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Nurse Practitioners provide valuable clinical leadership at NHH

Nurse Practitioners Karen Truter Rachel_Klompmaker Dmitri Goold

Role of Nurse Practitioners continues to expand at Northumberland Hills Hospital to meet evolving needs of patients and their families

Northumberland Hills Hospital (NHH) is pleased to announce an expansion to the scope of practice provided by Nurse Practitioners (NPs) within Post-Acute Specialty Services (PASS), specifically Inpatient Rehabilitation and Restorative Care.

The first NP was hired at NHH in 2013—a practice more commonly seen at larger urban hospitals, but an innovative recruitment at the time for a community hospital.

With steady and targeted recruitment, NPs have increasingly demonstrated their value to NHH patients, families and day-to-day hospital operations. Today, there are ten NPs on staff at NHH, key professionals within the interdisciplinary teams of the Emergency Department, Mental Health, Medical/Surgical Unit and Post-Acute Specialty Services. Within PASS, NP expertise has grown alongside their numbers, bringing specific skills geared to the evolving needs of the community in the areas of general rehabilitation, stroke care and gerontology.

Since 2013, the NP scope of practice has also been steadily expanded, to include controlled drug prescribing, admission and discharge of hospitalized patients and expansions in the ordering of selected diagnostic imaging tests.

“Patient feedback has been very positive,” said Dr. Wang Xi, Medical Chief for NHH’s PASS program.

Traditionally, when admitted to the hospital, a doctor will be assigned as ‘Most Responsible Practitioner’ (MRP). At NHH, this doctor may be either one’s own family physician, in instances where that physician has privileges at NHH, or—as is the case in more than 60 per cent of NHH inpatient admissions today—a hospitalist, a physician whose job it is to provide care for hospitalized inpatients for the duration of their stay.

In recent years, NPs have provided clinical leadership, in collaboration with the hospitalist team, to support the care of inpatients within Post-Acute Specialty Services (PASS), which includes the Inpatient Rehabilitation Unit and the Restorative Care Unit.

NP education requires a Master’s degree and their ‘scope of practice’ (the set of services they are permitted, as regulated health professionals, to perform) places them in a Registered Nurse Extended Class (RNEC) which allows Nurse Practitioners to also work independently. To this end, NHH is pleased to announce that NPs are now practicing with that expanded scope, formally serving, since February 1, 2021, as MRPs for all patients without local, NHH-affiliated primary care providers who are admitted to the Inpatient Rehabilitation Unit or Restorative Care.

“By augmenting the NP role to now include MRP in the PASS program we have further broadened the scope of NPs within the organization, and enhanced care,” added Dr. Xi.

In their capacity as MRPs, two PASS NPs—Rachel Klompmaker (1A, Inpatient Rehabilitation) and Karen Truter (1B, Restorative Care)—are responsible for overseeing the care of patients in those two units who would have previously been under the care of the Hospitalist. This includes ordering blood and other medical tests within the NP’s scope, and prescribing medications. They provide advice and input on overall health care management and convey information to/from their patients’ primary care provider when they are discharged. For duties outside the scope of the NP (for example, ordering MRI), a physician consult is provided from either the family physician on-call team or the hospitalist program.

In addition, Dmitri Goold is trailblazing a new role at NHH as the Integrated Care Nurse Practitioner (ICNP). This role has been introduced to develop new programs and services that link patients to our community. The ICNP will also be delivering primary care services at the Ontario Health Team of Northumberland’s new Rural Outreach Program in Colborne, creating a direct patient pathway for heart failure patients in that area and acting as a clinical liaison between community partners and the hospital.

“We are very pleased to formally welcome all three of these NPs into this expanded MRP role,” said Susan Walsh, VP, Patient Services, Chief Nurse Executive and Chief Clinical Information Officer. “By investing in Nurse Practitioners in this way, and steadily growing our team within the Post-Acute Specialty Service, we are matching skill set to the unique needs of each program and the patients and families each exists to serve. I have already received significant positive feedback about the care experience the NP as MRP model offers. It is an example of a model that has been developed by the PASS care team, in consultation with the patients and families served, and it is proving to be a win-win-win for all involved.”

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