Better health through group care

Nurse practitioners play a vital role in Ontario’s health system. The Registered Nurses’ Association of Ontario (RNAO) has been advocating for greater recognition of the role, and recently celebrated regulatory changes that allow NPs to discharge hospital in-patients within their scope of practice. NPs have long been involved in the process of preparing hospital in-patients for discharge, but until July 1, 2012, didn’t have the authority to give the order to go home. These enhanced powers, including the powers to admit and treat patients, translate into more timely, direct and efficient care for patients. To find out more about nurse practitioners, and the advocacy work of RNAO to enhance the role, visit and read Creating Vibrant Communities, a comprehensive report that lists priorities for improving access to patient care agnd nursing services. In the meantime, enjoy this compelling story about the work of a nurse practitioner outside hospital walls.   

For most people, visiting a nurse practitioner for help with one – or a number of – chronic conditions doesn’t evoke images of sitting in a room with 16 others who are also looking for help from the same NP. Ninety-nine-year-old Elizabeth* found herself in that very situation when she became a patient at the Smiths Falls Better Health Project (BHP), a clinic operated by Rideau Community Health Services.

During her first group visit, Elizabeth announced she had no interest in attending. But by the third visit, the elderly woman apologized, saying group care was the best health care she had ever received. It was a moment that made NP Susan Shea realize she was “in the right place, doing the right thing.”

The BHP, under the clinical leadership of Shea, began in May 2011, shortly after news broke that 5,000 people in Smiths Falls and surrounding towns did not have access to a primary care provider. Orphaned patients were forced to visit the hospital with a cough or to renew medications, overwhelming the ER.

The NP-led clinic aimed to relieve some of the pressure on hospitals. Priority was given to people who had complex chronic conditions and those who were regularly hospitalized or who routinely visited the ER. It was staffed by two part-time physicians, an RN, an RPN, two part-time pharmacists, a medical secretary, a social worker and Shea. Over a period of one year, the BHP team made a difference in 600 people’s lives.

Shea says the unique patient intake method attracted her to the project. Grouping people together allows them to share stories and experiences, she says. It also means practitioners can teach self-management skills to more than one person at a time.

The clinic was set up to allow for three group visits over a six-week period. When the six weeks were up, patients were transferred to a permanent health-care provider, and a new group would begin the cycle. Clients also had one-on-one time with the NP or physician. “Groups can be very powerful in influencing health change,” says Shea. That’s because patients often share stories about similar conditions, or an approach to self care they had success with, such as a drug they used to quit smoking.

Shea’s eyes tear up when she thinks of the woman who became emotional during her first group visit, recalling her plight to find a provider. “It was very rewarding to see that people who were so desperate for care, and so ill, were pleased and grateful they were finally getting the care that they needed,” she says.

When the BHP wrapped up this past June, Shea and the rest of the team applied the lessons they had learned to other group visits. A diabetes group was launched by Rideau Community Health Services, and a chronic disease management clinic is in the works. She says group visits are less traditional, but highly effective, adding “we have to look at new ways of providing high-quality care.”

Shea now works at the Children’s Hospital of Eastern Ontario. She meets with teens and their families individually and in groups for counseling, treatment and education, bringing her experience with group care to a younger demographic. Like NPs who practice in a number of different sectors of the health system, her emphasis is on caring for patients holistically. “It’s the most rewarding career I could ever hope for.”