Minister Lee.
Yesterday I think I touched on this when I stated, and I want to state again, that the nurse practitioner program is very important to us. As Ms. Bisaro mentioned yesterday, hopefully it’s more than a six-month situation at Stanton. I want to make it clear that what we know happened at Stanton should not be construed as a reflection or any sort of…. It’s hard to explain. It’s a situation that is really internal to the operation of the hospital in that those two positions were put there to be incorporated into the operation. That’s the understanding of all the authorities.
All the authorities are very proactive, and they’re open to hiring as many NPs as possible. We have lots of NPs in the Yellowknife Health Authority; we have an NP placed in Fort McPherson; we have one trained and placed in Fort Resolution. This is the way to go for the future, and you’ll see there is a lot more money being put toward training our nurse practitioners and placing them.
The difficulty a few NP positions at Stanton ran into was with the fact that the hospital setting was not as conducive to accommodating positions in a way that they are able to do in more primary clinic settings, such as the Yellowknife Health or in other regional centres. If we are to continue, and we are going to continue to rely on NP positions to enhance our services and to lessen the burden on the medical practitioners, it’s incumbent on our operators to use these NPs and to incorporate their work into the practice. It’s not supposed to mean extra services, but it’s a service that would replace some of the nursing positions or take on some of the work that is not typically done by nurses.
I just want to advise the Members here that the situation that happened at Stanton is an anomaly. It should not in any way reflect negatively on the commitment this government has, and that I have as Minister, to continue to pursue and support the NP program.
Through this program is the Government of the Northwest Territories paying for the training for RNs to become NPs at a rate at which we cannot fill empty positions? Because they do not exist. If that’s the case, how many do we have in training school? How many have we trained to date? How many openings do we have to provide for these people who have taken this training the territorial government has paid for?
The system as a whole is open to accepting all of the NPs we train. I could get the information on exactly how many NPs were trained. The situation is that they are meant to be in a primary care setting and we may not be able to have those NPs exactly where they want them and in exactly the jobs they want. I think we have to respect the ability of the health authorities to make decisions about where to place those NPs. Those are the things we need to iron out. It needs partnership and collaboration with all of the parties involved, with all the health care professionals that work with the NPs. But so far we have been able to place all the NPs we train.
Moving on, we’re on page 6-18. Mr. Krutko.
Thank you, Mr. Chair. In regard to the area of program delivery and services, I think as a government we have tried different things in the past. Some things have worked out, and other things have been problems by way of recruitment, implementation. I’ll use some examples. The midwifery legislation that was passed — and we were able to activate that program — seemed to be originating in one community, which is Fort Smith. But to enhance that program to other regions and other communities…. I know my colleague from Deh Cho made reference that it was something that community would like to also consider. I think that’s something communities elsewhere throughout the Territories could probably access. The legislation is there, but it’s not really being implemented to its fullest.
The same thing applies in regard to the mental health positions. We’ve implemented legislation to bring people under the public workforce whereas, before, a lot of these positions, such as alcohol and drug programs, were run out of the communities that needed them — government employees. Yet we made it so stringent that it’s very ineffective to find people for those positions. The qualifications are so high and so stringent we are having problems attracting and recruiting and, more importantly, training our own people to take on those positions.
I think also in regard to programs we have in this government, we seem to be quick on the draw, passing legislation, establishing these particular legislative authorities to do so, but it’s the implementation side I think we’re lacking in. I think we have to find a way to have the flexibility in the legislation, to realize we’re unique and we have some unique challenges. Through the ways that individuals, either at the regional level or at the territorial level, interpret that legislation, they have to have some flexibility or basic moral understanding of the people, the communities and the regions they’re serving, and work with those NGOs and community organizations to deliver a lot of these programs and services.
I talked about the Tl’oondih program. They had 200 and something people go through that program. It was unique because it was the first time in Canada, I think, they had a program strictly designed to deal with family issues, to deal with the children, the husbands, the wives, the grandparents and whatnot. It was unique in the sense that a lot of the problems we see in our communities and in our families you can track back decades to residential schools, going back to first contact. I think it’s important that we work with our community and aboriginal organizations to develop programs and services that meet their needs, meet their goals of trying to achieve some of these successes and not put road blocks in their place because we had so much legislative red tape in there.
I’m wondering if there is anything this government is doing by way of reviewing its policies, procedures and legislation, seeing if there are ways we can, not overhaul the system but review the procedures and policies and see if we can make it not as restrictive as it is right now.
Minister Lee.
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.
