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Ubiquitous Evolution Launches!

Hello, everybody, and welcome to Ubiquitous Evolution. This is our very first podcast and my name is

Roberta Heale. I'm the host of this podcast.

Okay, the podcast, is going to be about nurse practitioners. It's going to be for nurse practitioners for people who want to be nurse practitioners, people want to know more about nurse practitioners, or people who don't know anything about nurse practitioners!

I have a feeling it's going to branch out to other things as time goes by, like research and practice issues and policy and lots of stories told by the people who were there at the time.

I have to tell you a little secret. This is being posted in 2,022. However, the podcast was recorded in 2019. A lot of things have happened between then and now, and it took a little bit of time to get everything together. But I'm really excited to have our first guest Maureen Klenk. Maureen was the first license nurse practitioner in Saskatchewan, a province in Canada for those people outside of our country. She played many roles in the development of this role, in a position with the regulator, she was able to operationalize initial legislation. She worked with employers to develop nurse practitioner positions in their various communities. While working with the regulator, she took part in the development of the First National Exam for nurse practitioners. She taught in the first NP educational program in Saskatchewan before returning to a clinical practice, where she practiced within women's health, geriatric health and with Indigenous communities. Maureen is currently an associate Dean of student wellness, within the faculty of nursing at the University of Regina, where she has opened the first NP-led student wellness center on any Canadian University campus.

I first met Maureen in 2013 when she was the President of the Canadian Association of Advanced Practice Nurses. I became the President elect of that organization and, together, we saw it through to becoming the Nurse Practitioner Association of Canada. She's a very kind and warm person, very knowledgeable and truly authentic, and I've appreciated it being her friend for all these years. So, without further ado, I'm going to launch our first podcast.

All right Maureen Klenk. Thank you for joining me today to talk about your experience about becoming a nurse practitioner, and just wondering, when did you first hear about those practitioners?

Oh, I kind of backed into it. Roberta. I guess I should say that I had heard about nurse practitioners in the United States for quite some time, and I kind of had heard about stuff going on and Ontario but I was working mostly in north, in the northern communities in Canada, and so I kind of backed into it that way.

I was a diploma RN. Then I went back for my baccalaureate while I was still working in the north and I sort of started to hear about programs that, that you know, legitimized people, nurse practitioners or nurses, for prescribing. I should say like at the time they weren't even really talking about a nurse practitioner, and if I remember correctly, Roberta, Ontario were referring to nurse practitioners as nurse practitioners yet, were they?

We did from about the mid-nineties.

Yeah, yeah... yeah, that's kind of when I was starting into the search for various things.

So, I was actually working in the north and I knew I wanted my masters, and so I was phoning around to various universities, or you know, establishments that offered education, which in the early nineties, wasn't very many. So I was phoning different places and stuff, and I happened upon Athabasca (University), and I was chatting with you know one of them, I think she was probably an Associate Dean or something. Anyway, and she was telling me how "you know, they're going to start up this new program, and it's all about, you know, nurses who prescribe and you know this kind of stuff right?" It's going to be by distance and but a key they won't really calling at those practitioners per se. They said, you know, we'll have it ready and I don't know 6 months, whatever I can't remember the timeframe.

I was like "Oh, that sounds great" because I wanted to get my masters, and this was going to be eventually at a master's level. We started with an advanced graduate certificate, and then eventually moved to the master's level with this program. And so I was like, "Yeah, sounds like a great plan! Keep me informed!" So I went home to talk to my husband and my husband was like, "So you're going take more university towards the program that really has no confirmed jobs yet?"

For sure!

Why did we do this? Why did we always do this?

We were fairly newly married at that point so that's probably why I got away with it now. Now it would be like, "Are you crazy?" So that's kind of how came into it.

You know, being in the north, and I also think of northern nursing as kind of the precursor a little bit to the NP role, even though there are still nurses practicing it in the north. But that's certainly the way I had my path towards the NP. Long answer for a short question.

Really interesting, particularly because what you mentioned to your work in the north. you'd already, maybe not formally, but informally working in the role in a lot of ways.

Yeah, in many respects, I think probably it confirmed to me the importance of having the education to be a nurse practitioner, if you are going to work at that level or practice. You know, as I was studying to become a nurse practitioner and working in the north, it was so many aha moments of oh, my Lord, I didn't know that could happen if I prescribed that drug. I didn't know that I needed to look for this like that diagnostic test. I didn't know I didn't know I didn't know you know, and it's it really confirmed to me. If you don't you don't know what you don't know, and how serious that can be.

No that's so true, particularly when you're expected to meet the needs of a population and you don't have the resources and the skills to do it.

