Saskatchewan’s registered nurses (RNs) are utilizing their diverse skill sets to help address some of the unique health care challenges faced by people in rural and remote areas of the province.
Nearly one in three Saskatchewan residents live in rural and remote areas and face certain barriers to receiving quality health care. Some communities have access to a physician only a few days a month, experience difficulties in obtaining key health care services such as diagnostic testing or access to specialists, and even face issues around transportation to urban centres to receive medical care.
Registered nurses are a critical part of a skilled team of frontline professionals on the ground that is working hard to combat this problem.
“Registered nurses work together with physicians and the rest of health care professionals to make sure that people in rural and remote areas don’t get lost,” said Tracy Zambory, RN, president of the Saskatchewan Union of Nurses (SUN). “They understand the population they serve by developing great relationships with them. When they sit down with their patient, they view them holistically. They often have a deeper understanding about their patient’s social determinants of health: history of mental health or addiction, home situation, food security, and access to health care outside of appointments. This is because registered nurses have become a part of these small rural communities in which they live and work.”
She added that RNs have identified that this is the best way to tackle health care in rural and remote areas in Saskatchewan. “If we can keep people in their home communities to get the health care treatments that they need, it alleviates the pressure that major health care centres are under and creates immense cost savings that can be reinvested back into the health care system.”
There are two designations of RNs making a particularly strong impact on the health care system in rural and remote Saskatchewan: RN Nurse Practitioners (RN[NP]s) and RNs with Additional Authorized Practice (RN[AAP]s). RN(NP)s, who have achieved the most advanced level of education among RNs, can independently assess, diagnose and manage common medical conditions. RN(AAPs) can independently assess, diagnose and treat a more limited set of common medical conditions.
Zambory calls these groups the “eyes and the ears for the physicians when the physicians can’t be there.”
One of these sets of eyes and ears is Dre Erwin, an RN(AAP) stationed in the remote community of Pinehouse, 800 kilometres north of Regina. As a RN(AAP), he follows a strict set of standardized guidelines called Clinical Decision Tools.
“For example, if someone comes in with a throat infection and a swab shows they have a streptococcal infection, I’m able to treat them with amoxicillin,” he said. “We can order certain tests and evaluate those tests. We can suture and do emergency deliveries as well as perform pap smears and prenatal assessments. Additional authorized practice really gives us a very extensive list of things that we can and cannot do. It allows patients to get more timely care when they don’t have direct access to a physician. It means they can get treatment faster and get better faster.”
He said that one of the most important parts of his job is having a very strong, trusting relationship with the physicians in La Ronge.
“Because they aren’t physically here, they’re relying on our ability to assess patients and clients that walk through our doors,” he said. “As an RN, I need to be confident in my assessment skills and knowledge and the decisions I am responsible for making as a first responder.”
SUN hopes in the near future to make the RN(AAP) the standard for graduating RNs.
“Embedding this into the education program really aligns with our vision of how to improve rural and remote access to care,” she said.
Working in the province’s rural and remote areas comes with plenty of challenges for RNs, but it’s worth it for many of them like Erwin.
“It’s incredibly rewarding work. I get to not just work in the community, but actually live in the community,” he said. “The people become your friends and family and this really helps me to get to know them on an individual level. I’m able to develop a rapport and greater level of trust with the community and this helps me get a better understanding of what their specific needs are.”