Obviously, I’m not as familiar with the situation in Fort McPherson and Tl’oondih as the Member is, but I like to think I have spent some time in meeting with the people and talking to the Member. I have had the occasion of meeting with the people from Tl’oondih Healing Society and the community people. I don’t think we could generalize; we need to work on specific situations.
With respect to Tl’oondih, the Beaufort-Delta authority has been working with the community to have that community person do the job she has been doing for a long time. There were extra training models provided. She was following that path, but I understand some other personal situations have happened. I don’t know all the details, but she made the decision to discontinue.
I have made a commitment to the Member that I will work with the Member to find a community solution to that issue. The fact is that the authority is providing that service temporarily; it is to stay temporarily. The authority has assured me they are looking for proposals to work with the community. The community has agreed to make a submission to the authority with a plan on how to fill that position.
As well, I understand that at their meeting the Beaufort-Delta authority and Tl’oondih Healing Society as well as leadership in Fort McPherson have agreed to work together on communications, on other ways to work together on that project. So I just wanted to express my commitment to work with the Member on that project.
On another issue, as I mentioned in my opening comments in regard to this department, we have to find a solution to the apprehension of children and find a way so we don’t have 620 kids in care. We have to find a way to work with the families, work with the communities and work with the children to find workable solutions in our communities. I think it’s important to realize that apprehending children is not the way to find solutions to these problems. We can blame the parent; we can blame the community; we can blame society in general. But at the bottom of it all, a lot of it has to do.... We can blame history in regard to residential schools. We can blame the world for alcohol and drug problems. But at the end of the day, these are problems that are not just unique to us. They’re something we have to find solutions to. A way I see to take hold of that is finding control mechanisms and finding systems in place so we work with community social workers, community bands, people on the Community Justice committees, groups like that, to find ways of looking at this through a different lens than we are today.
I’d just like to ask the Minister: are you open to some sort of working arrangement that, like in the legislation...? I asked questions when the legislation was being brought forward in the Child and Family Services Act, that communities have to be involved.... One of the things we were assured of at the time legislation was being passed was that there are going to be Plan of Care committees. Communities will have a say in regard to the Plan of Care orders that are going to be issued. There will be an opportunity for people who have these orders placed on them to have a system in which they are being heard by their leaders.
I’d like to ask the Minister: exactly what is her department doing to ensure these Plan of Care committees are working? As far as I understand, talking to the only community in the Northwest Territories that has implemented it, they haven’t had any support whatsoever from your office out of Inuvik, in regard to Inuvik health board; there hasn’t been any attempt to work with them to basically give them the tools they need to productively do their job. Again, they are being stymied by a system that basically does not want to download or upload powers and authorities to other community groups where the legislation clearly states that Plan of Care committees is part of the Child and Family Services Act. I’d like to ask the Minister: exactly how are you going to improve that relationship with the communities in regard to the Plan of Care committees in communities, which seem to have done a bad job to date?
I want to advise the Member that I understand his commitment and passion on this issue. Department policies have been developed, and it’s working. The changes to the legislation also reflect the department’s focus on keeping the children in families as much as possible, in extended family and community, wherever possible.
The statistics show that in, say, 1999, we only had about 30 to 40 children who were in families or extended care out of what were, I’m sure, as many as we have now — I mean, out of the total number. This past year we have 630 children in care, and almost 400 of them, NWT-wide, are within either the families — with some sort of agreement with the department as to the actions they have to take — or extended families. I think we need to recognize that we’ve gone a long way in following the principle of keeping our children in their families and extended families as much as possible.
Now, with respect to Plan of Care, these are new changes to the law, and it’s the only one in Canada, so we are sort of developing our work as we go forward. There are no other models to follow.
That new provision is not being implemented by authorities. It’s the work of department headquarters and the shop of the director of Children and Family Services. He has been to communities, providing workshops on how to set up that Plan of Care committee.
I do agree with the Member that we’re not moving on that as fast as possible or as numerously as possible, because we do not have those Plan of Care committees set up in a lot of communities. But it’s one that I would like to see happening, and it’s one that, in talking to department officials, they’re committed to providing as well.
When I attended the NWT Foster Family Association, I encouraged all the foster families to talk to.... A lot of them are from communities, and they’re aboriginal foster parents from communities. I’ve asked them to help me and to work with the leadership, to make sure we have Plan of Care committees set up in as many communities as possible, because it’s an avenue for communities to get involved in the welfare of the children that are in care.
