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Nurse Practitioner Enjoys Full Scope Practice

Maple Creek Nurse Practitioner Dawn Kalinowski Shares Her Experiences

Nearly two years ago the opportunity arose for me to start practicing as a licensed Nurse Practitioner in Maple Creek. The idea of a NP in the rural community was met with doubt and confusion. Many times I heard,” well you are better than nothing,” or, “are you staying?”

The head doctor left suddenly just two days after I started and I was left working with a previously retired doctor, a d octor who was very new to Canada and one locum doctor after another in a brand new position involved in a new primary health care model. I had worked a year in another rural community, but the number of patients were much less in a community of 500. Maple Creek has 2600 people, a full hospital and nearly 180,000 people traveling through to Cypress Park every summer. I was overwhelmed by the people with many co-morbidities and complicated health problems who had suffered many months of rushed appointments, and no follow-up care due to the doctor shortage. Many people suffered with uncontrolled diabetes, kidney disease and heart disease. Breast cancer was like an epidemic and women’s wellness checkups had been greatly neglected. Pregnant women were immediately referred to Medicine Hat and very little basic prenatal care was done. Lab work was not up-to-date and prescriptions were given out for 6-12 months without any routine lab work or follow-up.

 

With no steady, full-time, qualified doctor around most days, the decisions were often difficult and complicated and for the first time I became aware of what a full scope NP was expected to do and know. All those years of education, training, experience and skill-building kicked in. I struggled with what people expected of me and what I felt safe and comfortable doing. There was no opportunity for second guessing or questioning decisions made. The people needed a confident , experienced, knowledgeable, patient communicator and care provider. They needed someone to explain test results, order medication, order tests and refer when needed to the appropriate persons. They needed a teacher to explain why they needed lifestyle changes and how they could improve their health and lives. They needed a reassuring hand and a patient listener to express their concerns and answer their questions. They needed a firm, fair caregiver to help them make the decisions they needed to improve their daily lives. They needed a space and person to share their secrets, their concerns, their anxieties and their sadness, to feel accepted and important and not ashamed or judged. Many days I went home mentally exhausted, playing the day over and over in my mind, feeling confident in my abilities but always planning for the next days. As the list of daily patients grew, so did the workload and the challenges. Many  evenings I spent 1-2 hours overtime working on never ending paperwork and writing referral letters, reviewing lab work and doing follow-up.

A few months after I started as an NP, the workload was heavy enough to hire a second full-time NP to help. Soon the clinic was bustling with even more patients and although the locums kept coming and going, the NP’s role became one of permanence and acceptance. I was soon hearing instead of “you are better than nothing”, it was, “I’m so glad you are here and we’re lucky to have you”.

Teamwork became very important in helping diagnose, treat, review, and educate the patients. I found myself consulting doctors, other NPs , pharmacists, diabetic educators, mental health workers, lab technicians, massage and physiotherapists, nutritionists, tobacco cessation workers, addictions counsellors and many more people involved in the healthcare fields. I tapped into their individual expertise and suddenly my job wasn’t as difficult and I found a lot of new friends and colleagues who offered support and ideas.

What an awesome group they are and all are available to help patients live longer and better and help primary caregivers plan and decide what’s best for the patient’s wellbeing. The doctors accepted the NPs very well. We each take call one night a week at the hospital and the locums always request the NPs to be on 1st call with them. We see all the emergency patients first. We handle most of the cases on our own. We do suturing, assess, diagnose, treat, order and read x-rays, order and assess ECGS, refer when we can. The doctor gives permission to admit and are usually updated on the cases if needed during call or otherwise told in AM after call is done. The doctors are always called if needed, but most are fairly comfortable with our judgment and skill level. Our doctors defend us and seem to enjoy working with us on a day to day basis. Recently one of our doctors said, “You NPs see as many patients and do as much work in the clinic as the doctors. If you ever decide to leave, give me a month’s notice and I’ll be leaving with you.” That was high praise from a doctor and we knew he accepted us and appreciated what we were doing.

The Nurse Practitioner role has become accepted in Maple Creek. I am often booked two weeks ahead and I see between 14-20 patients in a day depending on the needs of my patients. A regular appointment usually takes 20 minutes. A complete physical takes 40-60 minutes. Prenatal and postnatal checks take 40 minutes. People suffering with depression or other mental issues are often given 40 minute appointments or longer, so they can be assessed fully and have time to talk. Women’s Health has become a busy part of my practice which I greatly enjoy. Chronic disease and depression/anxiety issues continue as well. My day is filled with variety and there is always at least one new patient everyday coming to see me.

Everyday offers a new challenge and the need to continue to research and study. I attend several educational conferences every year, take university classes when I can and update all the physical skills I need annually to maintain them at a high level. I am constantly reading medical articles and magazines, listening to news and new ideas, always researching and looking up answers to any new puzzle that comes along in my daily practice. This week my NP role expands as I become a preceptor to a future NP. So the learner will now become the teacher! I only hope that my love of nursing and caring for the people will be passed on to the student as many of my preceptors passed onto me. Primary Care Nurse Practitioners are knowledgeable, dependable, confident, studious, always trying to improve themselves and their knowledge base, but before they were NPs they were bedside nurses who just cared for people. I don’t ever want to forget why I became a nur se or lose the determination, compassion, empathy and experience that got me to this point. I am still a nurse in an expanded role. I am eternally grateful that I can still learn, teach and contribute to society in a way that is valuable and important. What’s even more important - I still love what I do!

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Kalinowski, D. (2010, March). Nurse practitioner enjoys full scope practice. The Source: Cypress Hills Health Region.

 

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