Meet some of Alberta’s NPs

Tanya Kurich, Internal Medicine NP

Please tell us your name, where you work, and a little about yourself.
Hi! My name is Tanya Kurich and I currently work in Internal Medicine at SHC. I started as an RN in Coronary ICU full time for 6 years. Next, I moved into the role of Cardiac Nurse Navigator at the Mazankowski Alberta Heart Institute in Edmonton for 2 years. Working as a Navigator gave me the opportunity to learn more about the complexities of our health care system and an appreciation for how difficult it can be for patients to find their way through. Upon graduation from the Masters of Nursing NP Program, jobs were limited and mostly specialized. Fortunately, I was hired to fill a maternity position on Rapid Access Unit at SHC. Here I was exposed to a variety of acute medical illnesses and developed a broad base of experience and knowledge, preparing me well for my current NP position in Internal Medicine starting September 2016. Working on the GMU NP team has opened my eyes to the challenges of chronic disease management. I’m grateful for the supportive team and ongoing learning opportunities. SHC is a progressive place to work with the highest number of NPs compared to any other AB facility and I’m proud to be part of it.

Where did you go to school?
I started the Nursing Diploma Accelerated track at Grant MacEwan College. It was an 18-month program, equivalent to the first 3 years of the Nursing Degree. I worked in CICU for 2 years before pursuing my undergraduate Nursing Degree at the University of Alberta. Nearly a decade later, I returned to U of A to complete the Masters of Nursing – Adult NP program.

Why did you become a nurse practitioner?
When I first applied to the Master’s program, I wanted to pursue nursing leadership and improve what I saw as inefficiencies within the healthcare system. I quickly realized one can be a leader in any position. I didn’t want to lose my clinical skills or stop interacting with patients, so I applied to the NP program.

What do you enjoy most about your NP role?
I love working as part of a multidisciplinary team. Collaborating with each other allows us to learn from one other and provide individualized care focused on the patients’ unique needs. Additionally, I value the continuity the NP role brings to patient care by being a familiar face while other healthcare team members tend to change throughout the duration of a patients’ hospital stay.

What are the challenges?
Being presented with new conditions or unique patient circumstances keeps me on my toes and fosters new learning every day. The complexity of patients’ medical conditions coupled with the challenge of navigating our intricate healthcare system can be difficult at times, yet inspires me to think of new ways to be more efficient and hopefully improve patient
health care outcomes.

Are you involved in any research projects?
As part of the Master’s Program, I completed and published a literature review of Acute Coronary Syndrome Symptom Presentation in South Asians. Currently, I am involved in a project looking at GMU patient discharges and gaps in transition from hospital to home. Data collected thus far is interesting and highlights the unique value of NP’s. I am very interested in pursuing additional avenues of research when time permits.

What do you see as the future role of nurse practitioners in Alberta?
I believe the role of NP has the prospect to evolve as a catalyst to change health care delivery within Alberta. With NPs working to their full scope of practice, I hope to see the role of NPs expand into areas where system gaps exist to help improve access of care for patients. Hopefully, by continuing to provide high quality, low cost health care, the NP role will be recognized as part of the solution to our overspent healthcare system.

If you could change one thing about nursing in Alberta, what would that be?
Nursing has become more task based with the adoption and creation of a variety of protocols. While these can help achieve safety standards and ultimately improve patient care, one thing I
would NOT change is the compassion towards our patients, which I believe is integral to the role of a nurse.

Langdon, AB: A day in the life of a primary care NP

Langdon Medical Clinic (LMC) is a family practice built on the concept of the medical home; team­based health care intended to provide comprehensive and

continuous medical care to families with the goal of obtaining maximized health outcomes (1).  LMC is located in its namesake town, Langdon, east of Calgary. It is a young community with a population of almost 5000; 30.4% of whom are children aged 15 years and under (2). Hence, LMC has made child and teen health care a very important part of their practice, believing that when children and teens receive the best care early, they grow into healthy adults.

Lynette Wohlgemuth, a Nurse Practitioner (NP) specializing in Paediatric Primary Care, joined the LMC provider team of Family Physicians in May 2015, bringing her 18 years of experience as a critical care Paediatric Registered Nurse in the Intensive Care Unit of Alberta Children’s Hospital to the rural community. As a NP, Lynette provides comprehensive care for children including assessment, diagnosis, prescribing medicine, follow-­up, and referral, addressing growth and development or urgent care issues; all under a collaborative, team­-based model of care with the Physician group.