Thank you, Minister Lee. Moving on to Mr. Abernethy.
Thank you, Mr. Bromley. In my comments yesterday, I talked about how the Premier’s statement made reference that there’s going to be a one-time $1.8 million investment for on-the-job Community Health Nurse Development training programs and expansion of the nurse practitioner program.
Now, both sound really good to me, but I was having trouble reconciling the two, from the Premier’s statement, to the fact that the department is eliminating the full-time leave program for nurse practitioner education, as well as reducing the number of seats in the Community Health Nurse Development Program. So the two don’t seem to be consistent with the Premier’s statement.
First, about the nurse practitioner program. I applaud the department’s commitment to the nurse practitioners. Clearly, there’s a significant amount of value to integrating nurse practitioners into the system. But by cutting the NP education leave program — and the fact that Aurora College no longer delivers the nurse practitioner program, due to low enrolment — how does the department intend to live up to its commitment, in light of these reductions, to train and prepare nurse practitioners for the delivery of NP services in the Northwest Territories, with a primary focus on maximizing northern employment?
Thank you, Mr. Abernethy. Minister Lee.
Thank you, Mr. Chairman. I could assure the Member that the reductions being proposed are more than compensated for by new investments we’re making. As the Premier stated in his budget statement, there’s a $1.8 million new initiative, and most of the money is coming from THAF. It’s going to enhance the NP programming we have and the opportunities we can give to the NPs.
Just so I understand, it sounds to me — and I may misunderstand this, so feel free to correct me if I’m wrong — like you’re eliminating the departmental commitment, or the previous departmental investment, and you’re now going to rely on the staff funding — which, I understand, ends in a couple years — to enhance nurse practitioner training, which I suppose is all right as long as the training continues to go.
But I do still wonder how, in fact, this department intends to invest in nurse practitioners and train nurse practitioners, given that the primary delivery agent in the Northwest Territories is history: it doesn’t deliver the nurse practitioner program, due to low enrolments. So how does the department intend to use this THAF funding to enhance the training of nurse practitioners in the Northwest Territories?
Could I ask the deputy minister to provide that information.
Thank you, Minister Lee. Mr. Cummings.
Speaking to the Community Health Nurse Development Program and the nurse practitioner program?
My initial questions are about the nurse practitioner one. When I get some answers there, I have some on the CHN. So my first one is specific to the nurse practitioner program, and it’s related to the fact that you’re investing this $1.8 million THAF fund to train the nurse practitioners, yet you got rid of the nurse practitioner education leave program, and Aurora College doesn’t deliver the nurse practitioner program.
Like I said, I’m happy with your commitment to support nurse practitioners. I’m just not sure how you’re going to be doing this. I’m confused a little bit, and trying to reconcile what appears to be here with the Premier’s statements about investing the $1.8 million in. So just some clarity.
We’re in a position where we have to find a balance between the number of nurse practitioners we can take into the system, and providing a meaningful experience for them so they’ll be able to train themselves up to practise as nurse practitioners and also be able to practise to their full scope once they’re in a position.
We are fortunate to have more-than-adequate funding currently from the federal government, through THAF and also through the Wait Times Reduction Program, to take as many nurse practitioners as our system can accommodate. So that leaves us in the position to be able to reduce funding to the program from the Government of the Northwest Territories, and use this third-party funding to fund as many positions as we would be able to accommodate.
Does that mean that the Nurse Practitioner Education Leave Bursary program still exists, although now it’s funded by THAF? Or does that mean you’re looking for other alternatives to train nurse practitioners?
You’ve mentioned an ability, or willingness, to take as many as you can accommodate. Given our history with Stanton, do you have an idea of how you’re going to start placing the nurse practitioners? And when you say as many numbers as you can accommodate, do you have some idea of how many nurse practitioners that may be?
I understand that that bursary program still exists — it’s just reduced — and it still meets the level of demand or interest that has been shown in the past.
So what are you going to be using this THAF money for? To help develop nurse practitioners?
Mr. Chairman, the information I have is that the money will be used to provide nursing staff in smaller communities, as well as expanding nurse practitioner services in communities.
I’m not sure what that means. I’m not sure how you’re planning to train these individuals. I’d like some information on that.
