Throughout her pregnancy, Anne-Sophie Degroot was accompanied by a specialist nurse practitioner (IPS), rather than by an obstetrician-gynecologist. “I felt well taken care of,” says the young woman. She was always careful in the way she examined me and she was the one who did the smears (Editor’s note: a gynecological examination). I found it very good. »
In Quebec, there are approximately 1,600 NPs and they are divided into five classes or specialties: neonatology, primary care, mental health, adult care and pediatric care. For three years, law 6 authorizes these professionals to diagnose illnesses, prescribe medications and establish treatment plans independently, according to their specialty.
“This allows for smoother access to the health system, because it is no longer necessary to systematically consult a doctor. It’s a big gain,” said Luc Mathieu, president of the Order of Nurses of Quebec (OIIQ).
What is their training?
IPS are nurses who, after at least two years of clinical experience, have completed a master’s degree in nursing sciences and a DESS in one of the specialties. This gives them advanced knowledge in pharmacology, disease management and public health, to name only a tiny part of their knowledge. They are thus trained to perform certain medical procedures previously reserved for doctors. For example, they can do a biopsy, an intubation or even install an IUD.
They are present in hospitals, CLSCs, family medicine groups (GMF), private clinics, youth centers and even CHSLDs. On the front line, they can manage many common health problems, a stable chronic illness, or even monitor pregnancy. “These new skills allow us to provide all care without necessarily needing to send patients to other professionals,” says Christine Laliberté, president of the Association of Specialized Nurse Practitioners of Quebec (AIPSQ).
The IPS also takes care of the link with other health professionals, such as the endocrinologist for a diabetic patient or the hemato-oncologist for people with cancer. An aspect that Anne-Sophie Degroot particularly appreciated once she became a mother. “It takes a big mental load off,” she says. After giving birth, I could get a consultation within 24 to 48 hours, and if it wasn’t available, I was referred to a pediatrician. » Today, the IPS has become her point of contact as well as that of her husband and her son for all their health problems.
The new powers of IPS
Since August 2023, IPS have been authorized to support victims of an occupational injury and to sign forms from the Commission for Standards, Equity, Health and Safety at Work (CNESST), acts previously reserved for doctors. Last December, they also obtained the power to assess the eligibility of people to medical assistance in dying (MAiD) as well as continuous palliative sedation, and to administer them.
Where to consult an IPS?
Of the specialized clinics have been gradually opening their doors since December 2022. Ten establishments are currently in operation in the regions of Montreal, Laval, Lanaudière and Saguenay–Lac-Saint-Jean. Seven more will open during 2024, with a target of 23 clinics by 2028. However, some are experiencing difficulties, including a lack of staff stability.
The Ministry of Health and Social Services (MSSS) remains convinced of the relevance of these clinics. He believes that it is normal that certain processes, such as the recruitment of IPS and other professionals, require a little more time and certain adjustments. “Work continues with establishments to improve this model which has proven itself, both in Quebec and in other Canadian provinces,” says Marie-Pierre Blier, media relations officer at the MSSS.
These specialized clinics are inspired by successful initiatives, including SABSA solidarity cooperative and the Archimède pilot project, implemented at the Saint-Vallier clinic in Quebec. Despite challenges, a report on the Archimedes project highlights patient satisfaction with the speed of consultation. “The possibility of having a place without an appointment within 48 hours, sometimes the same day, avoids (…) emergency room consultations, in addition to reducing absences from work for medical reasons,” according to this report.
Not “super-nurses”
At the “GAMF clinic” (Access window to a family doctor) located in the Côte-des-Neiges–Notre-Dame-de-Grâce district and created in 2021, there is no doctor , but 10 front-line NPs, 1 mental health NP, 12 clinical nurses, 3 auxiliaries and 1 physiotherapist. “The great autonomy of decision-making and interdisciplinary work make it possible to quickly guide patients in the right direction,” says Diana Dima, head of the IPS workforce department at the CIUSSS du Centre-Ouest-de-l’Île-de- Montreal.
In total, 58 IPS work within this CIUSSS, and more are needed, according to the two department heads, while more than 53,000 orphan patients are on a waiting list. “At first, patients were a little reluctant to be followed by NPs, but today we see their great confidence and satisfaction,” emphasizes Dalila Benhaberou Brun, also head of department. The good reputation of the GAMF clinic even attracts recruits. »
According to Diana Dima and Dalila Benhaberou Brun, NPs should not be perceived as “super-nurses”, a term that many of them do not like at all. They prefer that their profession be considered different from that of nursing, and not “superior”, as this expression might suggest. “They have a unique field of practice that complements that of other nurses and health workers,” they specify.
New powers requested
Currently, hospital admission and discharge are still the responsibility of doctors. “When they are not available, it creates unnecessary delays,” notes Christine Laliberté, president of the AIPSQ. The Association would like IPS to obtain this right to facilitate turnover. It is also expected that front-line NPs will be able to register patients with the Régie de l’assurance santé du Québec (RAMQ).
Furthermore, the diagnosis of the state of mental health can only be established by mental health NPs. Discussions are underway to decide whether or not this power could be given to all IPS classes. The Ministry of Health is “considering reviewing certain regulatory elements for IPS”, as part of the project to expand professional practices.
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