Though many families had never heard of a NP before, word of Lynette’s expertise and LMC’s emphasis on collaborative care for families spread. “When I saw LMC was bringing in a NP I just knew it was going to be a definite asset to the Practice and I have not been wrong”, says Kristen Wilson, a client and mother. “I admire and respect their (NPs’) frame of practice…looking at all aspects of care including the family and how care affects and relates to everyone. NPs are true leaders in holistic care; not just looking at the disease but at how it affects the person and their family.”

Kristen describes her experience in working with LMC and Lynette:

“My little girl was seen numerous times for a breathing problem she was having since birth. We were always told, ‘She will outgrow it,’ and, ‘Nothing to worry about.’ At just over a year of age I took her in for a cold that she was struggling with. Lynette took one look at her and understood the severity of her breathing. A diagnosis of laryngomalacia was made and a referral made to an ENT (Ears, Nose, Throat) Specialist. At this appointment Lynette took her time thoroughly assessing her, from a detailed birth history to her current situation. She looked at her growth and eating patterns, which consisted of a lot of choking and vomiting. She put all the pieces of the puzzle together and a care plan was made to ensure she was treated for her current cold, followed up and given very detailed signs to watch for to seek further medical attention. Lynette knew I was a former RN but never once did she assume I knew because I was a Nurse. What made that visit so important was she both empathized and reassured me, and made me feel like a great mom. Her simple words, ‘How are you coping with her illness,’ was enlightening and provided emotional support and encouragement. My daughter had surgery in December of 2015. It was a very risky surgery and time was to be spent in the PICU for recovery. Lynette took time out of her very busy schedule to call the PICU on the day of her surgery to see how we were doing and to send warm wishes to let us know she was thinking of us. This was a genuine gesture on Lynette’s part that showcased her care and dedication to us.” (3)

Client and mother, Jennifer Sonnenberg states, “My son has some health challenges and Lynette has helped keep me calm and stay on top of his health. Her willingness for contact outside of normal medical clinic hours and ease to reach her has been nothing short of phenomenal in today’s society. She will even follow up after a visit to ensure the problem has corrected itself or gotten better.” (4)

LMC is better able to provide care for children experiencing challenges with learning and behavior, such as Attention Deficit Hyperactivity Disorder, Autism, or Anxiety Disorders. Lynette’s approach emphasizes the need for collaboration with the Physicians, children, their families, and with their schools.

“As a member of our school’s Learning Support team, I am most fortunate to have had the opportunity to work with Lynette. Working with a number of our students as a Nurse Practitioner, Lynette’s medical knowledge and professionalism have supported our school’s collective efforts to address student needs. Whether her intervention has addressed physical, mental health and/or academic concerns, Lynette’s involvement has been an important piece of our united efforts to best support our students. Lynette’s medical background, combined with her approachable demeanour and receptive manner, has contributed to families receiving direct, timely and supportive intervention. Her work as a Nurse Practitioner is thus an invaluable component of our collaborative efforts in supporting our students and community as a whole.“ says Leigh­Anne O’Brien, Learning Support Teacher, Rockyview Schools. (5)

As a representative of LMC, Lynette has partnered with the AHS Sexual and Reproductive Health Education Team in teaching Career and Life Management (CALM) classes at various schools in Rockyview and Wheatland counties. The opportunity to meet teens in the comfort of their own classrooms, ask questions, and know that LMC is a safe, confidential place with an open door policy to receive care has resulted in improved access for these young adults. LMC’s medical home concept allows for Lynette to utilize her advanced practice education in women’s health to participate in team­based comprehensive care for women. “There is something very different about Lynette; it’s the way she listens. She hears you. It’s how she makes you feel. She has time for you and wants to help. Her knowledge on women’s health is exceptional and I believe my story is just one of the many stories in which she has thrown a life ring into,” describes client Dawn Johnson. (6)

Langdon Medical Clinic is an example of collaborative practice between Physicians and a NP that provides expert care for their families in all ages and stages of life. “Having a NP with (Lynette’s) experience, dedication, curiosity and passion makes all the difference, firstly to our clients and secondly to me,” explains Dr. Alexander Lukubisa, a LMC Physician. “(Her) support and contribution at the clinic has been crucial to our growth and success. Our paediatric population has a passionate advocate who will help them navigate the current health care system and also provide them medical support so that they can be their best at school and in life.”(7)