I can at least partially answer the question. The THAF funding, in particular, is going to be used to allow nurse practitioners in the Territories to engage in the PLAR program, which is the Prior Learning Assessment and Recognition program. What that will do is identify existing community health nurses who are partway toward achieving nurse practitioner status and then tell us what we would have to invest to get them up to full nurse practitioner status so they can continue in existing jobs or move into jobs that can be re-profiled from community health nurse to nurse practitioner jobs.
I think that’s great. I think the PLAR process is an important one and certainly an avenue to help some of our nurses get to the level of NP. It’s good to hear that that’s where some of the money’s going and we’ll be continuing to invest in our current nurses who wish to upgrade to nurse practitioners.
I want to drop back to the Community Health Nurse Development Program. As I indicated before, there was specific reference in the Premier’s statement to enhancing the Community Health Nurse Development Program, but based on the reductions, it looks like you’re cutting the program by four positions.
Given the importance of the community health nurses and our desire to maximize northern employment and give northern nurses an opportunity to transition from a more hospital-based setting into a community-based setting — where our real demands and our real challenges lie — I’m not sure how I can reconcile the Premier’s statement to the departmental cuts in light of maximizing northern employment and supporting the development of nurses for community health roles. If you can help me understand that, that would be great.
We certainly do recognize the value of the Community Health Nurse Development Program, and it is actually a program that I think was initiated in the Northwest Territories, or at least we’ve put significant investment into it.
The difficulty we have with expansion of that program — considering that we do have a lot of candidates who would be prepared to participate in it — is that we have to find a balance between the current experience and expertise we have in our communities to be able to receive new grads and give them the kind of work experience they would need to be successful in the program. So there’s a limited number of people we can take.
The funding is really not a huge issue for us at the current time because of the Wait Times Reduction fund and THAF funds we have available to us. We would be happy to take all comers if we could provide them with valuable learning experience within our community health centres, but we’re limited in terms of the capacity we have to provide teaching opportunities in the health centres.
Thank you, Mr. Cummings. I’d like to move on now to Mr. Hawkins.
Thank you, Mr. Chairman. If I may seek some clarity on the Nurse Practitioner Program that we started: I don’t think I received a full answer in regard to how many we train. It may have been picked up somewhere else through another person’s question. My question specifically — and even if it’s for my own benefit, that is, Mr. Chairman — is: does the Minister know how many nurse practitioners we continue to train, and how many we have positions available for? The reason I’m asking it in that way is.... Are we training more nurse practitioners than we have positions available for?
Thank you, Mr. Hawkins. Minister Lee.
Thank you, Mr. Chairman. As of May 2008, we have 24.5 funded positions and two unfunded positions for nurse practitioners.
Currently, out of those, 11 funded NP positions are filled, plus two unfunded. So out of 26.5 NP positions available, we have 14 positions filled. Seven of them are in Yellowknife, one is in Resolution, one is in Smith, and two are in Fort Providence.
There are two unfunded positions at Stanton, as Members are aware, that we have funded for six months. And there is half PY funding being used for NP relief in Yellowknife.
Mr. Chairman, I could also add that there are 12 NP positions vacant all over the Territories: there are four in Beaufort-Delta, one in Fort Liard, one in Fort Smith, two in Hay River, two in Norman Wells and three in Tlicho. Obviously, we have room here to recruit and retain NPs.
I don’t have information on exactly how many NPs are in practice and in training, because we will take NPs trained not only in the North but anywhere. If they are willing to go to any of these communities, we will welcome them wholeheartedly. And really, they are meant for a primary-care community clinic setting.
Thank you, Minister Lee. Anything further, Mr. Hawkins?
Thank you, Mr. Chairman. I just want to be clear, if the Minister can provide the information to ensure whether we are training more NP nurses than we have available positions.
It’s not a question of whether I support training or not. That should never be put into question, because I do. The principle, really, is value for money. If we don’t have positions for them to fill, it draws the question as to how big of a resource pool of nurse practitioners do we need.
The other thing is these temporary positions we create and fill with newly trained nurse practitioners. Are they limited by their credentials and experience? When they go into that and then they’re placed back into their old jobs, do they lose some of that? Because I’ve been informed, whether it’s a fact or not, they lose some of their operating credentials if they’re not left in a nurse practitioner position.