Or the backup you know, living in the North, you have very little backup. You do have physicians, but you have to not to phone them. I don't even know to phone them,

then, you know. The nurses in the north, I don't want to sound like I'm... They're doing the very best they can with whatever, you know, what they're doing like there's group work going on. But it was really a very big eye opener for me.

Pivoting: Finding a New Career Path. Go to

So getting out, what was it like for you when you first graduated and started to practices in NP?

Well, I kind as I was graduating, I was leaving the north. My husband and I decided to move to Saskatchewan, where my family was, and there were no roles here as a nurse practitioner.

They were in the early stages. Saskatchewan had set up some pilot projects and they were calling them primary care nurses. And as I moved into the province these pilot projects were wrapping up, and the Ministry (Ministry of Health) had decided that they were successful, and that they really did want to move forward with this role.

They were negotiating with the regulatory body, the nursing regulatory body, and physician groups, and all that kind of stuff. You know about what they should call the role, how they should move forward, what needs to be in place. So basically, I walked into Saskatchewan when they were still shaping the regulation around the role of the nurse practitioner. I was probably the only person in Saskatchewan that had education that could support the role of the nurse practitioners. The primary care nurses that were in the pilot projects a lot of the education, but you know, didn't have the full education that would say, you could be a nurse practitioner tomorrow.

What year was that?

So '93 '90. No, sorry, that wasn't that at all. It was what much later than that was in the 2000s. It was cause I it was probably 2003. Yeah.

Yeah. So, it was kind of interesting to be a part of it at that at that level. And I did work with the regulatory body. My role with the regulatory body was to kind of liase with the Ministry of Health, and, you know, chatted back and forth about the role. Anyway. So yeah. I walked into nothing.

Like so many of us did!

Yeah, exactly. exactly. And I will say we were like so heavily in Saskatchewan on

Ontario on, you know, Newfoundland, I think, was also up and running at that point in time. We relied so much on help, and the other provinces were so generous to help everyone else out. It was. It was amazing. I had like, NPAO, on speed dial all the time. I was kind of tasked with trying to setting this up a little bit, and yeah, it was great. It was exciting little scary, of course, a little bit. But you know, exciting to, at the time.

Yeah, yeah those were interesting times weren't they, in every province? Glad to hear that there was some collegiality.

Yeah, there was. There was an initiative going on it at that point time, and you probably remember it. It was through CNA was given was given some money to develop the role at that time nationally, and it was around that time.

It was CNPI, Canadian Nurse Practitioner Initiative.

Yeah, Yes, yes. So, you know, going to those meetings was just so much fun, because you were meeting colleagues from all over the country and hearing what was going on and sharing some frustration, but sharing some happy time, You know it was.

It was. It was neat it was good. I was on one of those committees, and met somebody from Vancouver at the time but BC didn't have the licensing and I was working in the role as an NP.

She was insanely jealous, and low and behold BC, rolled out their NP program, sorry standards, with what we had we took over a decade to achieve, which was a reasonable prescribing authority.

Yeah, no, yeah. I mean, I just remember sort of thinking, oh, you know, like not like poor Ontario, not to be super negative, but because you were the front runners, because Ontario was the front runners, you couldn't learn from all the other mistakes like we could. You just jumped in there. You did it and the rest of us benefited from the fact that that you move forward, and I just did it. And Ontario was so generous to share their mistakes.

I just remember, because I remember hearing, "Oh, man, if we could do it all over again! This is what we would do" It was wonderful that that Ontario was able to do that for the rest of us! And then it was so painful to watch Ontario that manage to move forward eventually.

Well, so you've been an NP now for quite a while, and just wondering is there anything that stands out to you with your experience in being a nurse practitioner?

I love it! I'm so grateful that I chose the path that I did and that I am a nurse practitioner. It's

been interesting to, even yet.... the you know the you know cause I I've been in this practitioner now for 15 years. I yeah, I was licensed in Saskatchewan in 2004 and that's when Saskatchewan started licensing NPs in 2004. There has been so much change that's occurred, so many things added to the scope. I think finally, we've got... we've finally starting to reach a point in Saskatchewan where there is some trust, that we do know we're doing predominantly. Like as a profession, that we're not going to go out and suddenly do brain surgery on somebody which I think was the initial fear that was that was out there. That, you know, these nurses, if they start doing something they'll just carry on. You know, and that we were going to put that we're practice evidence -based health care. We still have a long way to go, though.

Did you find that that type of discussion arose from the public or physician groups or government?

