How online and remote nursing education can help treat Alberta’s ailing health-care system

It’s not hard to see signs of strain within Alberta’s health-care system.

In the Peace region alone, hospitals in Grande Prairie, Beaverlodge, Spirit River, and Fairview have been unable to operate at full capacity due to health-care staffing shortages. It’s a situation that Chantelle Gray is experiencing professionally and personally as a nurse and mom living and working in Grande Prairie.

Gray cannot find a family doctor, making her among the 1 in 4 Albertans without access to primary care, according to a recent report from the Nurse Practitioners Association of Alberta. Even getting basic screenings and checkups for her 2 young children is complicated because it’s so difficult to recruit health professionals to rural communities.

“It’s very challenging to be accessing that through walk-in services,” says Gray, an Athabasca University Master of Nursing – Nurse Practitioner student. “And for people who have chronic health conditions like diabetes or high blood pressure, it’s very challenging to get prescriptions and lab work.”

Nurse practitioners solution to health needs

One of the reasons why Gray chose AU and the Nurse Practitioner program is she felt she could do more to help her patients—and in turn, the health system. She’d already been working as a registered nurse for years, but a wider scope of practice allows nurse practitioners to not only work independently and conduct health screenings, manage chronic conditions, and refer patients to specialists, but to also diagnose ailments and prescribe medication. That makes the role similar in scope to a family physician.

“I wanted to do more,” Gray explains. “I feel like the expanded role would not only help me feel more satisfaction, but I can also offer patients more in terms of a proactive role in their health.”

AU a Canadian leader in nurse education

Gray continues to work part-time as a registered nurse while pursuing her master’s degree and raising her kids. As a long-time resident of Grande Prairie, she chose AU because she could advance her education without having to move to a bigger city such as Edmonton or Calgary. Her family loves the Peace region and the benefits of living and working in a smaller community.

“Flexibility has been a huge part of it, too,” she says. “I can take a semester off if I need to and not lose my standing in the program. I can learn from the comfort of my home while my kids are sleeping. That’s been huge.”

Flexibility is a major reason why AU runs the country’s largest nurse practitioner program, and educates more undergraduate nursing students than anywhere else in Canada. More than a third of nurse practitioners in Canada are AU grads, and undergraduate enrolment has increased by more than 200% between 2019-22.

AU President Dr. Alex Clark, who has a background as a registered nurse and a doctorate in nursing and community health, attributes this interest to high-quality programming.

“AU is distinctive within Canada, and within nursing programs in Alberta and Canada,” says Clark. “That 200% increase is really driven by the high quality of our programs and the online, open, flexible approach is really driving this growth.”

Nursing shortages a global problem

Research shows that there was a nursing shortage in Canada even before the COVID-19 pandemic strained the health-care system. A 2018 study suggests that Canada would be short 117,600 nurses by 2030.

Clark says this isn’t a Canadian problem, but a global issue because, “everywhere in the world, people are living longer and better lives.”

In fact, he adds, the fastest growing demographic in Canada is people over the age of 80. As a result, health systems have to “recalibrate” to focus on the kinds of illnesses that occur when people are older, such as chronic disease.

“So with this aging population, nursing is an absolutely key part of the workforce and ensuring that people live longer and better in their communities,” Clark says. “But it does raise unique and different challenges on our health-care systems and our health-care workforce.”

Supporting Indigenous health

One of those challenges is ensuring equity of care between urban, rural, and Indigenous communities. Kayla Milley (Master of Nursing – Nurse Practitioner ’19) works for Indigenous Services Canada treating patients from the nursing station office in Fox Lake, Alta. Part of Little Red River Cree Nation, Fox Lake is about 180 kilometres east of High Level and can only be accessed by road during the winter months.

Milley started her master’s program at AU while living in Halifax, N.S., and finished her degree in Victoria, where she currently lives. She flies into Fox Lake every 5 weeks for 2-week stints when she works roughly 75 hours per week treating complex cases and chronic illnesses such as diabetes.

“I fell in love with the community, and I feel like I can make more of a difference,” she says of her choice to work in a remote community.

Without nurse practitioners, her patients would still be able to access medical care through physicians who are also flown into the community. But one of the benefits of the nursing station, she says, is patients know they can drop in when it’s convenient for them. Making appointments isn’t ingrained in the local culture, she explains.

“They show up when they need to be seen so I get to take whatever time I need with the patient. So I definitely spend more time with them.”

Partners in solving the health-care crisis

In his former role as dean of the Faculty of Health Disciplines, Clark worked closely with Alberta Health Services and government to help expand nursing educational opportunities across Alberta, including in rural communities. Targeted seats in High Level will allow AU to enrol an additional 12 students in the Post-Licensed Practical Nurses Bachelor of Nursing and serve a need in the community.

Clark plans to continue this work as president, advocating for more training seats so universities and colleges across Alberta can graduate more nurses at all training levels.

“The good news is that governments, here in Alberta and across Canada, understand this is a priority. But together, we’re part of the solution to ensure that, going forward, everyone can expect good health care, but also expect good health care from nurses.”

Nurse practitioners relatively untapped in Canada

Nurse practitioners can play a particularly important role in health systems across the country, says Dr. Tammy O’Rourke, an assistant professor in AU’s Master of Nursing – Nurse Practitioner program.

O’Rourke helped establish two nurse practitioner-led clinics, in Edmonton and Belleville, Ont. After a recent move to Cape Breton, she has advocated for similar clinics in Nova Scotia.

“We see them work very well in Ontario,” O’Rourke said recently in an interview with CTV. “There’s 25 now that are still open. The one that I opened in Ontario is now, I think, 11 years into operation and we have NPs, registered nurses, practical nurses, pharmacists. We even had a chiropractor at that clinic.”

Compared to the U.S., where there are 40 nurse practitioners for every 100,000 people, the profession is relatively untapped in Canada, O’Rourke added. There are just four nurse practitioners per 100,000 Canadians.

“We have lots of room to increase and improve.”

Nurse practitioners can fill gaps in health care

That’s something Felicia Derby (Master of Nursing – Nurse Practitioner ’21) hopes governments will prioritize. Derby completed her nurse practitioner education while working as a registered nurse in Fort McMurray, but had to move further south due to lack of local employment opportunities.

Now, she is one of three nurse practitioners based at the Fort Saskatchewan Community Hospital, where she focuses on in-patient care that ranges from attending births and assessing newborns to end-of-life care and medical assistance in dying.

“We act to our full scope here in this hospital, which is really cool to be able to say.”

With all the issues facing Alberta hospitals, such as exceeding capacity and long wait times, she says nurse practitioners can play an important role in ensuring patients are treated earlier, before major problems arise, and help reduce pressures on emergency departments.

“If the government was able to support our work as autonomous independent providers—which we are trained to be—I think that would serve the health-care system well. Nurse practitioners can fill the holes and needs in our communities in a really unique way.”