Mr. Chairman, we have positions for every NP we have in the Territories, and we’ll have more coming, whether we have positions for them. As I said earlier, we may not be able to place them exactly where they want them. It’s like any other northern grads we train. Whether we support lawyers to be trained down south, or doctors, engineers, plumbers.... We, as a government, are committed to hiring these and offering them positions. It’s just that they may not all be able to work at the hospital, or in the exact section they would like to, because you have to respect the right of the operator of the hospital to place them.
I just want to say, Mr. Chairman, there are nine vacant positions in the Territories for NPs.
The question is still outstanding: do they lose their credentials if they’re not in a practitioner position?
Yes.
Further, Mr. Hawkins?
Then what’s the plan in the department for those people who come to the end of their term and there are no existing nurse practitioner positions? Is it a plan to convert existing RN positions into nurse practitioner positions, as primary care, obviously? And if there is, what’s the cost to do a transition from an RN to an NP position?
For a response, Mr. Cummings.
Thank you, Mr. Chair. For the nurse practitioners who do their return-of-service with us, our first priority is to place them into a position that is defined as a nurse practitioner role. We have a whole contingent of people working together to define how that role can be implemented into the authorities. We continue to work on that.
Certainly, it is our intention, when a fully trained nurse practitioner comes to us, to be able to utilize the full scope of practice they have, and we would place them into positions to be able to do that if we could.
We’re really maxed out in Yellowknife in terms of existing nurse practitioner positions, so we would have to work with the authorities to re-profile existing positions if we were going to allow additional nurse practitioners to work to their full scope here. But as the Minister stated previously, we have many opportunities for nurse practitioners to work to their full scope of practice outside of Yellowknife, and they would then not put their certification at risk.
How long has this been going on, in the sense of this training process? Have we lost any who had to return to their home position per se? When I say “Have we lost any,” I mean: how many have we lost who have gone back to being RNs, unable to practice as an NP, and how many have left the North because they couldn’t find an NP position? Furthermore, what protects our investment on that, if we’re training nurses who won’t go to a community, and there are no existing NP positions they will take and they end up leaving?
The nurse practitioner program in the Northwest Territories has been in place for 11 years. We have seen much progress in Yellowknife. The positions I think the Member may be speaking to, at Stanton.... Those NPs were informed of the fact that there were no permanent positions there. I think it’s incumbent on the employer and employee to work together to see if those positions could be re-profiled to make them available.
If not, as I stated earlier, we as a government want to accommodate NPs to be employed in our Territories, but we couldn’t guarantee employment in a specific setting, in a specific office, doing specific things that specific NPs feel they ought to do. That would be enormous and unreasonable limitations on the employer, the hospital authority, or even this government. It’s a commitment we could not meet. But I want to advise the Member that I believe progress has been made at Stanton. They are looking at all possible options to see how these NP positions could be re-profiled, and it’s the responsibility of the new public administrator to do that.
Mr. Chairman, I didn’t get an answer as to whether we have lost any to this program, where we’ve trained them and they didn’t want to go to the communities. How many have we lost because they decided to seek employment outside of the Northwest Territories, because quite obviously their first choice was not a small community so they’ve packed up and left? I’m trying to get a sense of how many we’ve lost and what that’s cost us in government money that’s been invested for that. I just want to make sure our investment is going in the right direction, which is filling nurse practitioner positions that are needed for the North. I’m trying to get a sense of the number of nurse practitioners who would have left the North that we’ve trained, and how much in financial dollars we’ve lost in that investment?
My information is that we do not know of any NPs trained in the North who have left. I got a motion from one of our Members, who knows there might have been one. I will undertake to look into that further and get back to the Member.
Thank you, Minister Lee. Mr. Abernethy.
Thank you, Mr. Chair. Given that we’re on the page, I just have a real quick question. I see that the graduate placement program is being reduced, and I understand that’s due to lack of enrolment or lack of uptake on the program, which makes sense. I mean, if we don’t have enough students, it makes sense not to spend the money — or rather, to reinvest that money in more appropriate areas. But it raises a different question to me.
Given the importance of nurses and the success we’ve had at Aurora College and intake on that nursing program, I’m really curious why the enrolment is dropping off so far. I understand that graduate levels next year.... There will only be seven nurses graduating out of the Aurora College nursing program. Given the importance of northern nurses and their ability to contribute to our system and hopefully help us alleviate some of our challenges, what is the department doing to help increase enrolment at Aurora College, thus increasing the number of nurses in the program?
