Nurse Practitioners, unique health-care workers

This week is National Nurse Practitioners’ Week, a time to honour these unique health-care specialists whose job scope differs significantly from that of other types of nurses.

NPs provide comprehensive patient care that includes the ability to diagnose and manage acute and chronic illnesses across a person’s lifespan.

Nurse practitioners possess clinical skills associated with both nursing and medicine. They may work in a variety of settings, such as acute care, primary care, urgent and primary care centers, long-term care facilities, rural/remote care, and end of life/palliative care. Most of Providence Health Care’s NPs work in areas like cardiac surgery, inherited bleeding disorders clinics, the Emergency Department, and the ambulatory cardiac clinic.

Like general practitioners and hospitalists (doctors who work exclusively inside a hospital), NPs do not require physicians to supervise their practice.

Apart from providing thorough care through a medical-nursing lens, NPs also participate in research, health promotion, education, leadership, collaboration and health advocacy.

At Providence Health Care and in most of BC’s health authorities, nurse practitioners are medical staff.

In BC, the field has grown at a rapid pace, helping to ease the challenge of physician shortages. In 2022 there were 890 registered NPs in BC, while today, there are over 1000 NPs across the province, according to the Canadian Institute for Health Information (CIHI). The 11-per-cent growth rate of NPs between 2021-22 is the fastest among health professionals in Canada, CIHI also reports.

Nurse practitioners hold a master’s and /or a doctoral degree and have additional education in clinical care, leadership, change management, health policy and program development.

To learn more about the role, read the personal story of one of Providence’s NPs, Alina Steinberg in this story published several years ago.

As a Nurse Practitioner at St. Paul’s Hospital, Alina Steinberg’s job description is different from other nursing disciplines.

With the autonomy to diagnose, treat and manage acute and chronic physical and mental illnesses, she does everything that a general practitioner physician does, but through a nursing lens.

“Nurse Practitioners (NPs) have the same scope of practice as physicians do in primary care,” says Steinberg. “It is a very distinct position.”  

Being a strong patient advocate

What appealed to her about the NP role was the clinical autonomy of the position. “I knew I could achieve more for patients if I could diagnose, refer, prescribe and medically manage them independently,” she says. “As an NP I’m able to be an even stronger advocate for every one of my patients.”

She adds: “I don’t know the evolving scope of all nursing roles, but what I know for sure is no other nursing role carries as much clinical autonomy, with the ability to practice medicine, as the NP role.”

In Providence and other BC health authorities, Nurse Practitioners are members of medical staff within their organization and have their own department.

“Our licence gives us the independence to provide for our patients as the ‘Most Responsible Provider’ with the ability to admit and discharge patients,” explains Steinberg.

Nursing not her original career choice

A career in nursing wasn’t Steinberg’s first choice after high school. She initially worked in computer science and finance.

But the lure of nursing was strong, motivated by a commitment to helping patients. “Finance was not for me,” she recalls. “I was really meant to work in the medical field.”

She studied at the University of British Columbia to become a Registered Nurse. Then, learning about the broader range of work and responsibilities of the NP, she obtained an NP masters degree from UBC. She also obtained post-NP graduate certification in acute care for adults through the University of Toronto.

Thriving on job autonomy

Now in her fifth year of working with the Internal Medicine program at St. Paul’s, Steinberg cares for a wide variety of patients and thrives on the independence the role gives her to make a significant impact on their health and outcomes.

“I learn something new in this role every day, whether it’s from reviewing clinical research or collaborating with the great team of Internal Medicine specialists on our service,” she says.

Treating patients with complex medical needs

Steinberg understands the important role she plays in continuity of care for patients and the complex conditions that many are struggling with.

“The majority of the patients we care for have mental health comorbidities and are substance users,” she adds, acknowledging that this added complexity requires ongoing communication with a team of health care professionals to help people make a smooth transition back to their community.

Her work and increasingly complex patient population keeps Steinberg stimulated and continually learning new things.

“Because Internal Medicine is the largest service in the hospital, I have a wide range of patient ages and conditions, from those presenting with new acute conditions to others with acute problems on top of ongoing chronic conditions.”

While her work as an NP is fulfilling in itself, she still appreciates when a patient or a family takes a minute to say thanks.

One particularly touching recent gesture involved a patient making a substantial donation to the St. Paul’s Foundation on her behalf. That led to the purchase of a new ice machine for the Medicine program (some surgical and other types of patients require ice therapy).

“Working in a hospital in this role is amazing,” she says. “I love my job.”

By Ann Gibbon, Providence Health Care