Nov 14, 2022 | Faces of HDGH
Nurse Practitioner Week takes place annually in the second week of November as a way to recognize and raise awareness of the vital role and contributions they play in healthcare every day. In this blog HDGH NP Shauna Carter gives us a detailed look at her role and specifically her role here within HDGH’s Complex Medical Care stream of service.
Over the years the roles and responsibilities of the registered nurse have undergone tremendous changes and increased responsibilities. The different nursing titles can be a bit overwhelming and confusing, to say the least. A nurse practitioner (NP), also referred to as a “registered nurse in the extended class RN(EC)”, is a registered nurse with added education and a very broadened scope. The main difference between a registered nurse who is a registered practical nurse (RPN) or a registered nurse (RN), is that an NP can independently make medical diagnoses, order diagnostic tests such as x-rays and ultrasounds, and most recently, order MRIs and CT scans, along with lab tests. NPs can also independently prescribe medications.
While both physicians and NPs can order medical tests, blood work, and medications, and can independently make medical diagnoses, the schooling model is still quite different. Physicians go through extensive medical schooling while NPs first must complete a 4-year degree in nursing, work for a minimum of two years full-time, and then can apply to become a nurse practitioner, at which point they need to complete a few years more at the university to become an NP. Similar to medical school, there are different specialties an NP can pursue. In Ontario, NPs can become a primary health care nurse practitioner who specializes in providing primary care for all ages across the lifespan. Some programs allow NPs to specialize only in the care of adults or the care of pediatric patients.
I am a primary health care nurse practitioner (PHCNP). As a PHCNP, my focus is on preventative care, which includes educating and providing my patients or “clients” with vaccinations throughout their life. I also ensure that appropriate screening tests are performed in my adult population. For example, breast cancer screening, and screening for osteoporosis (weakening or loss of bone density) help identify and treat illnesses earlier. PHCNPs are also responsible for the management of chronic diseases such as hypertension, diabetes, congestive heart failure, COPD and skin disorders - just to name a few.
Similarly, we also manage acute or what we call episodic illnesses, those that are curable and short-lived, such as colds/respiratory infections, and muscle sprains/injuries. Even though many NPs such as myself are primary care providers, it should be known that we can work in many locations, whether it be nursing homes, hospitals, primary care clinics, walk-in clinics, or in offices with specialists and family physicians. Many of us develop sub-specialties through additional training. Although we have similar roles and responsibilities as physicians, we work collaboratively and when things are beyond our scope we consult our physician partners and specialists.
Complex medical care (CMC) is a program designed to support individuals whose medical and functional needs cannot be safely met in the community, but no longer require the medical services of acute care. We have a variety of clients ranging from those with complex fractures who cannot physically manage in the community while their bones are healing; clients with new amputees who are not yet ready for the inpatient rehab program; and some clients who have complex medical needs such as extensive wound care, iv therapy or peritoneal dialysis who require more services than are available in the community setting. As an NP in CMC, my role is extensive, as I am involved in the client’s journey starting from the admission process, the inpatient stay, up until and including their discharge.
I work with my interdisciplinary team members to assist with the admissions of clients which involves ordering medications, performing history and physicals, and devising both medical and nursing plans of care. Throughout the client's stay, I also attend to both episodic and chronic diseases. An example of an episodic condition would be identifying, diagnosing and treating an infection. Managing and optimizing chronic diseases account for a large part of my NP role here at CMC, as complications arising from chronic diseases can often impact a client’s hospital stay or ability to return home. Because some of our clients have barriers to accessing primary health care in the community, an important part of the NP role here in a hospital setting is to ensure that client’s chronic diseases are well managed and that our clients are “tuned up” before being discharged back to their homes in the community.
Once the client has met their identified goals in CMC, the NP is also involved in the discharge process and working with the entire interdisciplinary team to ensure that client will have a successful and safe transition back to their home in their community. This not only involves ordering medications at discharge but involves the client and the team of their support of family or friends to ensure that client has the tools needed to be able to resume safe functioning in their home environment.
Shauna Carter is a PHCNP who currently works in the Complex Medical Care department (CMC) at HDGH and the Pelee Island Nursing Station for VON Canada. Shauna has been an NP for 13 years and previously an RN for 7 years. Shauna helped launch the NP-led outreach program to help decrease ER visits in long-term care facilities and had worked as an NP at the Village at St. Clair for 6 years. Shauna is a board director at Assisted Living Southwest Ontario (ALSO) and a member of the annual clinic day planning committee for the Essex County Medical Society (ECMS). Shauna was also the 2013 recipient of the Lois Fairley Community service award and the 2017 recipient of the HDGH Outstanding Contribution to the Patient Experience award.
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