More than a dozen nurses across the Northwest Territories and beyond are receiving specialized training to serve isolated health centres without leaving their home communities.
Registered nurses from northern British Columbia and Nunavut are among the 14 who entered Aurora College’s new remote nursing program in January. Others are based in Hay River, Inuvik, Fort Smith, Deline and Fort Good Hope.
Some are working after hours, some are sponsored by the GNWT and their employers, and given the opportunity to take the time out from work to listen in on three-hour teleconference classes on Monday and Thursday mornings. Some are taking their on-site component during their annual leave and some are totally sponsored by their employer, with everything paid for.
They will spend the next year in teleconference classes twice a week leading to a three-week on-site module in Yellowknife, after which they will be able to perform a broader range of services including differential diagnosis, prescribing medications and performing physical evaluations in health centres with as few as two nurses on staff.
The winter semester includes two distance courses twice per week and a three-week on-site component. Upon successful completion, each student spends two weeks in a clinical practicum in a remote health centre. The fall semester is similar, but has a five-week practicum in a remote centre.
The program is free for GNWT employees and about $1,200 per semester for everyone else. Students have to be members of the Registered Nurses Association of the Northwest Territories and Nunavut (RNANT/NU) if they are going to do the clinical component of the course within the NWT, otherwise a valid Canadian registered nurse license is required.
Senior instructor Pat Nymark said there is a trend nationally toward requiring nurses to obtain a special certification before they practice in a remote location. In British Columbia nurses are already required to be certified. Manitoba, Saskatchewan and Ontario are moving in that direction as well. The NWT does not yet require a certification but having the training is recommended and nurses who have it are given priority.
“When they go to work in a geographically isolated community, the nurses are entering practice in primary care,” Nymark said. “So they need expanded practice, to be working in advanced nursing practice, which takes additional skills, doing things that weren’t taught in nursing schools.”
The training is similar to that received by nurse practitioners. Courses include advanced health assessment and differential diagnosis. Registered nurses get a health assessment course during their undergraduate studies, but this course is more intense.
“When a patient comes in, you ask what brings them to the health centre, think about possibilities, take a really detailed history and do a physical assessment,” Nymark said. “They’re able to select a medication to treat the patient, discharge them and do the monitoring, so literally they are doing more than they would in a public health clinic or hospital.”
There are no more one-nurse health centres in the NWT, but there are two-nurse centres, three-, four-, five- and six-nurse centres depending on the size of the community. Nurses there have access to a regional physician, but are responsible for the day-to-day operations, including a mandate to promote health and wellness. That means holding public health clinics for men, women and children, and programming for management and prevention of chronic diseases such as diabetes and chronic obstructive pulmonary disorder (COPD).
“There are no pharmacists in the community either, so they have a very broad scope of practice.”
The program replaces the former six-week on-site advanced practice course and a former year-long mentoring program for nurses destined for remote locations. Now the on-site module has been cut in half and includes skills such as suturing and physical assessments, and all of their exams.
“It’s a big, responsible job and there’s a lot of stress and stuff working there,” Nymark said. “If nurses feel prepared academically with their skills and education, their confidence is better that they can deal with some of the situations that come in. Besides that, the patients are getting very good care from the nurses working there.”