Which leads to another question: if you do that and it works, and your enrolment goes back up, are you not going to be in trouble on the grad placement front? Are you then not going to have enough money to place the grads as you currently do?
Minister Lee.
The information we have is that almost all the grads who graduated from Aurora College this year — I believe there were about 18 — were offered positions within the NWT, some of them in Stanton; some of them have gone to Fort Smith and other areas — Beaufort-Delta. I think there are three who did not take the option. There are some who have chosen to move away; their families are elsewhere. But that was a huge success. Now I would like ask the deputy minister why there might be reduced enrolment for this year.
Thank you, Minister. Mr. Cummings.
Thank you, Mr. Chair. One of the issues we’re aware of is that many of the nurses who entered the Aurora College program are entering that program with a requirement to upgrade themselves to be able to participate in the nursing program. Also, many of those people are coming from communities outside of Yellowknife. The key fact we’re getting is that they’re having difficulty being away from their home or with child care or family responsibilities. Also, the requirement to upgrade and be able to participate fully in the nursing program is a difficult one for a lot of the people who have enrolled. That’s the reason for declining enrolment.
I commend you guys on the placement of the grads. I think that’s fantastic; I think it’s going a long way to helping us with our nursing problem.
My question was more around…. I understand that the enrolments are dropping, but to me that’s very worrisome. We need to keep those numbers up, and we need be graduating as many northern nurses as we can. So my question to you is: what are the department and the government going to do to continue to get people to enrol in this program and succeed? If the nursing students are facing challenges with child care and finances, what are we going to do to help maximize northern employment and keep our enrolment levels up in a program we know is good and successful? Your grad placement is good. You’ve placed almost every grad that’s come out of that program into this system. All great; all fantastic. I’m a little worried about what’s going to happen now with these enrolment levels dropping.
Then it comes back to the budget reduction. I get it now. It makes sense: if enrolment numbers are low, let’s spend the money somewhere else. But if we can get enrolment back up to where it needs to be, you might find you don’t have the money to actually do grad placement. So two questions: if you do your job well and you get these enrolments up and more graduates, are you going to have the money you need after you do this cut?
The program at Aurora College, even though it’s nursing- and health-related, is really the jurisdiction of the college. I’m sure the Minister responsible will be able to provide additional information in that regard.
I do agree with the Member. My observation has been also that we could do a better job in terms of coordinating the government work in the way we.... The nurses we train at Aurora College should be placed properly and get the support and resources needed to pursue their practice. I think we could do a better job of coordinating that, because I am aware of some of the pressures that Stanton has had in incorporating those nurse grads.
I think we will continue to face the challenge of not only nursing grads but other professionals who want to work in Yellowknife and are not so interested in working outside of Yellowknife. That’s a challenge for us, because that’s where the most needs are. I think Yellowknife is more capable and better positioned to be able to recruit and retain staff from southern jurisdictions — better, anyway, than smaller communities. We need to work toward refining the program, working the program better to enhance the opportunities for these professionals to move into communities.
I have not had a chance to look at that as part of the human resource work at Stanton and system-wide. As we move forward under this fiscal situation where we have to look at systematic changes to better use our human resources, whether they be doctors, nurses or any other health care professionals…. I am really interested in looking at staffing models, service-provision models and recruiting and retaining policies to better meet that. So I don’t have that answer. I understand the Member’s issue, and I look forward to going to the standing committee with that plan.
Just in closing, I think it’s all well and good; I think it’s great. I know that Aurora College is the responsibility of the Department of Education, Culture and Employment. But as the primary employer and the organization that facilitates practicum and on-the-job training opportunities, I do think the department should collaborate and work very closely with Education, Culture and Employment to find solutions to keep these enrolment levels up.
As far as placements go, I understand your challenges. I get it. I know we can’t place everybody in Yellowknife, and I think you have done a great job through the graduate placement program. I hope you continue to do a great job through the placement program. My questions were more specific to what we are going to do when there aren’t nurses coming out of that program, period. Like I said, I encourage you to work closely with the Minister of Education, Culture and Employment to find the solutions to these problems as they come forward. So no question; just a comment.
Thank you, Mr. Abernethy. That was a comment. Next on the list is Mrs. Groenewegen.
Thank you, Mr. Chairman. I move that we report progress.
Thank you, Mrs. Groenewegen. A motion is on the floor to report progress. The motion is in order and is non-debatable.
Motion carried.
