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Nurse practitioner program University of Alberta


									                      Nurse practitioner program: University of Alberta
                                                 F.A. HERBERT, MD, C. LITTLE, RN

This is the 10th anniversary of the             with emergencies when no physician       medical director, a full time nursing
nurse practitioner program in the               is available. This often requires a      director, two nursing instructors and
faculties of medicine and nursing at            departure from the traditional nurs-     two half-time physicians who are
the University of Alberta, and we               ing role, but the knowledge and          responsible for teaching clinical
wish to present the goals of the                practice gained in training provides     skills in pediatrics and adult medi-
program, its content and to provide             that individual with reasonable con-     cine. Approximately 45 physician
information about the activities of             fidence to make decisions indepen-       lecturers and 15 other specialists are
its graduates. We define a nurse                dently. The training also defines the    used in the program. The majority
practitioner as a registered nurse              limits beyond which a nurse practi-      of these individuals have travelled to
who has received 'training in the               tioner should not go. There is a         northern nursing stations or have
medical examination of adults and               special responsibility to the patient    experience in dealing with the prob-
children, and has become familiar               which implies that the commitments       lems of the native populations.
with common diseases and with                   of time and attention expected of a         The clinical facilities include four
methods of coping with medical,                 physician must be accepted by the        Edmonton city hospitals and three
surgical and dental emergencies. As             nurse under these circumstances.         laboratories. Attendance at the
such, nurse practitioners are distin-           Third, to continue to function effec-    emergency dental clinic and the or-
guished from nurse specialists who              tively as nurses at all times by         ganization of the dental program is
receive training in a particular spe-           continuing to supervise the overall      under the auspices of the dental
cialty, such as cardiology or ne-               health care of the community with        faculty. Specialty areas include res-
phrology.                                       emphasis on preventive management        piratory technology and surgery
   Currently there are two such pro-            and the anticipation of health prob-     skills taught in the surgical/medical
grams in Canada, both funded by                 lems.                                    research institute prior to the stu-
medical services, Department of                    To enter the nurse practitioner       dent's attendance in emergency de-
National Health and Welfare, one                program at the University of Alber-      partments.
at Dalhousie University and the                 ta the candidate must be a graduate         The course content can be sum-
other at the University of Alberta,             of a recognized school of nursing        marized under the four general
which exist for special clinical train-         and be currently registered in Cana-     headings of medicine, pediatrics, ob-
ing of nurses who are employed in               da. Experience is absolutely neces-      stetrics and gynecology, and emer-
all parts of northern Canada. Any of
the Canadian provinces are eligible
to participate in the programs to
improve the clinical competence of                   "We define a nurse practitioner as a registered
nurses serving in isolated areas.                     nurse who has received training in the medical
Memorial University has recently                        examination of adults and children, and has
developed a regional program, fun-
ded by the Newfoundland govern-                      become familiar with common diseases and with
ment, which emphasizes primary                         methods of coping with medical, surgical and
medical care and midwifery. The
programs of all three universities                                dental emergencies."
vary in their lengths, orientation,
training methods and emphases.
   The goals of the Alberta program             sary, preferably 1 year of active        gency medicine. Throughout the
can be summarized as: First, to                 nursing, 6 months of which should        course nurses receive lectures about
increase nurses' diagnostic ability to          have been spent in a nursing station     medical problems related to the par-
a level where they can interact with            under conditions in which a nurse        ticular medical area that they are
physicians elsewhere, and either                practitioner would be expected to        studying.
treat patients themselves or refer              operate.                                    In medicine, they are individually
them appropriately. Second, to cope                The course length is 20 weeks,        taught by one of the half-time physi-
                                                which includes some evenings,            cians the rudiments of taking a
Dr. Herbert is a professor of internal          nights and many weekends. Two            medical history and performing a
medicine at the University of Alberta and       courses of approximately 10 stu-         physical examination. They learn
medical director of the nurse practitioner      dents each are given each year.          simple laboratory techniques that
program. Ms. Little is the program's nursing    Seven weeks are devoted to lectures,     are relevant to clinical practice. Em-
director.                                       and these are interspersed with 12       phasis is placed on tests which they
   This text was originally presented in part   weeks of clinical experience and 1
at the 73rd Conference of the Canadian                                                   will be able to carry out themselves.
Public Health Association in 1982 at            week of examinations.                    Students are encouraged to send
Yellowknife, NWT.                                  The faculty consists of a part time   other specimens to reference labora-
                                                                    CAN MED ASSOC J, VOL. 128, JUNE 1, 1983                 1311
tories to increase diagnostic infor- techniques of airway intubation,              We are as yet unable to make an
mation and, in the case of infectious emergency immobilization of               objective appraisal of the perfor-
