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Day in the Life of Alexis First Nation’s NP Linda Wonitoway-Raw

What prompted you to consider moving into an Advanced Practice role in Nursing?  

To be honest my dissatisfaction with the health care system prompted me to move into an Advanced Practice nursing role. I felt like I was not making a difference to my patients in my job. I previously worked in the hospital, and I felt like I was always applying a band-aid to problems and not able to work with patients to get to the root of their health problems.  

How did you decide to practice where and how you do now? 

As my passion is primary health care, it was easy for me to decide to become a NP in Family All Ages. Early in my career as an NP, I worked for many years in a Family Medical Clinic and the Westview Women’s Health Clinic in Spruce Grove. I was also very fortunate to be asked to open a family clinic at Alexis First Nations one day a week when I graduated from my NP program. This position came about through some funding that the Nation had to use to learn what a Primary Care Network is. I have been at Alexis First Nations for 11 years and three years ago, let go of my NP positions in Spruce Grove and now work Monday-Thursday at Alexis First Nations.  

Can you tell us a bit about your clinical environment (e.g., where you work, with whom you collaborate, etc). 

My clinic is located within the Alexis Health Center on the Alexis Nakota Sioux Nations about 70kms northwest of Edmonton. I have a MOA who helps with patient recalls, make appointments and is my referral coordinator. Within our health centre there are RNs supported by Health Canada who provide public health, maternal health and homecare services. I also work closely with the NNADAP (National Native Alcohol and Drug Abuse Program) intake workers to provide services for our addition patients. I have an OAT program on site. I collaborate closely with the mental health team which consists of a variety of mental health providers from various different agencies. I also collaborate with Children Family Service social workers when needed and work closely with various band staff members regarding the psychosocial needs of my patients. 

Describe one significant learning about the role of the NP within your current practice environment. 

One significant learning about working as an NP in a First Nations community is to remember to meet your patient where they are at. I need to be able to provide accurate health information in simple language and terms my patients can relate to. I spend a lot of time teaching my patients, whether this applies to chronic illness, family planning, addictions, growth and development, injury prevention, mental health, etc…. Every moment spent with my patients is an opportunity to learn more about what’s going on in their lives and what might be contributing to ongoing health concerns.  

How does your role fit within established health care roles in your work area?  

On the nation, I have a medical clinic Monday-Thursday. I function as the primary care provider for many of my patients. For some, I am the only regular health care provider they have ever had. For others, I am there to augment care with their own family doctor or provide episodic care.  

What is one thing you wished you knew before starting in your current position? Describe the challenges you face in your position. 

I’m pretty fortunate to have worked in many different areas of nursing before becoming an NP. I worked in public health, homecare, acute care and emergency care, and all in a rural setting. So, I actually consider myself well prepared for Indigenous health because I know, all too well, the gaps that exist between areas of health care. I am very familiar with the gaps that exist between Alberta Health Services and Indigenous Services Canada because I encountered this all this time when I worked in the hospital as an RN. There are huge challenges in my job because access to services is so complicated and my patients often have to jump through hoops to get basic care on the nation. But I can honestly say, after working 25 years in health care, I get the sense that things are changing for the better. 

What is something that all NPs can learn from the work you are doing in your current environment? 

I think it is important for NPs to understand that while working in my setting, I am addressing all aspects of primary care. Clinically, my job description is that of a medical practitioner to my fullest scope, however, my role also requires me to be the strongest patient advocate I have ever needed to be. I work collaboratively with other health care providers and service providers in the community but also outside the community. I continue to network and create strong ties to other agencies, health care services, and levels of government that provide services or funding to First Nations members off reserve in hopes of bridging the gaps in accessing services and continuity of care.  

How could NPs working in your practice area be best supported? 

A strong interdisciplinary team that understands how NIHB (Non-Insured Health Benefits) funded patients access care and services differently from other non-Indigenous patients would help. As well, there is still a lot of work that needs to be done to allow ALL health care providers and services be transportable onto a First Nations community. Unfortunately, we continue to operate in “silos” that do not communicate effectively and this affects patient access of care and follow up services.  

What do you feel is unique about your practice role? 

My practice role is unique because of the relationship I have with the community. I have  been practicing in this community for 11 years. This community is very small and tight knit. It can be a very precarious position I am in sometimes, but this also adds to the validity of my role and the trust I have with community members.  

What does your typical day look like? 

A typical day for me is never the same. I have pre-booked patients in my schedule and allow a lot of time for walk-in clients. Often, my patients do not show up on time, so I have to be flexible. I work with my MOA (who is my right hand) to get patients to appointments as many of my patients do not have any transportation. I field many phone calls from patients, family members and other community service agency workers, such as social workers and other specialists from hospitals or pharmacy. I do have some scheduled time weekly for case conferencing of my addiction and mental health patients with our NNADAP team. Furthermore, in our community, there are visiting mental health providers, an AHS RPN and a community psychiatrist, and I will coordinate my schedule to work with them on the days they are in the community. I do many procedures such as mole removals and IUD insertions and try to schedule these as needed. However, I will often insert an IUD on same day appointments as this might be the only opportunity for my patient to have it done. So, I guess the take-away from this question is, my day is never the same and I have to be very flexible.  

What do you feel is the biggest impact of the role of the NP in your practice setting? 

I feel the biggest impact my role of NP in a First Nations community is access to reliable, consistent primary care. Many of my patients would not access any care if I was not here…end of story..