DIGBY, N.S. – Members of Nova Scotia Health Authority (NSHA) staff and the Digby health-care team recently shared their thoughts on the health centre facility, recruitment, job satisfaction and an upcoming community conversation that’s being designed to discuss improved communication and future health care developments.
Here are their responses to some frequently asked questions.
QUESTION: When will the NSHA community conversation series come to Digby?
ANSWER: The Nova Scotia Health Authority is hosting a series of community conversations in various locations across the province and the date has now been set to host a conversation in Digby on March 7 at Digby Regional High School.
While more specifics are still being put together, Fraser Mooney, the NSHA public engagement and communications officer, said the conversation process is a response to the public’s continued frustration over the lack of access to primary health care.
“We want to have conversations about communication and access, and we want to ask questions about how we can do that better, and we are making ourselves available for that,” Mooney said. “We certainly understand the frustrations in a community when we’re talking about someone who hasn’t had a health-care provider for a while and who doesn’t see the prospect of having one in the near future. So, of course, people are frustrated… we get that.”
Melanie Mooney, health service manager for primary health care with NSHA, said she wants the conversations to focus on hope and the future.
“I want people to feel hopeful that this situation is going to change,” she said. “Right now, we’re in a situation where we’ve had some people coming and going and we have to work towards a long-term sustainable solution… understanding that there may still be people who are going to come and go, but they’re still here to help and they’re invested while they’re here and they’re doing good work.”
Melanie Mooney is convinced NSHA needs the community’s help in creating that sustainable environment.
“We have to work together, we need the community on board with us – and I don’t expect people to feel positive all the time, but I don’t want the quick negative response all the time either,” she said. “I want us all to feel some hope, feeling like we’re in this together. That would make people feel like they’re in this with us and we’re moving together with the same ideas in mind.”
The meeting in March offers an opportunity for members of the public to meet members of the new health-care team in Digby and to be part of a conversation discussing ideas and solutions for the future.
“We need to start to shift to more solution-based thoughts, and we need people to feel like they’re part of that solution,” Melanie Mooney said. “I know it’s hard when you’re sick and you’re sitting in Emergency and you don’t have any other place to go, it’s pretty hard to feel positive about that, but if we can get people to a place where they can start believing that things are getting better and moving towards a solution-based type of thinking – ‘Yes, I’m part of this community’ and ‘Yes, I’m part of the solution’ and ‘Yes, there is hope’ and believing there is change that is coming, then we can move forward, together.”
QUESTION: Why don’t all doctors work in the emergency department?
ANSWER: Dr. Genna Bourget, a member of the new collaborative practice team in Digby, said she doesn’t currently work in the emergency department for a couple of very good reasons.
“In medicine, there are so many different scopes of practice that not everyone feels that emergency medicine is one of their strengths,” Bourget said. “The reality in Digby is if you want to work in emergency you can, for example Dr. (Jennifer) Chang does emergency coverage, but you’re not obliged to. It really depends on people’s comfort levels. This is a solo-manned emergency department, so I think it would be unsafe if somebody felt underqualified to do that coverage in the Digby emergency room.”
Dr. David LaPierre said working in emergency is also out of his current scope of practice.
“It’s been a few years since I’ve worked in emergency so for me to jump in right now wouldn’t be the right thing,” he said.
Dr. LaPierre said they’re working on a pilot project that’s being more formalized offering some extra training and mentorship to the team members who would like to take on an emergency shift, but who don’t currently feel experienced enough to jump into that role. Dr. Bourget said she’s a relatively new doctor and her residency focused primarily on obstetrics.
“It just depends on what your focus is,” she said. “The true general practitioner is a little less common now. If you’ve trained in a bigger centre, you’re not necessarily trained to come out and handle a rural emergency department by yourself.”
Dr. LaPierre said taking on the emergency department in Digby requires current experience, especially because it is a solo practice.
“It is serious, you’re working by yourself away from specialists, and that’s not a problem, that’s just the reality of rural health care, but you need to be able to resuscitate and stabilize critically ill people with competence and confidence,” he said.
QUESTION: How is the new health centre working out?
ANSWER: Melanie Mooney loves showing off the new health centre, pointing to the colour scheme, which she describes as calming.
“The space was designed to have a good work flow with space for offices and space for exam rooms,” Mooney said. “The design also features a central supply room, an alarmed vaccine fridge and and all of the latest equipment.”
Mooney said the exam rooms are a good size and it’s a nice welcoming space.
“Everybody who comes through here says it’s well equipped,” Melanie said.
The health centre also features a conference room that’s used for meetings and by the diabetes education team for their groups.
QUESTION: Are they taking new patients at the new health centre?
ANSWER: The answer is yes and no. While they had an obligation to take on patients who were rostered through doctors who have left or retired from the community, Dr. Bourget said they’ve tried to look at the population as a whole and to recognize the most vulnerable without overwhelming the team they now have in place.
