Adeleine VanDwinkerken had a great experience with the registered nurses at the Primary Care Clinic in Charlottetown. Her physician sent her to the clinic after she had mild heart failure due to sodium intake.
“They were really, really informative, really knowledgeable. They really kept me accountable for my sodium intake.”
VanDwinkerken participated in a 12-week program that gave her the tools she needed to monitor her own health. The registered nurses followed up with her and her health greatly improved.
She measures her blood pressure, oxygen saturation and weight every day - skills she learned at the clinic. During the program, she would electronically send the information to the nurses who would call her right away if the numbers weren’t ideal.
“Like, ‘Your weight is up today, what do you think caused that?’ and I would know right away of something that I would have eaten that caused that spike in weight,” she said.
If her weight increased, it meant she ate too much sodium. The nurses’ prompt feedback allowed VanDwinkerken to learn the causes of her sodium spikes.
“My weight is perfect because I’ve learned so much about sodium.”
When she started the program, she knew it meant making some changes to her diet and lifestyle.
“I just didn’t know how to change it effectively. And the program taught me that. And it taught me a lot about healthy eating, taking care of yourself. It taught me a lot of accountability, and only I can make those changes and be in control of them.”
“It was really empowering, extremely empowering, because I walked away with lifetime tools that I can use.”
VanDwinkerken only went in to the clinic a few times, but never felt alone as she worked on her health at home. She felt like she was in very close touch with them.
“The girls at the clinic were beyond my expectations,” she said. “They would never be condescending or anything like that. They were very hands-on helpful.”
She took away encouragement and skills. VanDwinkerken said people should take advantage of nurses’ knowledge of the many resources available. VanDwinkerken is even set up with a dietician because of the help she got from the registered nurses at the clinic.
“The more you participate, the more you get out of it and the stronger you become. Knowledge is power,” she said. “And the knowledge is right there, all you have to do is reach out and tap into it.”
Judy Gormley has been a registered nurse for over 43 years.
She graduated from the PEI School of Nursing in 1974 and worked in Vancouver for a year before returning to the PEI Hospital in the surgical unit. She moved on to the ER. She transitioned to the QEH when it opened in March 1981 - she remembered the month and year – pulling it from the many files in her memories.
She worked in the QEH emergency room until 1990 when she began work at a family practice in Montague.
“It was quite a change going from surgery to family practice,” she said. “You got to experience everything with the patients. You had the happy times, the sad times. You just knew so much about the patients.”
She got so close to patients, they wold stop her in the community.
“I enjoyed that part - the patients stopping you and sharing their difficult times and their happy times with you.”
She was able to develop a real caring which was a change from the emergency room.
“You developed a real closeness with the patients. You really worried about them, thought about them, and cared about them.”
Thursdays were her day off in family practice, so Gormley filled her time as a casual employee doing home care nursing visits.
Seeing people in their homes impacted the way she cared for her patients.
“You would have a different perspective. You’d see the patients in the office and, well, we all have perceptions of things. So, when you’d go into the patient’s home you might see the environment the patient’s living in. Maybe they have a lot of struggles or barriers.”
Sometimes compliance is related to factors out of their control, she realized.
While she loved the adrenaline of the ER, the patients moved on and you never knew what happened to them. In family practice, she developed such a strong bond and trust with patients she was humbled.
When the doctor she worked with decided to join the Montague Health Clinic, Gormley became a primary care nurse on a team of nurses that care for the patients of several doctors.
It meant going back to school in her late 50s.
“It wasn’t easy,” she said. “It was a challenge, but I did it.”
Her new courses allow her to do anti-coagulation therapy, spirometry testing and COPD education.
“We like to focus on educating our patients on their chronic disease, that’s really our goal. We’d like to educate them, and their family, so they can take a role in managing their own health. And help them to be more efficient at managing their health.”
Patients have become more engaged in their health, weather by looking up their symptoms on the internet or asking for time to consider a treatment before they commit. Gormley says it’s a good thing.
Nursing has evolved as well. When she started, nurses weren’t always allowed to counsel the patients. Now Gormley and her team of primary care nurses see patients on their own in a collaborative practice with doctors.
“Nurses are taking on more roles now. We make decisions, at the primary care clinic we do, we make decisions for your patient, because you’re able to because you’re educated in certain areas.”
What keeps Gormley nursing after all these years? It might be the way she consistently looks for the positive aspect.
“I’ll be at it 44 years, I’ve never really had a day where I’d get up and say, ‘I just don’t want to go to work today,’” she said. “I really always liked my job, whether it was surgical nursing, emergency nursing or family practice or primary care nursing. It’s just rewarding to be able to make people feel better.”
In nursing the focus is on the well-being of the whole person and though roles of nursing professionals differ across the country and globally, when nurses use their education to full capability, the health care provided can be exceptional.
Looking through the lens of her own nursing career, Kathleen MacMillan, PhD RN, FAAN (Fellow of the American Academy of Nursing), said there are gaps in care because people are being under utilized.
“We are preparing better educated RNs, but not using that to full potential,” said Ms MacMillan, who is now retired.
She has been in the profession for 50 years working not only in various clinical settings over the years, but also in policy, administration and most recently as Director of Nursing at Dalhousie University’s School of Nursing in Halifax.