diseases, to provide information that fractures and cardiopulmonary             mances of the Alberta nurse practi-
can be used for regional epidemiolo- resuscitation are learned in hospital.     tioner graduates in the field, al-
gic purposes.                           During this rotation, students are      though many anecdotal evaluations
   Following this training in infor- taught methods of evaluating emer-         from individual physicians or other
mation gathering, the students are gencies so that this information can         nurses who have contact with them
introduced to differential diagnosis. be relayed by telephone to a physi-       are very encouraging. The majority
This is intended to promote effective cian. The techniques of stabilization     of graduates said they have been
communication between the nurse of the patient for evacuation are               able to use the knowledge and skills
and the physician, who may be con- emphasized.                                  gained in their training. Seventeen
sulted by telephone. Finally, stu-         The dental faculty provides 18       percent of the graduates have pro-
dents are taught methods of medical hours of instruction in assessing dis-      ceeded on to obtain diplomas or
management which depend on the eases of the mouth and teeth, em-                university degrees.
gathered information.                   phasizing dental emergencies. Stu-         The majority of failed students
   The training format in pediatrics dents receive an additional 20 hours       either lacked adequate undergradu-
is similar in many respects to that of of training in the dental clinic, dur-   ate clinical nursing training or clini-
medicine, except for some differ- ing which time they learn techniques          cal experience in nursing stations.
ences in assessing children and man- of local anesthesia and emergency          Because of the intensive training
aging common pediatric problems extractions. The latter are under the           and close patient and professional
peculiar to this age group.             supervision of the dentist.             contact required, the occasional in-
   During training in obstetrics and       The nurse practitioner program       clusion of weak or difficult students
gynecology, common gynecological has enrolled a total of 173 students           has resulted in a heavy burden on
problems are discussed. Students are since its inception. One hundred and       everyone. This problem has occurred
taught preventive measures in ob- fifty-eight graduated, leaving fif-           infrequently since the formation of
stetrical practice, such as the impor- teen, or approximately 9%, who ei-       an effective selection committee
tance of regular prenatal care and ther dropped out or failed. A ques-          with firm admission standards.
the identification of high-risk factors tionnaire, intended to gain informa-       Students work very hard during
in pregnancy. They spend approxi- tion about the activities of the latter       their 20 weeks of training. The pace
mately 3 weeks in clinics, wards and group, was sent out in 1982 on the         of activities has had an undesirable
in case rooms, where they help in 10th anniversary of the program and           effect on some of the nursing in-
deliveries. Usually, they carry out a 70% of the graduates responded.           structors, particularly in obstetrics,
small number of deliveries them- From these the following informa-              resulting in a high staff turnover
                                                                                during the 10 years.
                                                                                   Nevertheless, we are reluctant to
                                                                                remove any of the course compo-
                                                                                nents, which have been carefully
                                                                                reviewed over several years. There-
        "It seems likely that there will continue to be a                       fore, we have recommended that
        place for the nurse practitioner in Canada, and                         our course be lengthened to 32
         possibly elsewhere, to provide medical care to                         weeks.
                                                                                   As for the future, it seems likely
           people living in sparcely populated areas."                          that there will continue to be a place
                                                                                for the nurse practitioner in Canada,
                                                                                and possibly elsewhere, to provide
                                                                                medical care to people living in
                                                                                sparcely populated areas. We be-
selves under the close supervision of tion was compiled.                        lieve that it would be worthwhile to
the obstetrician and the nursing in-       Ninety percent of the 111 gradu-     hold a conference of educators expe-
structor. This training is not intend- ates returned to Canadian govern-        rienced in this field, the specific
ed to qualify the student as a mid- ment medical service posts in accor-        goals of which could be the defini-
wife, since it is not anticipated that dance with their agreement to serve      tion of the role of the nurse practi-
deliveries will be carried out routine- for 40 weeks after completing the       tioner, examination of various cur-
ly in nursing stations.                 course while on full salary. Ninety-    ricula, the lengths of various pro-
   The emergency rotation is under- seven percent of these nurse practi-        grams and the development of stan-
taken after preliminary instruction tioners returned as staff or charge         dards of practice. It is vital that the
in the medical/surgical research in- nurses to nursing stations. Fifty-         medical profession, as represented
stitute where students learn the indi- eight percent served in these posts      by experienced physicians, partici-
cations for and treatment techniques for between 1 and 2 years and 15%          pate in such an assembly because of
of shock, wound care, suturing su- for over 3 years. Currently, 78% of          their fundamental role in the educa-
perficial wounds and hemostasis of these 111 nurse practitioners are            tion, direction and supervision of
deep wounds, cut downs, and limited employed in active nursing some-            nurse practitioner training pro-
treatment of thoracic injuries. The where.                                      grams..
 1312            CAN MED ASSOC J, VOL. 128, JUNE 1, 1983

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