All of them, I think. Certainly, the physician group. You know, I can remember having discussions with physicians when I was in my role with the regulator. I remember in particular one physician kind of challenging me saying "you know, you shouldn't be doing PAP smears if you don't understand what the PAP smear results are saying to you" and I'm like "Well, first of all, I do understand what the PAP smear results are saying to me. Secondly, we have specialists in our province that you would refer to, so I would refer as well when we're a little bit stumped." It that was kind of like an 'aha' moment for that physician. They just assumed that we would just stop, I guess, I don't know. It was kind of an interesting time, but alright you know. It was an interesting world, and the Ministry as well had some challenges with understanding you know that that we were very aware of the fact that we were licensed, and we knew our scope of practice, and that, no, we wouldn't be going outside that scope of practice.

There was kind of like an idea that they needed to keep us small, our practice small, so that you know we didn't we didn't just sort of suddenly start doing things that were beyond what we should be doing, or something.

So that everybody could control it.

Yes, yes

Very much control, at least my experience, everybody wants to somehow control (NPs).

Yeah, and I think they probably won over the public first. Certainly the public that were exposed to nurse practitioners, as has happened across the country. Once a person of the public has come under the care of a nurse practitioner, it's pretty rare they want to leave that kind of practice... Once they were exposed to it.

Before they were exposed to it, I know in rural Saskatchewan particularly, there was this fear that if they allow a nurse practitioner into rural Saskatchewan, into a small community,

then they'll lose their hospital. At first, I didn't twig to that and couldn't figure out what they were thinking, but you know I think they thought that the nurse practitioners wouldn't be able to admit and discharge and so then they would have to lose their hospital. So, we had to do a lot of education with the public in relation to that, and we managed to get around that predominantly.

So yeah, it was interesting.

There was a lot of work, you're right, things have settled down quite a bit, but there was a lot of work in the and dealing with the misconception, and really the fear that some people some groups had and some of them were promoted, but I agree it's settled, which is good. It's nice to just work as a nurse practitioner.

In Saskatchewan I still think we have some barriers. It's Saskatchewan is still very physician-centric. Nurse practitioners are kind of only allowed to practice where physicians won't or you know, can't, or whatever.

And to me that's an interesting phenomenon, because in Saskatchewan, as I think the same with in the rest of the provinces there doesn't seem to be problem with replacing RNs with LPN (licensed practical nurses), or RNs (registered nurses) with paramedics. There seems to be this this real shift you know, and I don't know if that's happening in Ontario, but as I said it's happening a lot here.

Oh yeah..

Even though the NP practice has been researched up the 'yin yang' and there is incredible evidence to prove that that our practice is solid and beneficial, and we do improve mortality. We do improve morbidity, we do improve chronic disease outcomes. All that research has been done. It's verifiable research, whereas there hasn't been the research, as far as I know, about the LPN versus the RN, or the parametric. Maybe I'm just not that familiar with it I you know it's a possibility.

But I try and encourage as many as I can, that's for sure. It's so worthwhile and it's just so much fun. I have fun. I really do have fun being a nurse practitioner, absolutely. Every day, 100% of the time? Of course not. But you know predominantly, I can say my job satisfaction with being a nurse practitioner is very, very high, far higher than it ever was when I was a registered nurse. I was, I was very happy and proud to be a registered nurse. I still am very happy and proud to be a registered nurse. But it's but to me it's even it's just the icing on the cake to be a nurse practitioner. To be able to help people at the level that we are able to is very, very rewarding. I just can't imagine doing anything but, to be totally frank. I really can't.

I'm not surprised to hear you say that because I gave tours around the NPLC the Nurse Practitioner-Led Clinic often, or, used to more often than now, RNs who were interested in becoming NPs. I asked the NPs there, you know, do you regret becoming an NP?

Every single one of them said, "Nope, not at all, love it!" So yeah, I think it's a common thread, regardless of all the problems people are still happy with the role.

Absolutely. I don't know any NP that isn't happy with being an NP. I really don't. Whereas unfortunately, you do hear a lot of registered nurses who, are maybe not quite as happy.

There's a lot of stress in working as an RN. It's different. A different type of stress and I think, a lot of it is they don't have the same autonomy. That makes a huge difference. That is great I think this is wonderful!

Well, that is the end of our first podcast and thank you very much to Maureen Klenk for diving in with me head first into this new project. A few things did come up that I wanted to clarify and keep in mind.


The role was called nurse practitioner (NP) in Ontario since the 1970's.

NPAO: Nurse Practitioners' Association of Ontario

CNA: Canadian Nurses Association

CNPI: Canadian Nurse Practitioner Initiative

LPN: Licensed Practical Nurse

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