by Connie Tabbert
Editor
BEACHBURG — Nursing staff at the Whitewater Bromley Community Health Centre agree that while they enjoy working in a team, the wage disparity between nurses needs to change.
This was just one of the topics discussed in a 45-minute meeting with Renfrew-Nipissing-Pembroke MPP John Yakabuski during a visit he made to the centre last Friday, the final day of Nurses’ Week.
Nurse practitioners Jacqueline Kirkland and Heather Robertson, along with nurses Marg Cliché and Brenda Aubrey, as well as Marion Graves, Director of Health Services, met with the MPP to talk about the qualities and benefits of the WBCHC; traditional private practice verses community health centre practice and wage disparity.
Ms. Cliché said this centre offers same day access to care which means fewer emergency room visits, which equals lower health care costs. She said one of the important things for this centre is the team approach, which means there isn’t duplication in services.
Programs and services are designed to meet the community’s needs based on a survey done through the centre, she said.
“Our team approach is client-centred,” Ms. Cliché said, which means, “Team members consult with each other and develop an approach best suited to each client.”
As an example, Ms. Cliché presented an imaginary client – a 54-year-old obese man, who smokes, has cardiovascular problems and is a diabetic. Instead of going to see his physician first, the man would see a nurse who could then suggest other programs at the centre that may help him, such as foot care (due to being diabetic), smoking cessation, weight management, lab services, as well as his physician.
“He has the ability to access all those programs through our centre,” Ms. Cliché said.
She added that he can access these programs on his own or be referred.
“The client is a partner in their care,” she stated.
Ms. Cliché noted that many people throughout Whitewater and Bromley townships are not aware of all the programs this centre provides to them, such as the memory clinic, weight management, foot care, social work, urgent care, ongoing clinical care, smoking cessation and more.
“We are the best kept secret,” Ms. Cliché said, adding, “And the care extends beyond the walls of the CHC. We bring expertise and value to our clients.”
There are also community partners, such as diabetes educators from Pembroke Regional Hospital, chiropody, cardiac rehab, community paramedics, telemedicine and telederm, among others, she added.
Ms. Aubrey said the CHC model works well because it’s everyone involved in the patient’s care, not just one or two people. The administrative staff are familiar with most of the patients and patients feel comfortable talking with them. Then it’s the opportunity to either talk directly with someone involved in one of the program’s offered, a nurse or even their physician.
The traditional private practice method is to go and see your physician and then be directed to where a person needs to go, and that’s only if the physician is aware of what’s available, she said.
A nurse at a CHC works to the scope of their full abilities while nurses in private practice or even a hospital may only use some of their abilities, Ms. Aubrey said.
She said even though she enjoys working at the CHC because she can work to her full potential as a nurse, many leave heath centres due to the wage difference, which can be as high as $25,000.
“CHCs are cost-effective because the staff don’t receive the same pay as those who work in hospitals,” she said.
Ms. Kirkland agreed that many nurse practitioners and nurses leave community health centres to work in hospitals because they are better compensated.
MPP Yakabuski said it sounds like the CHC model helps the patient manage their disease and keeps them healthy, as opposed to going to a physician when the person realizes they are ill.
He further said it sounds like nurses at a CHC work to their full scope and find it rewarding work. However, it’s disheartening that CHC nursing staff don’t receive the same wage as those who work in a hospital centre, he said.
Ms. Aubrey noted the nurses, and nurse practitioners, fill a gap. She noted patients can remain in their homes for palliative care.
Ms. Kirkland said there are no fees for the services provided. Along with palliative care, she said there are home visits and phone calls to patients.
“We provide the most supreme model of care that is sustainable,” she said.
Ms. Kirkland believes there is “hardly a patient who falls through a crack. There is so much communication between the staff that it’s difficult for that to happen.”
She said there is a staff meeting at the WBCHC each day at 1 p.m., and patients files are reviewed, those who have been in recently and those who should be coming in.
However, she said one item of care that is missing is dental care.
“We have been lobbying the provincial government to provide dental coverage,” Ms. Kirkland said.
She knows there are repeated visits to urgent care by some people because they cannot get to a dentist due to the costs.
“Did you know dental disease leads to cardiovascular disease,” she said. “Even cleanings would help.”
Ms. Robertson said there is a wonderful team at the WBCHC and they are able to work to the full scope of their abilities. A nurse practitioner is a registered nurse who has returned to school for more education, she explained.
A nurse practitioner sees a variety of patients, from babies to teens to adults to palliative care, she said. Compared to a physician, a nurse practitioner can spend more time with each patient as well, she said. There are stories of people who have to make repeated visits to their family physician because only one medical discussion can occur for each visit, she added.
While nurse practitioners can prescribe most medicines and diagnostic imaging, there are some they cannot order, such as narcotics. This means that if a physician is not available when the patient is seen by the nurse practitioner, there could be a delay in treatment, she said.
“We want to encourage the ministry to open the barriers that are causing a delay in treatment,” Ms. Robertson said.
She noted that many nurse practitioners see just as many patients as physicians do, but are paid significantly less for almost the same responsibilities. And, she believes because of this wage disparity, there is a 35 percent decrease in the number of nurses who are going through to be a nurse practitioner.
Ms. Graves noted that many nurses and nurse practitioners at the centre travel a long way to work at the Beachburg office.
“They have to be committed to work here and to travel as far as they do,” she said.
There is also a huge catchment area for the WBCHC, Ms. Graves said. It covers all of Whitewater Region and the former Bromley township. However, there are people from further afield who are patients as well, she added.
MPP Yakabuski was provided with a discussion paper entitled Patients First – A proposal to strengthen patient-centred health care in Ontario, released on Dec. 17, 2015 by the Minister of Health and Long Term Care. This paper describes the need to improve access to primary care, reduce structural and integration issues that create health inequities, and better link population health and public health services to improve patient care, particularly of vulnerable populations.
He also received a fact sheet on the CHC Model of Care and a history of the Lanark Renfrew Health and Community Services. This is an umbrella organization providing health and social services in Lanark and neighbouring counties. The LRHCS is composed of Lanark Community Programs, North Lanark Community Health Centre and the Whitewater Bromley Community Health Care.
Following the meeting with the nurses, MPP Yakabuski had a private meeting with John Jordan, the executive director of the Lanark Renfrew Health and Community Services.
“The meeting went well,” Ms. Graves said. “John (the MPP) was very interested in what we had to say and understood the points we made.”
Prior to his meeting, MPP Yakabuski had a complete tour of the centre and was “impressed with the amount of services we provide,” she said.
While she’s not sure what the MPP will do with the information he received, Ms. Graves said, “He’s better able to understand our services.”
