The executive director of the Association of Registered Nurses in Newfoundland and Labrador says the Child and Youth Advocate's report into a fatal house fire in Nain is tragic, and that nurses working in remote areas face complex issues.

"Clearly it's a tragic story… but it's quite an impactful report," said Lynn Power.

"Health care and community-based health care services, then add remote services onto that — it's very complex."

The report released earlier this week looks at how government agencies and police failed two children and their grandfather when they perished in a 2010 fire.

It recommends the review of practices and policies in coastal Labrador clinics.

Power told the St. John's Morning Show Thursday that regional nurses in coastal Labrador work in a unique environment and have various roles.

"Clearly not all the pieces were put together and acted on, so there was certainly room for improvement.' - Lynn Power

She said nurses don't work directly with a doctor by their side and the scope of the position is much broader, requiring much more independence, but Labrador-Grenfell Health has various supports in place.

"The limited services that may be in one of these remote areas results in a model of service delivery that has been created to accommodate the more urgent … and practical day to day needs of the individuals in those communities," said Power, adding that vacancies and turnover in staff add to the complexity of the situation.

Room for improvement

She said that stress and long hours are also a reality in these positions and nurses have to "counterbalance" this to deliver the expected standard and quality of care.

carol chafe, nl child advocate

Child advocate Carol Chafe says two children who died in a house fire were failed by provincial employees and the RCMP. (CBC)

Another issue identified in the report is the over use of antibiotics — 101 prescriptions over eight years for the Nain children, according to the child advocate's report.

While nurses in remote areas are able to prescribe and dispense medications, Power said there are limitations and directives that have to be followed.

"There are other parts of the report where the nurses have expressed concern … but clearly not all the pieces were put together and acted on, so there was certainly room for improvement," said Power.

She doesn't feel there is "one magic bullet" but said recognizing the complexity of the environment and the job "is a critical first step."

Professional development and resources are also important, she said.

"I wouldn't want to imply that, in any way, they didn't have the knowledge to competently care for individuals in any registered nurse practice around the province."

Power said the nurses' association is seeing a trend across Canada that has nurses performing more duties.

She said the association has been looking at that to assess what education is needed both in school and on the ground.