The Yukon is the only jurisdiction in Canada without nurse practitioners.
And that “surprises” Judith Shamian.
“I thought the territories would be leaders on this,” said the president of the Canadian Nurses Association.
In most Yukon communities, it’s nurses who care for the residents.
“So they’re already acting in an extended role,” said Shamian.
But Yukon’s nurses can’t diagnose their patients, write prescriptions, or refer them to specialists.
Nurse practitioners could.
“Yukon communities would be better off with nurse practitioners,” she said.
“This would give them access to primary care.”
Regulations are still in the works to allow nurse practitioners to work in the Yukon.
“They can’t practice here until those regulations are approved,” said Shamian.
“So I hope the government passes this quickly, because I think Yukoners would really benefit.”
Yukoners would benefit even more if the government changed its hiring policy, she added.
Touring the territory this week, Shamian heard numerous complaints from nurses about government hiring practices.
“Nurses would like to see more permanent positions,” she said.
“Because they can’t make a life here, or enrol their kids in school if they’re only offered term positions.”
The regular turnover also breeds dissatisfaction in the communities, said Shamian, who’d just met two nurses in Dawson.
Both nurses live Outside, but spend six to eight months in the territory.
“But not in the same community,” said Shamian.
“They may spend two months in one community, then four in another.”
It would be better for the communities to have full-time nurses, she said.
“And it would also be more cost effective.”
The Yukon seems to lack a comprehensive health-care plan, said Shamian.
“I don’t see a five-year plan, or a collective planning effort,” she said.
“But the territory is small enough, we should be working together.
“The top-down approach, where decisions are made without involving the community, doesn’t work well.”
Right now, Yukon health care sits in silos, said Shamian.
“But if you are one individual, why would you take your diabetes issues to one person and your mental-health issues to another?”
The Canadian Nursing Association is calling for “collaborative practise,” she said.
Shamian sees family physicians and nurse practitioners across the country working side by side.
In Ontario, some clinics don’t even have physicians and are run solely by nurse practitioners.
More than five million Canadians don’t have access to primary care or a family physician.
“More nurse practitioners could change that,” said Shamian.
“The quality of care nurse practitioners provide is as good as a family physician.”
Instead of using the emergency room as a walk-in clinic, and hospital beds for continuing care, the Yukon should be using nurse practitioners, she said.
“It would help diffuse the major challenges facing hospitals, whether it’s an overcrowded ER or a lack of free beds.”
In the Yukon, Shamian talked to nurses who were interested in training to become nurse practitioners.
“But the government has to make a commitment to fund those positions before nurses pay for the additional education and training,” she said.
“If there were no funded positions, then it would be useless.
“Nurses need to know their future.”
Shamian grew up with a very ill parent.
“As a young girl, I grew familiar with ambulances and hospitals,” she said.
“The rest is history.”
Now, aside from her role as president of the nursing association, Shamian also heads up the Victorian Order of Nurses, Canada’s largest nonprofit, focusing on home and community care.
Nurses work with the vulnerable, the down-and-out and the hard-to-house, she said.
“And we have a lot of solutions.”
More than 25 years ago, in London, Ontario, a nurse started to help patients at the local Salvation Army shelter.
“She didn’t have permission to be there,” said Shamian.
“But she knew there was a lot of need.”
Almost three decades later, the London shelter has 10 health care professionals caring for its homeless population and acts as a poster child for other shelters in the region.
It can take years to change policy, said Shamian.
“And this frustrates a lot of people, but we can’t give up.”
Canada’s health care is falling behind.
Infant mortality and child poverty is on the rise, she said.
“And this is Canada – it’s a well-to-do country with people who care.”
Nurses have solutions, said Shamian.
“And we want to be part of those solutions – we want to be at the table.”
Contact Genesee Keevil at