1. Langdon Medical Clinic Website, www.langdonmedical.com, 2016

2. aodbt architecture + interior design, Recreation Facility Feasibility Study,

Langdon, Alberta, September 25, 2014

3. Kristen Wilson, LMC NP Utilization Survey, email communication, August 30,

2016

4. Jennifer Sonnenberg, LMC NP Utilization Survey, email communication,

September 1, 2016

5. Leigh­Anne O’Brien, Learning Support Teacher, Langdon School, Rocky View

School Division, LMC NP Utilization Survey, email communication, September 14,

2016

6. Dawn Johnson, LMC NP Utilization Survey, email communication, September 15,

2016

7. Dr. Alexander Lukubisa, Family Physician, Langdon Medical Clinic, LMC NP

Utilization Survey, email communication, September 21, 2016

Edmonton: A day in the life of an urgent response NP

-Jennifer Fech, Urgent Response Team Nurse Practitioner, EMS, Alberta Health Services

Nurse Practitioners are uniquely positioned to provide urgent care services in the Community through EMS and Continuing Care. As part of mobile teams, these NPs travel to see patients and address chronic or acute issues when the Most Responsible Provider (MRP) is unable to.

The goal and intent of the EMS Community Care Urgent Response Team (URT) is to assess, diagnose and treat in place. The team consists of 5 NPs working with 5 Paramedics across multiple shifts. The URT can be called to any Continuing Care facility, such as extended care (nursing home) or supportive living, within Edmonton. Instead of calling 911, the site staff and MRP should consider if the patient could potentially remain, and be treated, at the facility. NPs (and patients) benefit from a Paramedic’s acute assessment skills, action-oriented training, and connection to Edmonton Metro Emergency Medical Services (EMS) to appropriately care for facility-bound people. Paramedics benefit from the NP’s skill and knowledge as it is a rarity to be called to treat someone without an arms-long list of diagnoses and medications, and in anything other than a frail state of health. Paramedics also have protocols that they follow for giving appropriate medications. While, according to current legislation, they do not take verbal orders from an NP, they work in collaboration with NPs to effectively treat-in- place.

Often, the Most Responsible Provider (MRP – MD or NP) is not on site at a facility when urgent situations arise, and only receive a fax or a phone call describing the nature of the urgency. When on-site staff and the MRP recognize a potentially urgent/emergent condition in a patient, the URT can be consulted via a central phone number. At the time of writing, the URT can also be connected to a 911 EMS call via the EMS dispatch system, depending on how the call is coded. The URT line is staffed by a Paramedic or a Nurse Practitioner from 0700-2100h, Monday to Friday. The consult is simply a verbal description of the urgent issue along with the most current VS. We ask more questions if needed to determine our response time requirements, or whether this matter should be deferred back to the MRP or to 911.

Once a consult is accepted, the team is dispatched. Staff members are dispersed throughout the city, each in a marked response vehicle in an attempt to decrease response time. Paramedics are usually on- scene first and begin the assessments which include (more or less) a 12-lead ECG, VS, physical assessment, discussion with site staff and general evaluation of the situation.

It is then the NPs responsibility to assess, determine a treatment plan, and continue the discussion with staff, patient, and family/key decision-makers. We document on an order sheet specific to our team, so it’s easily recognizable, and also create an electronic patient care record (PCR) which is part of the EMS system. NPs also liaise with the MRP (MD or NP) to ensure proper communication and agreement with the treatment plan. This ensures orders are carried out and not changed during the team’s absence (unless medically warranted), and lab or diagnostic results are reviewed. The team has access to inter- facility transport for transport to East Edmonton Health Centre for diagnostic imaging. We are well equipped for bloodwork, fluid and medication administration, and other tasks such as Foley insertion and suturing. We also book our own follow-up visits, for example, for IV antibiotic administration, follow-up of lab or diagnostic results, or reassessment of patient condition. Generally speaking, we do not follow patients for more than 3 days, since our focus is on caring for acute & urgent needs.

Certain urgent issues, such as a broken hip or dehydration, make treatment plans simple. Other conditions, such as progressive SOB (shortness of breath), are complex in their etiology and potential treatment plans. The NP provides the necessary medical and nursing expertise to appropriately assess, diagnose and treat these complex patients.

We prevent 80% of direct consults (URT intake line) and 60% of the EMS 911 consults from being transferred to ER. Patients and families often express appreciation for the care provided in the facility. Many Physicians, initially somewhat resistant to the idea, have welcomed our approach and treatments. It has been a privilege to be part of a growing team, and we look forward to continuing to provide acute and urgent care for facilities in Edmonton.