Nurses step up to take on expanded role during pandemic

 Nurses step up to take on expanded role during pandemic – Alberta RN

It’s hard to find a silver lining during a pandemic. But for a dozen Alberta nurses, the recent Influenza outbreak gave them the important role of prescribing antiviral drugs to patients without them having to see a physician.

In November, when four Influenza Assessment Clinics opened around the province, then-Health Minister Ron Liepert recognized that there needed to be extra help on the front lines to help serve the large numbers of patients that were expected to flood into the clinics.

“He sent out a ministerial order to try to speed patients through the clinics, assuming the number of patients would reach the anticipated 600 patients in a 16-hour day,” explains Martin King, a nurse and site manager from Oilfields Hospital.

That order was to quickly train 10 nurses in Calgary and two in Lethbridge so they could see patients themselves and prescribe the antiviral medications Tamiflu or Relenza without the patients having to see a physician or a nurse practitioner. The minister set up a working group to develop a teaching module and the key nurses who would get the training were chosen. CARNA was confident that the expanded role for RNs would be beneficial to the public by giving them the high standard of treatment they expect, while receiving it efficiently. Because of that, CARNA worked with Alberta Health and Wellness to make the process as smooth as possible.

Alexis Mageau, a clinical nurse specializing in emergency, was one of the nurses to be chosen for the extra responsibility.

“It was interesting and exciting to be able to do something new and something nurses don’t usually get the chance to do,” she said.

Once the nurses were trained, they had to assess five patients under the supervision of a physician before they were signed off and able to see patients and prescribe and dispense the medication on their own. Patients who could be seen by nurses had to meet specific criteria — they must have only had influenza symptoms for up to 48 hours, they had to have normal vital signs and they had to have one of a number of risk factors such as asthma or being an aboriginal living in an isolated community. As the H1N1 virus progressed, nurses were then able to see patients who had symptoms for up to 72 hours.

“If a patient had all those symptoms, we could prescribe Tamiflu,” Mageau said. “If they had abnormal vital signs, such as history of renal failure or they were pregnant, it was mandated they get a secondary assessment by a nurse practitioner or physician.”

Mageau, who has had the chance to work in an expanded role before, was excited for the opportunity.

“It was certainly huge for me as a nurse. Having the nurses prescribing Tamiflu following a primary assessment really assisted in processing a larger number of patients. Those patients could be discharged right from primary with a prescription. They didn’t need a secondary assessment,” she said.

To aid in the process, the Calgary centre had a pharmacist on site, which was a huge benefit, according to the nurse.

“It was a huge asset to have a pharmacist on site, to aid in dispensing and to answer questions,” Mageau said, noting the pharmacists were helpful in situations such as aiding in modifying dosage for patients who had other complications. “They always looked our questions up for us and gave us and the patients consultations, which was great. It was part of the reasons we had such success. Having the pharmacists as a buffer or a safety net gave me a lot of confidence. They were always there if we needed any help.”

Mageau said she was proud of the teamwork from the multi-disciplinary unit that ultimately benefited the patients and the public.

“I learned an enormous amount and working with nurse practitioners, I gained a new, better understanding of their scope of practice,” she said, noting if there was another Influenza Clinic, nurses should definitely be a part of it. “I found the whole experience very rewarding. The patients were well cared for and they had their questions answered and were seen in a timely manner.”

King said he was also very proud of his fellow nurses for their role in helping patients at the clinics.

“It’s showing that we can do these roles with the proper authority and the proper drugs and the proper situation, like the pandemic,” he said.