Ms MacMillan points to examples where the collaboration of medical professionals is most beneficial to patients. In the UK, RNs are able to prescribe some medications and run minor clinics giving patients the most efficient care.
“The right provider for the right problem at the right time,” is what needs to happen across Canada, the Kilmuir resident said, noting Ontario and British Columbia are two jurisdictions where the system is working.
Nurse Practitioners and RNs are taking on more responsibilities within the PEI system and the more overlap between medicine and nursing the better it is for patient care.
Ms. MacMillan, who has spent the winter months recovering from surgery due to a fractured ankle, said the care received at all levels was second to none because the system is designed for that type of immediate care.
The entire system “should be based on what people need and who is prepared to meet those needs,” Ms. MacMillan said. As more Nurse Practitioners are being recruited to the PEI system, Ms. MacMillan urges the public to engage their services. “If you get offered a NP, try it you’ll like it,” she said.
Credits Charlotte MacAulay Eastern Graphic story original May 2 2018
Belinda Hicken Registered Nurse was recently interviewed by the Eastern Graphic to share her perspective about how RN practice has broadened through her scope of practice to improve patient outcomes.
Belinda Hicken, one of three RNs who work in Primary Care at the Montague Health Centre said her job nowadays is very different from her past role as both a UCI nurse and working in the hospital Emergency Room.
One of the many tasks Belinda Hicken, primary care RN at Montague Health Centre, carries out daily is INR blood tests for patients who attend the warfarin clinic.
Belinda Hicken, RN Montague Health Centre
“In the community setting there is more independence,” Ms. Hicken, who has been at the clinic since 2016, said. “We educate and support patients, so they can have an active role in their own health management.” Some of the services provided are warfarin management, breathing tests, COPD management, smoking cessation support and cervical cancer screening. “We are not addressing just one issue but helping the patient and the family as a whole,” she added. The days are diverse. The job is both challenging and rewarding. Because the scope of practise is expanded RNs like Ms. Hicken make a lot of decisions in patient care as opposed to following orders from a physician. “What is rewarding for me is seeing those patients and families feel the sense of empowerment that comes with the information we give them,” she said. “It has an impact.” Ms. Hicken, who graduated from UPEI in 2007, said being in more than one scope of practise over the years has certainly broadened her perspective on nursing. “We have changed from a reactive to a proactive system and are providing the tools for patients to make their own health care decisions. “We take the time and make a difference for them,” she said.
“We are not addressing just one issue but helping the patient and the family as a whole”.
Credits: Charlotte MacAulay photo and story. Originally story in Eastern Graphic May 2 2018
Bethany MacIsaac RN , "We have had the most impact probably with mental health."
Bethany MacIsaac has been a registered nurse for 20 years and is still keen for a challenge.
Last year, she joined a pilot program to deliver mental health care to Island schools, as a comprehensive school health nurse.
The new student well- being team of five has a mental health clinician, two youth outreach workers, and two RNs. They work in the Westisle family of nine schools.
“It’s been amazing. A big learning curve, but always enjoy a new challenge.”
MacIsaac graduated from the UPEI School of Nursing and it was the start of a career she’d dreamed of since childhood.
“I always knew I wanted to be in a helping profession. I was that kid on the playground that would go rushing towards another kid who was hurt and try to fix them up,” she said.
MacIsaac worked in Calgary for a while, then moved home to work at the Prince County Hospital. She filled a number of roles in the hospital and then went into community health nursing. As a Public Health Nurse, she met and immunized many of the kids in her community.
Now, as a Comprehensive School Health Nurse, Bethany sees the kids she visited at home or immunized in the schools.
It’s hard to estimate the number of students she’s helped – she does presentations to classes, holds groups and has one-on-one meetings.
She helps care for chronic illnesses like Crohn’s Disease and Colitis or Diabetes, as well acute illnesses like Cancer and she discusses Communicable Diseases.
But a lot of the work is around mental health.
She is involved in Anxiety groups where they talk about how to regulate emotions and cope with stress, worry and anxiety. And at the high school she talks to students about sex education, self-image and risky behaviours.
“We have had the most impact probably with mental health. That is our mandate. So, teaching children that it’s normal to have a variety of emotions including anxiety and giving them strategies and tools to help them cope and manage and be effective.”
A lot of the role is connecting and collaborating with families and services in the community.
She sees herself and the other RN as advocates for the students and their families.
“We are the person that they can trust. It’s confidential, they can lean on us to help them understand.”
Anyone can refer someone for help - “every door is the right door” so if a teacher, student, parent or anyone asks for help for themselves or on behalf of someone, the school team looks into it and makes sure they get help.
“We are very, very busy,” she said. “We’ve been welcomed with open arms at the schools.”
When she’s in the junior high schools, she’s often approached by the students in the halls.
“Bethany can you c’mere for a sec?”
What has kept her nursing for so long?
The variety of new challenges, she said.
“Self-care is very important,” she said. Because her work is confidential, she can’t talk it over with anyone, so she finds other ways to cope. MacIsaac stays active with ball in the summer and hockey in the winter and regular workouts.
“Taking a walk and thinking it through. I go to church, so I pray a lot, I pray a lot for my clients. I think that’s very helpful. Exercise and good friends and family is great.”
Credits Alison Jenkins Holland College Journalism student. Edits ARNPEI