“This is not a competition” -- Nurse practitioners are filling a gap in health system

Nurse practitioners Amanda Tinning (left) and Lesley MacGregor say they are part of the solution to the complex challenges in health care.
Nurse practitioners Amanda Tinning (left) and Lesley MacGregor say they are part of the solution to the complex challenges in health care.

(The following feature story was written prior to COVID-19. We have added an updated section to reflect how their work has evolved during the pandemic.)

Lesley MacGregor and Amanda Tinning are nurse practitioners on a mission: to help fill a gap in patient care in Nova Scotia for individuals living with advanced chronic disease.  

The duo provides home-based care to patients living with chronic and end-stage diseases. 

MacGregor is the nurse practitioner for the INSPIRED COPD outreach team, while Tinning works as the clinical lead for the Transitional Heart Failure Clinic

Their patients are frail, often elderly and nearing the end of life, yet rarely do they need to visit the hospital or emergency department. 

Their advanced symptoms, including shortness of breath and fatigue, render them housebound. 

MacGregor and Tinning’s services may range from primary care, to palliative symptom management and they also provide home-based end-of-life care to their patients who wish to die at home. 

The nurse practitioners can also facilitate a transfer to Halifax Hospice.  

“We treat people from their recliner chairs,” said Tinning. “Our work involves symptom management and considers the needs of the whole person and their family.”  

Whether they are prescribing or administering medication, drawing blood work or organizing home care services and supports, these nurse practitioners provide comprehensive patient care.  

They establish goals of care for their patients and address the symptoms of advanced chronic disease with a central focus on maintaining an individual’s function and ultimately their quality of life.  

But they don’t do it alone.  

Working as a team in the community allows for collaboration with care partners such as the VON or continuing care, among others. 

They understand there is still confusion about the nurse practitioner role, which gained legislative authority in Nova Scotia in 2002.  

Essentially, nurse practitioners build on the scope of registered nurses, but with graduate level education nurse practitioners gain the ability to diagnose and prescribe. 

MacGregor and Tinning are aware of the concern by some that nurse practitioners are trying to replace doctors. 

“This is not a competition,” said MacGregor. “We work adjacent to and part of a health care team; that is true collaboration. When there is some ambiguity around our scope of practice, we see it quickly disappear after one patient visit or in working together with physicians.” 

Dr. Stephanie Connidis, medical director for Hospice Halifax and the INSPIRED COPD outreach program, sees the value nurse practitioners bring to her team and to the community. 

“Nurse practitioners such as Lesley and Amanda are an essential component in the INSPIRED and Transitional Heart Failure programs as they truly integrate care between subspecialty programs and community based organizations, such as the EHS Special Patient Program and Hospice Halifax,” she said.

MacGregor and Tinning continue to educate their colleagues and the public about their work and would like to see a greater investment of community-based care programs in the province, as their work reduces emergency department use and hospital admissions for people with end-stage chronic disease.   

“We believe nurse practitioners are one solution to the complex health care challenges faced in Nova Scotia,” said MacGregor and Tinning. “Our services are both patient-centred and system focused.”  

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June 2020: We asked MacGregor and Tinning to describe their roles now that face-to-face contact with patients isn’t possible. 

MacGregor’s scope of patient care has broadened to meet the needs of INSPIRED patients as many with COPD have not been able to access primary care. However providing care virtually is not new to the program.

“As the INSPIRED Nurse Practitioner in Central Zone, I have been providing remote care and support to the Cape Breton INSPIRED program patients via telephone for two years and over the past five months via MEDEO Telemedicine. The use of technology - specifically video - has been extremely helpful in planning and managing patient care. Our patients report feeling less afraid and isolated knowing we are there for them during times of crisis. This type of innovation and shift is what makes our team unique.”

Tinning says the Transitional Heart Failure Clinic has also been ahead of the curve when it comes to technology.

“Since the establishment of our clinic in February 2018, regular telemedicine contact has been the primary means of support for patients and families living with advanced chronic disease,” said Tinning. 

“At the onset of the COVID-19 pandemic, we have placed home visits on hold and virtual care has now become an essential option for patient follow-up, assessment and care planning for some, but not all patients. We have clients who do not have access to this technology or would require increased support from family to operate virtual care reliably. In this case, regular and sometimes daily telemedicine contact and collaboration with home support services have remained the mainstay of THFC care to support patients and their families at home.” 

When asked about the drawbacks of virtual care, MacGregor and Tinning had similar responses: 

“The drawback is of course not being physically present in the patients home - which often allows for a deeper understanding of the level of functioning for that individual,” said MacGregor.  

Tinning agrees, “The amount of information gathered at an in-person home visit is unparalleled.”

The continued dedication of community partners has remained during COVID-19 to allow the safest care possible for patients. 

“The COVID19  pandemic is truly an ‘all hands on deck’ scenario, and the INSPIRED team together with multiple other programs have risen to the challenge,” said MacGregor.  

In addition to their roles with INSPIRED and the Heart Failure Clinic, both nurse practitioners have also become clinicians for the Medical Support Service for Long-Term Care (MED LTC) which was established to support LTC facilities during the COVID-19 pandemic.