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Telegram (May 31): Psychiatric nursing would improve N.L. health care, says Alberta RPN

Why are there no psychiatric nurses working in Newfoundland and Labrador’s health-care system?

That’s a question Samantha Smith, a registered psychiatric nurse (RPN) in Edmonton, has been asking for years. Smith, who is originally from Marystown, is passionate about her job with Alberta Health Services. And with family still in Newfoundland, she’s very familiar with challenges people in this province face when trying to access mental health care.

When Smith contacted the provincial government about bringing RPNs to Newfoundland and Labrador, the province said it will continue to take a generalist approach to nursing. A letter from Health Minister John Haggie said when registered nurses (RNs) in the province work in areas such as mental health, they are given the necessary supplemental training.
 
But Smith doesn’t think the current system is addressing what she considers a mental health crisis.
 
“All these people are suffering back home, and there’s no help, and you have this whole specialty area that could help with this population, and they’re just refusing to implement it,” Smith said.
 
After the All-Party Committee on Mental Health and Addictions released its report in March, which included 54 recommendations on how to improve care, Smith reached out to The Telegram to talk about her profession. She said she believes introducing psychiatric nursing to the health-care system here would take care of several of the recommendations.
 
She said psychiatric nursing has a heavy focus on proactive treatment that helps avert crisis situations. In Alberta, RPNs work alongside registered nurses (RNs) in a hospital’s psychiatric unit — “they include everybody in the disciplinary team,” she said.
 
The difference between an RN and an RPN, Smith said, is that the RPN has completed an educational program based entirely on mental health, where an RN’s program will spend much less time on the subject.
 
“So you’re understanding the illnesses more, you’re understanding behaviours more, and you’re able to quickly pick up on behaviours, whereas another nurse wouldn’t pick up on that behaviour, and you’re able to prevent a crisis from happening before it even starts,” she said.
 
 
“I really believe registered nurses can take care of the population, but one or two courses on mental health does not make you a specialized person in that area, and for mental health, somebody who’s going through crisis and somebody who’s going through a decline and is possibly suicidal, would you rather have somebody specialized in that area to take care of them, or would you rather a general approach? If that’s the case, why do we have psychiatrists? Because MDs should be able to just take care of them, right?” she said.
 
She said more specialized care is needed in Newfoundland and Labrador, and not just in the Waterford Hospital. Patients coming out of surgery, for example, may need psychiatric support.
 
But as of now, she said, the only way she’d be able to work in the province is if she worked at a federally managed facility such as Her Majesty’s Penitentiary. While RPNs registered in Western Canada can technically work anywhere in the country, the province’s approach to nursing simply doesn’t include that job.
 
No immediate plans in N.L. A spokesperson for the Department of Health and Community Services told The Telegram the same thing Haggie told Smith.
 
“The model of care for mental health nurses in Newfoundland and Labrador is founded on a generalist scope of practice for nurses. As such, the mental health and addiction nursing workforce in Newfoundland and Labrador has the required skills to provide care holistically. The Department has no immediate plans to change the model of care to include psychiatric nursing.”’
 
The spokesperson also pointed out that the provincial government has accepted all 54 of the all-party committee’s recommendations, and said an action plan on implementing them will be released in the coming weeks.
 
Newfoundland and Labrador is not alone in its approach. Only four provinces — British Columbia, Alberta, Saskatchewan and Manitoba — regulate psychiatric nursing. The only education programs offered in Canada are at western universities such as MacEwan University in Edmonton, where Smith studied to become an RPN after working as a licensed practical nurse for eight years.
 
‘It would make sense’
 
And Smith is not alone in advocating for the profession; she has plenty of company with other RPNs and regulatory bodies out west, and support from Newfoundland and Labrador’s health critic, Steve Kent.
 
Kent said during his brief time as health minister, he inquired about bringing in RPNs, and found the biggest challenge was the lack of education on this coast.  
 
“But given the mental health needs that exist in our health care system, I believe it would make sense to pursue including registered psychiatric nurses as part of the solution,” he said, adding he would like to see a bigger emphasis on nurse practitioners, too.
 
He said there is a huge shortage of psychologists and psychiatrists working in the province, with multiple psychology positions that the health authorities can’t seem to fill.
 
“We have access problems because there are not enough services in the community. There are not enough mental health professionals providing services to those that need them. Given the shortage of psychiatric and psychology services and the long wait for services, it seems to make sense that registered psychiatric nurses could help alleviate some of that challenge,” he said.
 
“I’m not suggesting that they would take the place of psychologists or psychiatrists, but my point is if there were more people with specialized expertise, they can definitely add value and take some pressure off the system.”
 
Kent said it’s an issue he’s happy to raise with the Department of Health, but didn’t specify any plans for advocacy.
 
“As we monitor government’s implementation of the 54 recommendations, I believe both opposition parties will be working hard to hold government’s feet to the fire, This is just one example of something that can be done to make the system better, and we really want to focus on solutions,” he said.
 
Meanwhile, Smith has no plans to give up. Along with advocating for RPNs in her home province, she continues to speak with governments from this province to Ontario.
 

 

Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.