The Search

They might not be doctors, but these health-care professionals say they could be doing more

As the Nova Scotia government tries to find ways to attract and retain more doctors, other health professionals say they could be doing more to ease the workloads of physicians and broaden patients' access to services — they just need the opportunity.

Nurses, pharmacists, physician assistants all say their scopes of practice could be broader

Kevin Dickson is a physician assistant who works in the emergency department at the Chalmers hospital in Fredericton. The role isn't used in Nova Scotia, but is common in other parts of Canada and in the United States. (Michael Gorman/CBC)

As the Nova Scotia government tries to find ways to attract and retain more doctors, other health professionals say they could be doing more to ease the workloads of physicians and broaden patients' access to services — they just need the opportunity.

Nova Scotia Nurses' Union president Janet Hazelton said she thinks registered nurses, family practice nurses and nurse practitioners in the province aren't being used to their full abilities.

"They are very, very skilled individuals that have the skill set, quite frankly, to treat most Nova Scotians," she said.

While nurse practitioners are becoming more common as the province rolls out more collaborative-care clinics, Hazelton said she'd like to see consideration given to putting nurse practitioners on their own in areas that struggle to attract a doctor.

"Sooner or later we need to stop looking and start doing," she said.

Janet Hazelton, president of the Nova Scotia Nurses' Union, says many of her members aren't working to their full scope of practice. (Rob Short/CBC)

There are models in the province where disciplines such as physiotherapy are fully integrated into primary care services.

Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia, said there's room for more integration with pharmacy, too.

With 305 pharmacies across the province — most which are open for long hours each day — and patients usually attending those more than they do the doctor's office, Bodnar said pharmacists are well positioned to help.

There are a variety of minor illnesses for which pharmacists are trained to assess, diagnose and prescribe, said Bodnar. Taking those minor cases out of emergency rooms or doctors' offices makes space for more pressing patients, she said.

It's a role pharmacy has been playing in a casual way for years, said Bodnar.

"Patients come into the pharmacy all the time with issues and they talk to their pharmacist and the pharmacist will say, 'You know what, this isn't something you can handle with a medication that's over the counter and you really need to go see a physician.'"

Pharmacists in Nova Scotia are allowed to renew prescriptions for 90 days, do some injections, prescribe for some minor ailments and help manage chronic disease cases.

But all of that could be expanded for the good of the patient and system, said Bodnar. In Alberta, for example, pharmacists can prescribe most drugs other than narcotics for up to a year.

Allison Bodnar is CEO of the Pharmacy Association of Nova Scotia. (Pharmacy Association of Nova Scotia)

Then there are roles that don't exist in Nova Scotia but are integrated in systems in other areas.

Kevin Dickson, for instance, is a physician assistant in the emergency department at the Dr. Everett Chalmers Regional Hospital in Fredericton.

The role is considered a "physician extender," sort of akin to a lifelong medical school resident. Working under the supervision of a doctor, the physician assistant takes on tasks and patients as delegated by his or her supervisor. They can also write prescriptions.

"We take on more routine jobs, interviews and manage simple straightforward cases that can be handled quickly and easy," said Dickson. "If we run into trouble, we refer along to our physician supervisor for advice or help."

Training for the job comes either through university programs or the military. The role is widespread in the United States, and common in Ontario and Manitoba. Dickson said there's enough evidence to show the role works that it would be worth any province starting to use them.

'Need to look at all kinds of ways'

If a nurse or a pharmacist can provide a service more cheaply than a doctor, then Bodnar said it makes sense for them to do so because it will save money and free up physicians to treat more urgent cases. 

However, such a move will require proper compensation, she said, as well as an electronic medical records system where health-care professionals from any part of the province can immediately pull up a patient's health history.

While there can be friction between various health-care professionals as some fear a loss of work or income, Hazelton believes there's plenty of work to go around.

"To keep Nova Scotia healthy, we need to look at all kinds of ways — different ways of making it happen — and we have enough professionals to do it, we just need to get in the same room and make it happen."

About the Author

Michael Gorman

Reporter

Michael Gorman is a reporter in Nova Scotia who covers Province House, rural communities, and everything in between. Contact him with story ideas at michael.gorman@cbc.ca

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