Improving the Function of Nursing Stations in Canada
Improving the Function of Nursing Stations in Canadian First Nations Reserves
Introduction
Health Canada supports First Nations people through various health programs based on the 1979 Indian Health Policy1. This policy was created in acknowledgment of the circumstance of Indian communities that have put them at a disadvantage compared to most Canadians in terms of health2. The First Nations and Inuit Health Branch (FNIHB) is the entity within Health Canada established to improve health outcomes and achieve an increasing level of health in First Nations communities. They provide and deliver the various health care services to reserves including nursing stations.
The first point of healthcare contact for First Nations peoples living on reserves is at the nursing stations. Their roles usually revolve around assessing patient conditions, determining urgency and completing necessary actions. However, according to a report by the Office of the Auditor General of Canada (OAG), there are many problems associated with these nursing stations. Some of these problems are (1) limited standardization of the mechanisms for nurses to function beyond their scope (2) incomplete nurse attainment of necessary training to work beyond their scopes. This briefing note aims to further discuss these problems in the context of Canada as a whole, and propose appropriate solutions.
Health Canada agrees with the claim made by the OAG that nurses at these stations may work outside their designated scope of practice to provide health services to First Nations people. However, they do not have a mechanism that coordinates the performing of these activities beyond the scope of practice1. Activities may include prescribing certain drugs to performing X ray imaging. This is an issue for two reasons. Firstly, it is at odds with public perception that nurses are operating within their scope of practice. Regardless of ethnicity, all people want their nurses to operate within their dedicated workflow to ensure high-quality care. Secondly, it represents the greater problem of gaps in treatment availability in First Nations reserves. Essentially, when a nurse is operating beyond their scope, they are doing so out of necessity as there is no one else to provide the required care.
Nurses may not always have the necessary training to work beyond the scopes of their practice. Particularly in emergency situations, it is imperative that nurses have the knowledge to react appropriately. Health Canada is aware of this and has required certain mandatory training to be completed. However, as noted by the OAG, only 2% of nurses at the nursing stations in Ontario and Manitoba have fully completed this requirement.
Solution
These problems are interdependent and represent various themes. Health Canada seems to have the appropriate plans and regulations for improved nursing station quality, but they are not executed appropriately, nor is their progress measured. The theme of reserve remoteness plays a role in each of the problems. Low retention and high turnover of nurses, a result of reserve remoteness from urban settings, influences the ability of governing bodies to standardize the function and training for situations beyond the scope of a nurse3. Solutions to these problems should aim to improve nursing station quality by preventing nurses from unnecessarily functioning beyond their scope and ensuring that they have the necessary training when doing so.
The proposed solution requires a series of workflow redesigns with the integration of information technology. Current nursing station workflows need to be analyzed to determine the gaps in the services they provide which is creating the need for nurses to work beyond the scope of their practice. It should then be determined if these gaps can be filled by an external entity. It is suggested that telemedicine be introduced to lift the responsibilities of filling these gaps from the nurses when possible, specifically for the prescribing and dispensing of drugs.
Just as the government of Ontario changed the Drug Pharmacies Regulation Act in 2011, other provinces in Canada should allow for the utilization of automated remote drug dispensing technology4. Dispensing machines can be placed in these reserves, allowing First Nations people to collect medications they were prescribed without a pharmacist on site. When paired with telemedicine’s ability to remotely provide prescriptions, this dynamic represents an effective solution in maintaining nurses scope of practice.
At this point, the workflow for nurses who work beyond their scope of practice should be developed. This framework is to be standardized and made clear to all employees to prevent error in protocol and treatment delays. To facilitate appropriate training of nurses who are required to work beyond their scope, it is suggested that a nurse administration portal be implemented to provide online training to nurses in these remote areas. This will also double as a solution to mitigate the effects of high turnover rate, allowing for quicker recruitment of nurses at the stations as they do not have to wait to have the necessary extra training.
To assess the compliance rate of these solutions and their abilities to provide essential services to first nations people, computerized checkpoints should be implemented in all phases of the solution. For example, the FNIHB can remotely determine nurse completion of necessary training through the nurse administration portal.
Conclusion
The problems of nurses operating beyond their scope and incomplete training can be remedied through analysis of nurse workflow, appropriately filling in gaps with telemedicine, and implementing a nurse administrative portal for training. It should be noted that this solution has some limitations. It assumes that all First Nation reserve nursing stations have similar health needs and workflows. In addition, telemedicine and nurse administrative portals require the existence of an added dimension of computer literacy. However, it’s superiority over other solutions should not be overlooked. Fixing the problems of nursing stations is not a matter of simply increasing funding as it may further exaggerate the problem. The proposed solutions improve core workflow of nurses, allowing for feasible and effective healthcare at nursing stations in Canadian First Nation reserves.
References
1. Report 4-Access to Health Services for Remote First Nations Communities. Office of the Auditor General of Canada, 2015. (Accessed February 26, 2017, at http://www.oag-bvg.gc.ca/internet/English/parl_oag_201504_04_e_40350.html#hd3b.)
2. Indian Health Policy 1979. Health Canada, 2014. (Accessed February 26, 2017, at http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/poli_1979-eng.php.)
3. Access to Health Care on Aboriginal Reserves. The Public Policy & Governance Review, 2016. (Accessed February 27, 2017, at https://ppgreview.ca/2016/04/06/access-to-health-care-on-aboriginal-reserves-2/.)
4. Making It Easier For Ontarians To Fill Prescriptions: McGuinty Government Supports Innovative Model For Drug Dispensing. Ministry of Health and Long-Term Care, 2011. (Accessed Februay 27, 2017, at https://news.ontario.ca/mohltc/en/2011/03/making-it-easier-for-ontarians-to-fill-prescriptions.html.)