By Daris Klemmer-Lamoureux
Hello to all Alberta Nurse Practitioners! We’re excited to post another blog edition just as summer is arriving. This edition is not a history lesson going back 40+ years, but a focus on Nurse Practitioner practice within the city of Edmonton at a Hospital that is known for rehab excellence. In my mind, Glenrose’ mission was adult rehab, and only very recently did I become aware of its pediatric programming. There are three NPs that work at the Glenrose Rehabilitation Hospital. Corinne Huedepohl works at the Glenrose and Stollery Hospitals in the Tone Management Service for Children, and Shelia Gallagher is based at the Glenrose working with children who have autism. What follows is an interview with the third Pediatric NP at the Glenrose Rehabilitation Hospital, Douglas King.
Douglas King, FNP. Pediatrics Rehabilitation at the Glenrose Rehabilitation Hospital. 9 years of NP Practice.
What prompted you to consider moving into an Advanced Practice role in Nursing?
I was ready to grow in my skill set after being an RN for 15 years. The increased knowledge base, autonomy, and clinical decision making ability all appealed to me. They still do.
How did you make the transition from RN work, through your advanced degree, and into NP practice?
I took my time and completed my Masters degree over 4 years. I continued to work part time as an RN throughout. This gave me the opportunity to start incorporating more advanced assessments, and to practice looking at my patient’s medical issues at a more in-depth level. After I graduated there was a period over a year where I was working as an NP at one facility and as an RN at another facility. There was some role strain [in that situation], as I needed to adapt my level of practice according to where I was working.
How did you land your first job as an NP?
Shortly after completing my NP education, my spouse Jennie (who is an amazing NP by the way) heard about a job posting in Urgent Care. I applied, interviewed, and was the successful applicant. It was a busy urgent care in a growing satellite community of Calgary. It was a steep learning curve. Fortunately I had the benefit of being mentored by some pretty amazing NPs and physicians.
Can you tell us a bit about your practice site?
I work in the Glenrose Hospital Pediatric Inpatient unit. Patients who come here tend to have complex rehabilitation needs that cannot be met as outpatients and stay for several months on our unit. Common conditions include cerebral palsy, Duchenne muscular dystrophy, brain injuries, and significant orthopedic injuries. Many of these patients have had surgeries to correct chronic musculoskeletal issues or to address acute injuries. In addition to physical handicaps, many of our patients have associated complex medical, neurological, developmental, cognitive, psychological, and/or behavioral issues. Our patients and their families may be struggling and have complex care needs. I work closely with a large interdisciplinary team including pediatricians, physiatrists, various other medical specialists, nursing, physical therapists, occupational therapists, psychologists and neuropsychologists, speech language therapists, child life therapists, social work, and dieticians. Most patients continue to be followed at Glenrose outpatient clinics after discharge, as well as receive ongoing outpatient rehabilitation.
What extra training did your current position require over and above your NP program?
My current position requires me to have one foot in managing medical issues, and another managing rehabilitation. My education and prior NP positions generally prepared me for the medical piece however the rehabilitation piece is quite new to me. I have needed extensive reading and mentorship to get me up to speed on this. Almost 1 year in and I am continuing to learn more every day. For example the rehabilitation care of children with cerebral palsy involves in depth knowledge of the neuromuscular and cognitive issues involved.
What do you feel is unique about your practice role?
I’d like to think I work at the center of a truly interdisciplinary team. I have the experience of working closely with and learning from many professional disciplines. Together we have the privilege of being able to assist some special children and their families make meaningful improvements in their lives.
What does your typical day look like?
Most days begin with a report from the nursing team followed by some administration time. Because our children are quite busy with rehabilitation sessions with various disciplines and attending school in between, I tend to round and chart on patients throughout the day. I am constantly in communication with various team disciplines as they come and go, and also via Connect Care. I am responsible for admissions, as well as for completing admission and discharge summaries. Because the care needs of our patients are quite complex, I spend a lot of time reviewing the charts of prospective admissions as well as ensuring the various components of care are in place for upcoming discharges. On a team this big we have a few meetings every week including family conferences. Once a week I attend the Stollery Children’s Hospital with the Physiatrist (rehab physician) to consult on new Glenrose Referrals and prospective future admissions. It keeps me busy.
Describe one significant thing you have learned about the role of the NP within your current practice environment.
One of my roles is to be a consistent medical provider to children and their families on a unit where pediatricians and physiatrists (rehabilitation specialist physicians) frequently rotate through. As both groups have different clinical [foci], learning where the balance lies in my NP role has been a learning curve. There are also numerous other professional disciplines involved in patient care: physical therapists, occupational therapists, psychologists, neuropsychologists, speech and language therapists, social workers, child life specialists, nursing, not to mention the numerous other medical specialists involved. Keeping abreast of what each discipline is doing and continuously synthesizing the parts into a unified picture can be challenging.
How does your role fit within established health care roles in your work area?
My NP role is more of a generalized oversight role. As various pediatricians and physiatrists rotate I am the consistent provider. I also take a more comprehensive perspective of patient and family needs compared to the physicians I work with.
What do you feel is the biggest impact of the role of the NP in your practice setting?
I believe the NP role has brought more comprehensive oversight to the complex care needs of our patients. Having a consistent medical provider throughout a patient’s hospital stay also improves communication with family, as well among the interdisciplinary team.
What is one thing you wished you knew before starting in your current position? Describe the challenges you face in your position.
In my prior NP job I was working relatively independently as a primary care provider. When I started this position I underestimated the demands of the communication piece of my job. Working in the center of an interdisciplinary team with numerous professions and personalities can be challenging. I have learned that constant ongoing and active communication with the interdisciplinary team, patients, and their families is critical. Time management is critical as I try to ensure the communication component is ongoing while attending to my own responsibilities.
What is something that all NPs can learn from the work you are doing in your current environment?
It takes a village. Especially in individuals with disabilities and special needs, medical management is only one spoke in the wheel. In my prior experiences medical providers and other professionals tend to practice in relatively separate silos without significant coordination. The quality of patient care vastly improves when various disciplines are able to actively communicate with each other.
How can the NPAA support NPs working in your practice area?
I’m not sure on this one. The NPAA has done great work in advocating for the NP profession in Alberta.
What is one thing that you think NPs should be pursuing, as a group of professionals working towards the future of healthcare in AB?
Despite the quality care that NPs have demonstrated as primary care providers, there continues to be a lack of primary care jobs across Alberta. Until a perpetual funding model (or billing structure) has been established, I am concerned this trend will continue.
Advice for any NP students who want to work in your field?
I think my advice will be the same for any field: Build a solid base of knowledge and skills as an RN before starting your NP education. I’ve noticed a wide difference of competency and advance practice preparedness between beginning NP students. The difference can often be attributed to their experiences as an RN. Those with that solid base to draw from are generally able to progress to a much higher level of performance by the end of their NP education.
Thank you Doug for that wonderful review of what sounds like a challenging but rewarding complex and unique NP role! Keep this group in mind for any pediatric patients that might need this very specialized care – it truly sounds like the children benefit immensely from your work.
I hope everyone has been able to enjoy some sun and a little more freedom with it, cheers to you all!
Editor’s Note: No Rehabilitation NP jobs posted right now on the AHS website, but one in pediatrics at the Stollery Children’s Hospital – https://careers.albertahealthservices.ca/jobs/nurse-practitioner-160740