Remote nursing a unique challenge for Canada's nurses.
CANADA presents an almost unique challenge for providing nursing services. The second largest country in the world, with a population of just around 33 million, it has a population density of only 3.3 people per square kilometre. Given most Canadians live in southern urban centres close to the US border, expansive swaths of land are virtually unsettled and isolated from modern amenities. Nursing patients in these area is tough and expensive.
Half of Canada has less than 50 nurses per 10,000 people, and those 10,000 could be spread over huge areas. The most remote areas of Labrador, northern Quebec, the arctic regions of the Northwest Territories (NWT), the Yukon and Nunavut, have nurses working out of community health centres in fly-in locations, usually with less than 1,000 people.
In the Beaufort Delta, NWT, residents from the hundreds of small communities scattered across the vast landscape rely on community nurses for health care, as physicians only visit every five weeks for just a few days. If a patient's ailment becomes too dire for treatment locally he or she must be flown, usually by helicopter, to the Inuvik Regional Hospital, the only hospital serving the area.
This kind of extreme isolation is one of the biggest remote nursing challenges. Even at the Inuvik hospital with regular hospital facilities such as a 24-hour emergency room, on-call physicians and operating room (OR), much-needed specialists such as cardiologists and psychiatrists only visit once a month. And patients must fly 1,219 miles to Edmonton, Alberta for an MRI (magnetic resonance imaging). There are logistical problems, too. "You're fighting the limitations related to the infrastructure. For example, if the water truck is [delayed]...we have no water, we...shut down," said Ms Rachel Munday (NOTE: CORRECT SPELLING), a British-trained nurse and midwife who has been a community health nurse in Canada for 20 years and now serves the 650-person town of Aklavik, (NOTE: CORRECT SPELLING) 34 miles west of Inuvik. Amenities such as water can be slow arriving in isolated areas--Labrador now has piped water--but the Canadian arctic is the last frontier for these innovations. Across the country, community nurses in remote areas must be creative in the face of out-of-stock provisions and drugs. "If we have a patient with a special need, we have to be inventive about how we supply that need," Ms Munday said. Nurses must cope with the unpredictability of the job.
"Working as a community health nurse in a remote setting is ... 'whatever comes through the door next'--which suits ... nurses who have worked in emergency or the intensive care unit (ICU)," explained Ms Munday, who began her career at the Basingstoke District Hospital in the UK before heading to Labrador for her first Canadian placement. "It encompasses anything and everything. We work Monday to Friday, 9:00 to 5:00, and we're on-call the rest of the time. During the day we're seeing regular, minor episodic illnesses--earaches, urine infections--and ... a large public health component, prenatal and maternal health, chronic diseases such as hypertension and diabetes, well baby clinics, also well men and women clinics."
Ms Munday stated since nurses are the primary health care providers for a community, they collaborate with environmental health officers, federal, provincial, territorial and municipal agencies, and provide animal care such as rabies vaccinations.
Since most nurses coming to the north are not members of local aboriginal communities that can predominate here, a cultural learning curve exists. Ms Munday indicated successful community nurses learn the local language, participate in community events and embrace the outdoors.
For nurses studying at Aurora College in Yellowknife, the NWT capital, northern culture is part and parcel with learning nursing techniques, said Dr Pertice Moffitt, senior nursing instructor at Aurora College and president of the Canadian Association for Rural and Remote Nursing (CARRN).(NOTE: COLLEGE, NAME, ASSOCIATION ALL CORRECT) "We touch on the cultural aspect in many different ways. We have elders...do sharing circles, a drum-making workshop, and in our women's health class, a Dene [an aboriginal group] woman recently spoke about traditional birthing methods, menstruation, and puberty rights. We go out for land experiences as well ... an elder ... told us traditional stories, taught us how to dry meat, fillet fish, and even pull in his nets."
There are only two colleges in the NWT and Nunavut region which offer nursing programmes, hardly producing enough local graduates to supply the region, according to Steven Leck, executive director of the Registered Nurses Association of the NWT and Nunavut (RNANT/NU). (NOTE: NAME, TITLE, ORGINISATION ALL CORRECT) "In Nunavut, there's a need to fill 200 jobs plus, but the college graduates only two to five nurses annually. In the NWT there are about 15 or 20 graduates each year but up to 600 jobs," Mr Leck said.
This year there are 19 Aurora College nursing graduates, Dr Moffitt said. Clearly these few graduates -30% are aboriginal 'First Nations'--cannot fill the many jobs available, and nurses must come from elsewhere. Scott Robertson, chief nursing officer, of the NWT department of health and social services in Yellowknife, (NOTE: NAME, TITLE & DEPT. CORRECT) said most nurses working in the north are either young and single or empty nesters with a new-found freedom approaching retirement. The problem is few nurses want to stay in remote, 500-person towns for the rest of their lives, and so continuity of care is almost impossible to maintain.
"It's a bit of an accepted reality that nurses...leave. But we've seen good success when nurses...come back," he said. "Often they can job share, doing six weeks in the remote town and six weeks out. Even that level of continuity is important. The majority of our nurses, although not permanent, are at least regular."
However, the reality is nurses moving to northern Canada do find making long term commitments tough because of the stark lifestyle changes that are required.
"Working in remote areas is unique, attractive; you get to do things you'd never get to do otherwise. But it's not as conducive to the rest of your life," explained Robertson. "If you have a family, it's hard to bring your family to a town that's only accessible by air, where it's winter 10 months of the year, and where food is 10 times the usual cost or more. You don't have all the amenities available to you. And if you aren't by yourself, if you have a spouse, there may not be work for them in that community." That said, there are certainly professional benefits. "If you're a community nurse, you're seeing people through the entire continuum, from birth to death. It's a very extended scope of employment compared to working in a big city," Robertson said.