A first-hand look at a thriving interprofessional practice: Gold River, BC

Nurse practitioner, Laura Koop, and GP rural locum, Dr. Robert Henderson, are part of the healthcare team in Gold River, BC Nurse practitioner, Laura Koop, and GP rural locum, Dr. Robert Henderson, are part of the healthcare team in Gold River, BC

The Rural Coordination Centre of BC (RCCbc) recently interviewed three members of Gold River’s interprofessional healthcare team: Laura Koop, a nurse practitioner (NP) who permanently lives in Gold River; Barbara Pelletier, a casual, part-time registered nurse who lives in Nanaimo; and, Dr. Robert Henderson, a family practice rural locum from Gabriola Island.

How did you end up working in the Gold River Health Clinic?  

Laura Koop: After about 10 or 12 years of nursing practice, I went into remote nursing for eight or nine years. I went into the Nurse Practitioner program because it allowed me to expand my role in the remote communities. When I graduated, I took a position as a clinic lead overseeing several remote clinics because I love remote and wanted to stay in it. After about a year and a half as lead, I put in a proposal for doing NP work in Gold River with outreach to the communities I was leading.

Barbara Pelletier: I’m a part-time coordinator of site operations at Nanaimo Regional General Hospital, but I like remote nursing. I want to be at the bedside and to do more advanced practice. I go to Gold River, partially because it is the expectation that you work as a team, but also because of the culture of the clinic more than anything else. There is a high level of collegiality and collaboration there.

Robert Henderson: I was in family practice in Vernon for 27 years. I found that I didn’t want to run a practice anymore but I still enjoyed medicine. A friend in the Rural Locum Program kept saying “oh, you should locum,” so I moved out to Gabriola Island to locum. I took up a half-time practice on Hornby Island, and then left that. The first locum I did after Hornby Island was Gold River. I’ve been going back there since.

It’s an impressive place to work. They’re a well-funded community, they have excellent nurses, and they have services that are available to communities that are really useful and helpful to practicing good medicine, like mental health, public health, nurse practitioners, X-ray, on-site lab. They have one full-time physician and two physicians who split a practice, so there are three physicians altogether in the community.

What’s it like to work together, given that some of you are only in the clinic part-time?

BP: You need to be a good fit for the culture of the clinic.  There are certain expectations when you walk through the door.  Every expectation that I’ve ever had has been met, too, so it’s a very reciprocal relationship.

You are never afraid to say “I don’t know this,” or “you need to catch me up on this.” There is always somebody who will show you the newest piece of equipment or if they’re doing business differently. You only need to say “I need help” on any level, and it’s there. I credit the clinic manager for that. She is incredibly dynamic.

How would you describe the culture of the clinic? Is it flat, with no hierarchy, or is it more fluid?

LK: There’s definitely hierarchy. It exists because that’s the way our medical system works. But it’s far more fluid than that. Without exception, any one of us is free to say to anyone else “I think you should reconsider what you’re doing there.”  It’s constant give and take, all the time – we have an incredibly open team. As nurses, as a nurse practitioner, we’ll correct the physicians, they’ll correct us – it’s constant learning.

Because our physicians are on salary, there is a greater willingness to share patients, practices and skill sets. The more they teach everybody else, the easier their job is. We have a call system after hours – the more Bob can rely on our skills over the phone, the less frequently we have to wake him up at 2 a.m.

RH: Everyone has to work as a team for it to work efficiently.  You have to be able to rely on the other person, to know that they’re doing their job. The staff in Gold River are exceptionally well-trained and have great experience.

How do the patients in Gold River react or feel about having this interdisciplinary care?

LK: For so many people in the province, seeing a nurse for healthcare would be a really strange thing.

For Gold River residents, however, walking down the hallway into my office to get a prescription or an X-ray requisition is a natural extension of nursing practice to them. When patients here visit Urgent Care, the nurse makes the initial assessment, and in a lot of cases, makes a diagnosis and decides on treatment needs and initiates the care, and sometimes completes the care without ever discussing it with the physician or NP. Sometimes the physician will come down and examine the patient and simply approves the care plan the RN formulated. Only as the complexity increases, does the physician involvement increase. As an NP, I see and do more before I say “this is getting a little more complex than I can handle, I’m going to call a physician”. The patients are really open and comfortable with this practice. At the end of the day, they almost all recognize that they care they get, regardless of which provider they saw, is exceptional.

BP: Patients base their level of trust on outcome. I’ve been regaled with stories about how, when a resident’s spouse was passing away, the clinic staff palliated that patient in the community with a high level of care and equipment. My sense of it is, residents have complete trust that when they walk through the clinic door, everybody that needs to see them will see them that day.

LK: And yet if all they see is the nurse, when they’re sent home by the nurse, they’re okay with that. They don’t insist on seeing a physician.

Oh, really?

BP: Never.

Has the community of Gold River had a role in recruiting healthcare workers?

BP: I don’t necessarily see that but what I am seeing is that they’re respectful because they know if they burn the nurse out, the nurse won’t come back. Gold River has really educated and developed a culture with their patients where they’re very thoughtful about phoning after hours, and about how staff are treated.

LK: I’ve generally found that in any of the remote communities I go to, they want us there and will do what they can to look after you.

RH: If the clinic wasn’t here, the emergency room in Campbell River could be overwhelmed with just Gold River patients. The clinic prevents excess transportation out of the community.

There’s a huge diversity of, or discrepancy in, what happens in one community versus another community. Gabriola Island, for example, has 5,000 residents and no nurses. You see exceptional situations like Gold River, that shouldn’t be exceptional and should be the standard for everyone.

LK: The Gold River Health Clinic is probably the closest thing you’re going to get to a real primary care centre in a small place.

Gold River, BC is a small village located adjacent to Strathcona Park on Vancouver Island and is the “gateway to Nootka Sound.”  The health clinic in the village offers both primary care and urgent care services, and contains an onsite lab, and X-ray facilities. Other healthcare services offered include home care nursing, home support, child health clinics, physiotherapy, a youth substance abuse support program, and adult mental health and addiction services.

The health clinic in Gold River serves approximately 2,000 residents within a large catchment area, including Tahsis, Kayuquot, and Zeballos, along with a number of small logging camps.

 

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