Nurse practitioner role proves valuable to care of orthopedic patients

left to right: Dr. Don Brien, orthopedic surgeon; Crystal Robinson, surgical nurse practitioner; Harvey McPhee, joint replacement patient; Serena Parsons, nurse practitioner and Mary Parago, unit manager and registered nurse.

Many of us associate the role of nurse practitioners with collaborative family practice teams in the province.
Nurse practitioners are also playing an increasingly important role in many other services in Nova Scotia, including emergency departments, mental health and addictions, chronic disease and wellness, perioperative (surgical) services, and long-term care. 

Last summer Nova Scotia Health Authority (NSHA) launched a new surgical nurse practitioner role within the elective orthopedic inpatient unit (3A) at Cape Breton Regional Hospital. 

Modelled after similar roles at Dartmouth General Hospital and the IWK, it has proven to be a valuable addition to the team.
According to orthopedic surgeon, Dr. Don Brien, the role has positively affected all the areas of patient care and has been a major improvement for patients, surgeons and nurses.   
“This has been a real game changer for us in terms of running an efficient orthopedic service,” said Dr. Brien. 

“We can leave the floor to go to the operating room or to see other patients in our office and are very comfortable that our patients are being well taken care of.”
Nurse practitioner Serena Parsons, was initially hired into the role in the spring and underwent training with nurse practitioners at other Nova Scotia hospitals before joining the inpatient unit in July. 

When Serena went off on maternity leave in August, nurse practitioner Crystal Robinson stepped in where she left off, supporting elective hip and knee joint replacement patients and other orthopedic surgery patients.
“They have increased capacity, reducing our demand and reliance on surgeons and increasing the support available to our patients and nursing team,” said Mary Parago, unit manager and registered nurse.
There are many benefits to having a nurse practitioner as part of the orthopedic team.

Nurse practitioners can order pain medication, assess and admit emergency department patients with injuries like a hip fracture and spend more time with patients answering questions and educating them on what to expect after they go home.  

In fact, nurse practitioners play a big part in helping patients return home. 

Surgeons typically come check-in with patients early in the morning to ensure they are progressing as expected. Often patients are almost ready to go home, but awaiting things like final bloodwork results. 

At times patients had to wait until the surgeon could return to complete their discharge. 

Now the nurse practitioner can review test results and finalize patient discharges, helping patients return home sooner and freeing-up inpatient beds for other surgical patients.
On a typical day, surgeons like Dr. Brien could have four or five patients to operate on or several patients to see in their office, along with five to six patients in hospital recovering from surgery, and consult requests for patients who have come to the emergency department. 
“This has completely changed the number of calls I get from nurses on the inpatient unit and has expedited the care that our patients receive,” said Dr. Brien.
The successful introduction of this role has resulted in the approval to keep two nurse practitioners. 

Robinson will join the general inpatient surgery unit when Parsons returns to the orthopedic surgery unit this summer.
Originally from Cape Breton, both Parsons and Robinson are recent graduates. They are grateful to have found full-time positions so soon after graduation, and for the opportunity to help promote patient-centred care as members of the orthopedic and surgical team.
“Accepting the first surgical nurse practitioner position in Cape Breton has been both exciting and challenging,” said Parsons. 

“After seeing all the role had to offer, I could not wait to get started and in my short time in the role I was already seeing increased patient satisfaction and improved patient flow.” 
Robinson completely agrees that the role has improved continuity of care for patients. 
“The nurse practitioner role on 3A has come a long way in just a few months,” said Robinson. 

“I feel like my role has become the common denominator for our orthopedic inpatients. I work with every discipline within the health care team to facilitate positive outcomes for our patients.”

The inpatient surgical nurse practitioner position is one of more than 90 positions hired under the multi-year hip and knee action plan, aimed at improving access and care for hip and knee joint replacement patients.  

Under the plan, teams at each of the health authority’s five joint replacement sites identified what they needed to complete more surgeries and implement a new centralized intake and wellness model. 

The inpatient nurse practitioner role emerged as a priority at the Cape Breton site.

Wait times for joint replacement surgeries at Cape Breton Regional Hospital are among the best in the province. 

Data from between April to December of 2019 showed that 5 out of every 10 patients who had surgery, had it within the national benchmark of 182 days or less.  

Nearly 800 hip or knee replacement surgeries are expected to be completed at the site this year (2019/20).