“The people we’ve identified so far are those requiring prenatal care, children under six years, palliative care patients – that’s an area that Dr. Chang has been working in – and people who are identified as a high priority after hospital discharge.”
While community members can self-refer to the clinic if they’re pregnant or for their children under six years, hospital discharge patients are decided on a case-by-case basis.
Crystal Harris, a nurse practitioner working with the collaborative health team, said she’s doing her best to take people on, every week and every duty clinic she works.
“I’m impressed with how far we’ve come in such a short amount of time,” Harris said. “We feel like the access is improving and we’re able to see more patients in a timely manner when they want to come or need to come. I can’t speak for everybody, but I know I’m accepting new patients every day – I’m constantly adding people to my roster – so that can only help.”
Harris described a few people she’s added in the last week – the parents of a newborn and a man she saw in duty clinic and his wife.
“Every time I work duty clinic I try to take at least one and sometimes several patients each time so I can constantly build numbers and get people matched up.”
Erin Bohan, a new NP, said the situation is pretty much the same for her.
“I took over the roster of the previous NP, so I’m still in the process of meeting everybody through that roster, but through duty clinic I’m picking up clients.”
As far as the 811 list is concerned, Dr. LaPierre said: “Ideally, we keep recruiting, keep growing our practice and get that list down to zero and then as soon as it’s feasible, we can start taking people off the 811 list… when that day arrives we’d have to have a celebration. There has been turnover in the number of people who are unattached – it is getting smaller.”
QUESTION: What’s happening with health care on the Islands?
ANSWER: Melanie Mooney said a lot of people have understandable concerns about what’s happening with health care on the Islands and that their new model will hopefully address the turnover there.
“The model we’re looking to move towards and are recruiting for are two nurse practitioners sharing the full-time position there – so they will work 50 per cent of their time here and 50 per cent on the Islands,” she said. “We’re hoping that by having two that will lead to better sustainability, better connection with the team, and better job satisfaction, so we’re taking more of a team approach to the Islands Health Centre. We have two positions that we’re actively recruiting for.”
Crystal Harris said she thinks it’s a welcome change.
“I know it’s scary for people who live on the Islands to know that change is coming, but I’m really pleased with this. I think this model is sustainable… I like to think I could provide extra support because I know the patients – as does Erin – so these two new people will be coming in and they’ll have so much support right when they start. I think it’s a great model.”
QUESTION: Will there be more turnover in Digby?
ANSWER: Dr. Bourget said community engagement and having a positive community experience will play a large role in her decision to stay in Digby – or not.
“More important than the contract, it will depend on how things are going and how well I feel I’m transitioning into Digby,” she said.
Melanie Mooney said while all of the health team are basically permanent positions, the community needs to remember that anyone can leave at any time.
“Staying or leaving at any time is really about job satisfaction and work-life balance and all of those pieces that go along with anybody in their jobs,” Mooney said.
Dr. Bourget said moving the health-care conversation into a solution-based area with more positive dialogue would help.
“If things are going well, you choose to renew your contract…One of the take-home messages is also the need to focus on what this town has to offer people – what the people in the community are like and what type of town people are moving into – will it be welcoming? It needs to be a positive experience so hopefully we can keep making changes and recruit more people,” Dr. Bourget said.
Crystal Harris added her thoughts: “I just feel like all of us are always trying to figure out new ways to make positive changes and I feel it’s a very positive team going forward right now. It’s a good feeling coming to work and you feel positive and supported and you’re making big changes – slowly – but aiming in the right direction. We have a really good team here – we have fun at work and we enjoy each other’s company.”
QUESTION: What about recruitment?
ANSWER: Melanie Mooney said recruitment is an ongoing piece. “People move, people retire, recruitment is always changing.”
Both doctors Bourget and LaPierre said their team does have some influence on local recruiting.
“NSHA has a strong infrastructure to support recruitment, but that works best when you have NSHA partnering with the local health-care team – people who can speak with enthusiasm about what it’s like to live and work in the community,” Dr. LaPierre said.
They also agreed that there are no further limits on where people can work in the province. Fraser Mooney explained that there was an endeavour by the health authority to focus on areas with the most need for family physicians in the past. “That didn’t really work well so they revisited that idea,” Mooney said.
Dr. LaPierre said the Digby team is actively reaching out to students.
“We keep reaching out to people who are graduating and who are independently licensed and at the same time we talk to students who are becoming doctors and nurse practitioners – especially people with local roots.”
Melanie Mooney said they need the community’s help in recruitment.
“It’s a community initiative,” she said, pointing to Clare as a model, where the municipality owns the medical centre, where they send out care baskets to medical students at Christmas and where they take them out to dinner when they’re back home. “They’re not high-cost things, but they create a sense of community and connection and the people appreciate it and it endears them to the community so much they want to come back and be a part of it. It would be nice to see something similar here.”