Improving your access to health care

UVic research leads to the creation of B.C.'s first nurse practitioners

by Debbie Willis

When the University of Victoria's first class of nurse practitioners graduates this fall, the new grads will have reason to thank two UVic researchers.

Nurse practitioners are advanced practice registered nurses who can provide a range of primary health care services. They can diagnose and treat common illnesses, order tests, prescribe medications, and refer to specialists. They can also help patients with chronic problems such as depression, hypertension, diabetes and asthma.

The new occupation is being introduced in B.C. to improve access to health services. Ten students at UVic and seven at UBC will complete master's degrees in 2005 to become nurse practitioners.

Research carried out by UVic nursing professors Marjorie MacDonald and Rita Schreiber—in collaboration with government, professional association and health authority partners—helped make make this possible.

MacDonald and Schreiber have researched the role of the nurse practitioner for more than five years, working with the Registered Nurses Association of B.C., the Vancouver Island Health Authority, and the B.C. Ministry of Health. They interviewed nurses, doctors, patients, and employers and studied areas where nurse practitioners already practise.

Their work resulted in recommendations that were adopted by the B.C. government. "What we see happening now is informed by our research," says MacDonald.

MacDonald, Schreiber and their team recommended that nurse practitioners have sole authority for their practice rather than being supervised by physicians, that they receive master's-level education, and that the position be implemented only when stable funding to sustain the role is assured.

These and other recommendations were adopted by policy-makers and regulations allowing nurse practioners to practise in the province were approved in 2005.

At a time when more than two million Canadians don't have a primary health care provider, the hope is that nurse practitioners will improve access to health care, say Schreiber and MacDonald. Their research in other jurisdictions has shown that people consult a nurse practitioner as they would a family physician, and that they're satisfied with the care they receive.

"Nurse practitioners provide a unique value-added service," says MacDonald. "Their work is often structured to allow them to spend more time with patients than physicians can, and to work with other health and social service providers such as social workers, nutritionists and occupational therapists."

Some nurses and doctors remain opposed to the nurse practitioner role because it overlaps with medical practice. "On the nursing end, they don't see it as nursing. And on the medical end, they don't see it as nursing either," says Schreiber.

She's certain, however, that the students in UVic's nurse practitioner program—all registered nurses with 10 to 15 years experience—will impress the public and other health care providers. "They are so smart and competent, I could weep!"

After the first students graduate, Schreiber and MacDonald will help ensure that they're smoothly and successfully included in B.C.'s health care system. They plan to study sites where nurse practitioners are employed and to interview the nurses, their colleagues, and patients.
"We have to make sure they're effectively integrated," says MacDonald, "because we think they have something really significant to contribute to the health of British Columbians."

Schreiber and MacDonald's research has been funded by the Canadian Health Services Research Foundation, the Nursing Research Fund, the B.C. Ministry of Health Services, the Vancouver Island Health Authority, and UVic.

This article was written by Debbie Willis, a student in the departments of English and writing, as a participant in the UVic SPARK program (Students Promoting Awareness of Research Knowledge).