On July 21, 2021, Dying With Dignity Canada hosted a webinar focussing on the work of nurse practitioners in Canada.
Our speakers included:
Valerie Cooper, a Hospice Palliative Care Nurse Practitioner with Home and Community Care Support Services South East. She sees patients in their homes in a variety of geographies, from urban to remote. She works in a shared-care model with patients’ existing primary care providers to support patients with malignancies and end-stage organ diseases to die in their preferred place of death. She lectures in the undergraduate program at Queen’s School of Nursing and has developed and taught an elective undergraduate course on hospice palliative care nursing. She has also contributed to a continuing education course for nurse practitioners on palliative care through the University of Toronto. Valerie is a member of the Dying With Dignity Canada’s Clinician Advisory Council, as well as many Communities of Practice related to both Palliative and End-of-Life Care and Medical Assistance in Dying. She recently became co-chair of the NPAO Palliative and End of Life Care Community of Practice.
Elizabeth Leonardis, a nurse practitioner practicing in Vancouver, BC providing primary care to homebound elders through the Home ViVE (Visiting Vancouver’s Elders) program. She has also been a MAID Assessor and Provider since 2017. While originally hailing from the US, she now calls Canada home and recently made it official with Canadian citizenship.
This blog post will summarize some of the key takeaways from this informative session.
If you prefer to view this content in video format, you can access the recording here.
A Registered Practical Nurse (RPN) or a Licensed Practical Nurse (LPN) holds a diploma degree. RPNs and LPNs are generally tasked with taking care of patients who have a predictable trajectory. This could be in a hospital setting or in the community – they would take care of patients who are going to get better or are low risks for complications.
A Registered Nurse (RN) holds a bachelor's degree. RNs work in complex areas like ICU and post anesthesia care units, where critical thinking skills are essential.
A Nurse Practitioner (NP) holds a master’s degree that is clinically focussed. It is a bigger scope of practice that includes more complex cases. There is variation across the world, North America, Canada and our provinces in the scope of nurse practitioner work. Generally, in Canada, a nurse practitioner works as an autonomous professional – they do not need oversight by a physician or other health professionals. Physicians and nurse practitioners have similar practices. They come from a different education stream and from a different lens, but do very similar work.
Key takeaway #1: A day in the life of a nurse practitioner is always different
The work of a nurse practitioner can vary widely, but typically they work in the community, from home, in a clinic or at a hospital. Nurse practitioners (NPs) are usually employed by the local health authority as a salaried employee. They can have their own case load similar to a physician. There are still barriers in some jurisdictions, but NPs can order medications, some tests and diagnostics.
Key takeaway #2: There are many misconceptions about the work of nurse practitioners
The work of a nurse practitioner is still not commonly understood by the general public. The many classifications of nursing (see definitions above) do contribute to this issue, but both speakers commented that there is confusion outside and inside the health care community. They still feel like they are trail blazers and that, over time and with experience, people will begin to better understand the role of nurse practitioners.
A common misconception is that nurse practitioners must work with, or under, a physician. They are in fact autonomous practitioners with their own patients and caseloads for whom they are the primary care provider.
People often ask, “Where’s the doctor?” Both speakers shared that they will occasionally have to say, “I am the doctor, only I’m a nurse practitioner.” There is still work to do clarifying the work and the role of NPs in the health care community, but it is slowly improving.
Key takeaway #3: Death and dying is still not a topic that is well addressed in health care
In most nursing education, death and dying is an elective course and not considered an essential curriculum. This gap was identified by both speakers, as inevitably a nursing student is going to experience death no matter what area of medicine they choose. Normalizing death and dying would benefit everyone involved in health care. The legalization of medical assistance in dying (MAID) has helped to open up conversations about death, as people make the choice to end life on their own terms, but there is still work to do.
Many health care professionals are reluctant to discuss MAID with patients. There is a concern that talking about MAID could be seen as coercion. Both speakers expressed that with specific training, pre-emptive conversations about end-of-life can help people prepare through advance directives and will ease stress and anxiety when end-of-life does come.
Key takeaway #4: Nurse practitioners can be MAID assessors and providers in most areas of Canada
Nurse practitioners make up 7% of MAID assessors and providers in Canada.
In British Columbia, NPs can be both MAID assessors and providers (there is some nuance between health authorities).
In Ontario, NPs can assess but not always provide MAID.
In Quebec, NPs cannot be involved in MAID assessment or provision.
One major challenge for NPs who would like to be involved in MAID is that there is no payment mechanism in place for them outside of their employment to bill for medical assistance in dying. This has implicated how many nurse practitioners are willing to provide MAID outside of their employed hours and responsibilities. Some NPs are providing MAID for free in their communities until a payment method is put in place.
These are just a few of the insights gathered from our spotlight on nurse practitioners. To learn more, watch the recording here.