Introduction
After many years working with NPs/CNS in critical care and Long-Term Care settings, I chose and elaborated on the University Health Network (UHN) framework. This model of framework is exciting to me, as a Registered Nurse and Director of Care. I have always worked closely with NPs/CNSs daily and have dealt with patients, families, team members, and stakeholders in our complex healthcare system. Taking this course is an excellent opportunity to appreciate and observe the considerable effort and study nurses have invested in advancing their positions.
The evidence suggests that APNs were able to advance their roles to create their detailed frameworks to increase the quality of care in a few major areas: “Primary Care, Long Term Care, Cancer Care, and Transitional Care” (Advanced Practice Nursing, p. 9, 2019; Almost, 2021). The driving force in Canada that led to the evolution of the APN framework includes a recognized need for healthcare services, staff development challenges, community requests for better-quality care accessible to as many people as possible, and proficient expansion/job development for nursing (Schober, 2016; Hanrahan & Hartley, 2008, as cited in Advanced Practice Nursing, 2019). The need for a more adaptable and cost-effective approach to healthcare led to the delivery of opportunities for nurses to develop their skills and create new ones (Advanced Practice Nursing, p. 7).
Background
To compensate for reductions in the number of pediatric residents, the CNS/NP job, which combines the responsibilities of a clinical nurse specialist and a nurse practitioner, was initially implemented in the late 1980s in Ontario at tertiary-level neonatal critical care units (Hunsberger et al., 1992; Pringle, 2007). The Clinical Nurse Specialist (CNS) was added to the job description to highlight the nonclinical aspects of advanced practice roles, such as education, research, and leadership (DiCenso, 2008; Hunsberger et al., 1992, as cited in Almost, 2021). Since the conclusion of the Canadian Nurse Practitioner Initiative, there has been a significant increase in the variety and quantity of care models involving nurse practitioners.
For instance, the first clinic to be directed by a nurse practitioner was established in Ontario in 2008. (Delvin, Braithwaite & Plazas, 2018 as cited in Almost, 2021). In 1997, the provinces of British Columbia and Ontario established the first nursing laws, which included the legislative authority of nurse practitioners, as well as their scope of practice and regulation. Today, nurse practitioners are subject to regulation in every province and territory, with the Yukon being the most recent to implement legislation in this area in 2012.
In the early 2000s, a group of nurse practitioners from the University Health Network (UHN) in Toronto established a subcommittee that Health Canada later endorsed. This subcommittee aimed to develop a comprehensive theoretical and practical framework for advanced practice nurses (APNs) to support role clarity (Micevski et al., 2004). The UHN Framework for Advanced Nursing Practice was developed to incorporate many diverse aspects from various models (Micevski et al., 2004). The strong model was comparable to the UHN Framework, with the primary distinctions being that the UHN Framework emphasized the severity of the patient’s condition, the educational preparation of the APN, regulations governing entry into practice, and social values.
Micevski et al. (2004) state that the expansion of the UHN for Advanced Nursing Practice (UHN-FANP) effectively communicates all of the scopes of the jobs included in advanced nursing practice. ” Advanced knowledge, scholarship, experience, communication, and compassion for others” were the five pillars that formed the foundation of the APN practice, which was built on the central circle.
Rationale for Choosing the Model
Patient-centeredness is the fundamental principle guiding the organization of medical care, representing the most desirable model of the relationship among the patient, the insurance representative, and the physician, in which all parties share equal responsibility for the treatment process and outcomes. The task of medical organizations within this model is to facilitate the creation of favorable conditions for its formation, based on the fundamental principles of quality management. The relationship between patients and physicians often worries managers of medical institutions, only after a patient has complained to a higher authority or an insurance company. However, most defects in the quality of medical care can be prevented and eliminated at the stage of providing medical care through joint work in this direction by the management of medical institutions, the insurance representative, and the patients themselves.
A vital competence that will ensure the successful provision of medical services is teamwork. For the latter, the chosen model creates all the necessary conditions. The UHN clinics are characterized by cooperation and flexible regulations, which enable the selection of a team of experts for the individual treatment of patients, serving consumers of medical services.
It is not uncommon for patients to have to deal with several doctors. As a rule, the first treating doctor is responsible for coordinating interaction with other UHN clinicians and the doctor who serves the person in their home. Most clinic patients see only one physician, who consults informally with other specialists when making a diagnosis and prescribing a course of treatment.
