions per year for the next three years. Seven of those are allotted to the Vancouver Island Health Authority.

Competition for NPs is fierce. For the first round of seven positions, VIHA received 30 proposals for funding and Broadmead Care didn’t make the cut. A full-time NP position would cost Broadmead Care about $100,000 per year.

Norm Peters, director of continuing health services contracts for VIHA, said Broadmead’s pilot project has demonstrated a strong case for an NP, and that such positions save money over the long run and improve patient care.

“It is a worthwhile project with great outcomes,” Peters said. “Certainly based on what we’ve seen, NPs improve the quality of care … for people in residential care.

“It’s not only improvement to the quality of care. There’s savings to the system. There is a distinct advantage of having a nurse practitioner involved.”

Peters said Broadmead Care will be considered in the next round of funding for NP positions. “We will continue to advocate for (Broadmead’s) goal to have a NP,” he said.

In the meantime, Robinson continues to work half time as the centre’s nurse practitioner, and half time as a clinical nurse specialist, although she never really turns off her role as NP.

“In other jurisdictions in Canada and the U.S., there are lots of NPs in residential care,” she said.

“I’m passionate about care for frail, older adults and making sure they have the care they need. Having a nurse practitioner helps with that.”

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