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Spotlight on Airdrie Urgent Care Center Nurse Practitioners

Describe your setting: location, volumes, demographics etc.

Airdrie Urgent Care Centre (AUCC) is a 13 bed Urgent Care and is the only acute care accessible for citizens of Airdrie and surrounding areas including north Calgary, as there is no hospital.

On a usual day, the AUCC will see anywhere from 90-110 patients and sometimes up to 140 patients per day.  Patients are all-ages ranging from newborn to the elderly.  Patient presentations range from life-threatening illness to acute on chronic flares of chronic disease in addition to simple non-urgent health care needs.

AUCC has patients from diverse cultures, socioeconomic status with varying levels of health literacy. 

Part-time NP Jordis Gheseger

When did the urgent care clinic start and how did it develop?

AUCC opened in 2007 seven days a week operating from 0800-2200 with 9 beds. This was in response to an identified need for after-hours healthcare services. Prior to the formal opening in 2007 we were an “after hours clinic” providing semi-urgent patients.  In 2016 treatment spaces increased to 13 and in 2017 Airdrie Urgent Care became a 24/7 center.

AUCC functions similar to an emergency department and uses the Canadian Triage and Acuity Scale (CTAS) to stratify patients and identify those in immediate need of life-saving resuscitation. It is not like a medical clinic in that we see patients based on patient complaint/triage score, not time of arrival (ie. ‘first come, first served’).

We have evolved from a unit having one old defibrillator with a scaled down crash cart to now having two crash carts, a full PALS cart, multiple fetal dopplers, a bedside ultrasound and multiple cardiac monitors.

AUCC has incorporated NPs into their treatment team from the very beginning. We have been a foundational part of the Urgent Care team, supported by the physician group and widely accepted by the rest of the multidisciplinary team.

 Who is part of your NP team?

A multidisciplinary team of LPNs, RNs, Paramedics, Nurse Practitioners, Social Workers, Mental Health Nurses and Urgent Care Physicians.

There are 3 part-time NPs (Jared Friesen NP F/AA, Jen Rice NP F/AA and Jordis Gheseger GNP F/AA) with 2 casual NPs (Ellen Novak NP F/AA and Jenna Habib GNP F/AA). Our group of NPs have a diverse range of experience from working in northern remote nursing stations to primary care to more subspecialty areas such as nephrology. Our combined RN experience in ICU, ER, L&D, Rural nursing, Recovery Room, Primary Care and Chronic Disease Management strengthens the NP group and the care of patients on a daily basis.

Describe an average day at AUCC.

Part-time NP Jen Rice

As Nurse Practitioners, we work day shifts (0730-1545), evenings (1500-2315) and afternoons (1400-2215). Currently we have no NP coverage on nights or Sundays.  Physicians typically practice solo at night.

Nurse Practitioners autonomously see and manage patients in the same way our physician colleagues do. We are a resource for both our nursing and physician colleagues with many informal consults taking place throughout the shift. NPs at AUCC see all patients and are not limited by the CTAS score, but by our individual scope of practice. Patients are triaged at Urgent Care with the CTAS scoring system (1-resuscitation and 5-non urgent). 

Nurse Practitioners at Airdrie Urgent Care will perform a variety of emergency procedures; some of which include incision and drainage of abscess, reduction and setting of fractures, procedural sedation, electrical cardioversion, laceration repair etc.

There really is no “typical” day in our department. Between seeing patients, NPs follow-ups on outstanding diagnostic tests and complete referrals to specialists as needed.

What are the main challenges the NPs face in your setting? Are there barriers to practice?

The primary challenges include navigating multiple complicated acute patients simultaneously, organizing treatment plans and pathways, and planning safe dispositions in a timely manner.

Another challenge is lack of access to primary care providers. Many patients will require follow-up in the future or preventative health screening but are unable to access or a primary care provider.

There is a steep learning curve for new NPs coming into AUCC and as a result; retention of (casual) NPs can be challenging.  It is difficult to retain casual NPs as permanent positions are not readily available and without more permanent positions casual NPs often look for work elsewhere.

What is the most rewarding part of working in AUCC?

Part-time NP Jared Friesen

One of the most rewarding things about working in Urgent Care is successfully curing illness or alleviating pain and discomfort, educating patients regarding their illness/presentation, and creating disposition plans for a safe and comprehensive discharge plan.

What special training or certifications have you sought out to work in this setting?

Nurse Practitioners at the AUCC are expected to perform at an advanced level.  NPs at the Airdrie Urgent Care have specialist orthopedic and casting training, procedural sedation/anesthesia training, point of care ultrasound (POCUS course), ACLS, PALS and NRP training. Learning is further augmented by attending conferences and region-specific urgent care conferences where relevant topics are explored and workshops are used to reinforce skills.

Do you see this model of care expanding to other parts of the province?

We hope that the success of AUCC with NPs integration becomes the provincial standard. There is much work to be done to accomplish this.

In our zone (Calgary) there are 5 urgent care centers and 2 of them staff with NPs. AUCC is currently the only one with consistent NP staffing.