Depending on the patient’s needs, the treatment team may include surgical and technical staff, specialty nurses, nutritionists, physical rehabilitation specialists, social workers, and other relevant professionals. The hospital is aggressively seeking team players; it hires them and then encourages them to collaborate, investing significantly in communication technology and medical equipment. Collaboration is also stimulated by the principle of remuneration: An employee’s salary does not depend on the number of patients they see or treat. Doctors at the clinic have no financial incentive to retain a patient and not refer them to a colleague who can better meet the patient’s needs.
Teamwork is driven by the corporate strategy of integrated multidisciplinary medicine and the severity and complexity of patients’ illnesses. The collaborative spirit that dominates the clinic is a powerful learning mechanism. The professional level of physicians here increases over time as they face the need for their own development, without which they cannot work effectively in this system. Similarly, the professional development of the rest of the staff is observed. The clinic expects a lot from its staff; teamwork helps them meet those expectations.
The clinic’s culture is remarkable for allowing employees to seek help and encouraging them. Failure to seek counseling or assistance when needed threatens career advancement. The UHN culture increases the inherent power of respect. Showing respect is necessary for the work environment. If a person is respected at work, is trusted, listened to carefully, and involved in the production process, their contributions are valued and treated fairly. Teamwork is inconceivable without mutual respect, and it also depends on the partners’ trust, their ability to listen attentively, their involvement in the work process and contribution to it, and their honest attitude towards their colleagues.
A corporate culture that supports the principle of mutual respect emphasizes the value of people’s work and fills them with a sense of dignity, another advantage of this model that appeals to me. Respect lifts a person’s spirit and nourishes him with the energy needed to show goodwill. The latter unite colleagues, strengthen self-confidence, motivate employees, and improve team interaction.
Limitations and Gaps
When considering this model in the context of collaborative connections with other health care providers, territorial regulatory nursing organizations must pay more attention to it. According to what is said on page 27 of the Advanced Practice Nursing Model:
Companies and government legislation typically determine the scope of practice of nurse practitioners and certified nursing assistants.
This fact raises the following question for me: Are NP and CNS jobs safeguarded by the legal scope of practice of nurses? Do they require more help and teaching from their nursing regulatory organizations than medical doctors do from their regulatory organizations?
Envisioning Future Practice
After gaining sufficient experience as a Nurse Practitioner and working with primary health care professionals, I can envision myself functioning as an NP who practices preventative medicine within the parameters of the Nurse Practitioner Scope of Practice. (Charlton, 1995). My new position as a Nurse Practitioner will enable me to assist and direct a wide range of client demographics toward a better way of life.
My approach will be centered on the holistic patient care model, particularly emphasizing my patients’ physical and mental well-being and providing emotional support for their families. (Canadian Nurses Association, 2016a; Nurse Practitioner Association of Canada, 2018 as cited in Almost, 2021). In addition to this, I will be conducting in-depth health evaluations, as well as diagnosing and treating health and ailment conditions (Almost, 2021).
In the future, I might picture myself informing others and educating them on the nutritional value of our food. I might also educate them on the significance of daily physical activity and identify any nutritional deficiencies to provide the customer with the appropriate vitamins and minerals. I would also like to educate my clients about meditation, the power of their subconscious mind, and self-healing. I sincerely hope that I will be able to give them the critical and high-quality care that they deserve.
Conclusion
Pehlivan and Güner (2020) state that practitioners in the nursing field need to have a high level of empathy, persistence, a strong sense of honesty, and self-respect. My model of practice will be based on providing care that is centered on the client and their family (Advanced Practice Nursing, p. 29). To provide the finest possible level of care to each of my patients, I prioritize showing compassion for them and their families and respecting the cultural traditions they come from. My professional activities shall be conducted to comply with the regulatory authorities and professional associations that apply to NPs in Ontario, Canada. I will be opening my own Wellness Clinic in a private location. In addition, I would like to work part-time as a Nurse Practitioner consultant for Ontario Long Term Care homes to contribute to improving the standard of care provided to our elderly population.
References
Advanced Practice Nursing: A Pan-Canadian framework. (2019).
Almost, J. & Canadian Nurses Association. (2021). Regulated nursing in Canada: The landscape in 2021. In Canadian Nurses Association [Report]. Canadian Nurses Association.
Charlton, B. G. (1995). A critique of Geoffrey Rose’s ‘Population strategy’ for preventive medicine. Journal of the Royal Society of Medicine, 88(11), 607–610.
Micevski, V., Korkola, L., Sarkissian, S., Mulcahy, V., Shobbrook, C., Belford, L., & Kells, L. (2004). University Health Network Framework for Advanced Nursing Practice: Development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses. Nursing Leadership, 17(3), 52–64.
Pehlivan, T., & Güner, P. (n.d.). Compassionate care: Can it be defined, provided, and measured?