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Are Nurse Practitioners the Answer to our Long-term Care Crisis?

Nurse practitioners support staff by building better work environments, ensuring staff safety and boosting morale.

With more than 8,000 COVID-19 deaths recorded so far, thousands of Ontarians now count themselves among the unfortunate group who’ve lost family and friends to the deadly disease. 

But there’s another group that’s also had to deal with loss. With many deaths occurring in long-term care (LTC) homes, staff members have had to deal with the stress and anxiety that comes with the loss of life of residents under their care. 

LTC homes in Ontario have long been the subject of scrutiny for a variety of reasons, including understaffing, poor working conditions and a general lack of timely access to care for residents. As COVID-19 swept through the LTC system, all these issues were exacerbated, with at least 6,977 staff becoming infected and a total of 3,760 residents dying, according to Government of Ontario data. 

There are many issues that contributed to these numbers. In some cases, physicians were asked to work virtual, while thousands of staff quit or had to take time off after contracting COVID-19. Those left to fend off the virus faced a steep learning curve while adapting to new infection prevention procedures and new practices in care.

Now, Dr. Kathy McGilton, a senior scientist at UHN’s KITE Research Institute, believes she has identified at least one solution that could help avoid a similar scenario in the future. Nurse practitioners (NPs), she says, represent an “untapped resource” that could be the answer for Ontario’s LTC woes.

“Long-term care home administrators who work with nurse practitioners can’t imagine how difficult it must have been in some sites without them,” said McGilton, who is also a registered nurse and professor at the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing.

Nurse practitioners are advanced nurses, starting as registered nurses and earning master’s degrees. They can assess, diagnose, prescribe and treat residents and work collaboratively with staff, managers and physicians to provide care. These health professionals are well-suited to the LTC environment thanks to their expanded knowledge and leadership abilities, which enable them to take on a variety of roles and responsibilities. 

McGilton’s research, which was recently highlighted in Ontario’s LTC COVID-19 Commission Report, found that nurse practitioners, when deployed, played key roles in LTC homes during the pandemic, helping contain the spread, supporting staff and families, and establishing links between fragmented care systems. They helped institute proper pandemic control measures, acted as medical directors when doctors stopped in-person visits and provided emotional support to anxious and overworked staff. 

Despite the critical role they could play in LTC homes, only about one in 10 homes employ a nurse practitioner. Another estimated 65 nurse practitioners work in what are called nurse-led outreach teams (NLOTs), which hospitals employ to provide acute care and reduce emergency room visits. 

Nurse practitioners are quickly becoming key members of care teams in the LTC homes in which they work. They support staff by building better work environments, ensuring staff safety and boosting morale. 

“There’s a lot of evidence that if you have a healthy workforce, you’re going to have good quality outcomes for the residents, so we have to start building LTC home environments where staff feel supported,” said McGilton. 

In order to increase the number of nurse practitioners working in LTC, more funding and educational programs are needed and barriers limiting their work need to be removed. The Nurse Practitioners’ Association of Ontario recommends one NP per 100 residents, but McGilton, says some oversee as many as 400 residents.

McGilton is confident there would have been far fewer deaths in Ontario LTC homes during the COVID-19 pandemic if they had more NPs.

“The lessons from the tragedy of COVID-19 in LTC homes should not be overlooked. They are a painful reminder of the work needed to ensure this never happens again,” said McGilton.

Read more about McGilton’s research here.