My Health Care Role

I am a Site Clinical manager in the largest regional health authority in St. John's Newfoundland. This role is carried out under the umbrella of clinical efficiency within Eastern heath. Eastern Health is one of 4 regional health authorities in the province that are subject to mandates by the Health and Community Services department of the provincial government. In this role I am responsible for issues that arise on the nursing floors of the facility to which I am assigned in the after hours and tasked with placing patients which often means finding space in hospitals that are already at or over capacity. Access to health care and the department of clinical efficiency are inextricably linked. Site managers collaborate with senior management, physicians, management and frontline staff to implement strategies that improve patient flow throughout the continuum of care.

The Canada Health Act's primary principle is focused on access to health care. It strives to create equality when it comes to medically necessary health interventions across the board no matter a person's financial standing (Government of Canada, 2019, Aug 17). Newfoundland and Labrador is a province that geographically challenges this ability to allow equal access to health care. The province's only tertiary care facility is located on the Avalon Peninsula along with approximately half of the province's population. This is not a centrally located facility however and much collaboration and cooperation among regional health authorities and paramedicine is required to work towards achieving access equality.

My background as a Registered Nurse (RN) helps me make informed decisions. As an RN I am governed by the regulations that the College of Registered Nurses of Newfoundland and Labrador (CRNNL) imposes on me. These regulations are developed with the over-site of officials from the Department of Health and Community services and help to ensure safe and competent patient care (CRNNL, 2014). I have also relied on input from the Canadian Nurses Association(CNA) which helps define the role of a registered Nurse in Canada and helps nurses uphold standards of care (CNA, 2015). The CNA includes administration as way in which RN's help to provide care to populations throughout all stages of life, this would be encompassed in my role.

My nursing background allows me to discuss with the team the patients condition and understand the acuity so that the proper level of urgency is placed on a patient's placement. In providing access to care I collaborate with many members of the health care team. To better illustrate the process involved I will give you an example of a patient that is requiring intervention in the Cath lab but is in hospital in Corner brook (over 600 km away). The patient is within the Western Health authority so the sending physician must first contact an accepting physician in Eastern health to begin the transportation process. The accepting physician then, ideally, contacts me or my counterpart within the clinical efficiency program to inform me of the patient's plan. I may ask about the level of urgency in transporting this patient especially if there is no bed available. If there is no bed available in the hospital the patient may require boarding in the emergency department which effects the access to care of all of the patients in the waiting room. I may call the site manager at the sending facility and see if there is a possibility that we could repatriate one of their patients in order to free up capacity for the new patient. Once the approval is given to accept the patient I then speak with the flight team dispatch liaison as a plan is worked out to retrieve and place the patient. I may speak to the charge nurse of the accepting floor to discuss discharges and possible bed assignment not to mention staffing which relates to capacity to take this patient. I may have to speak to the charge nurse in emergency with regards to the possibility of the patient being boarded there. During this process I may also be talking to our social worker who works with patients to find long term care placement or supports to return home when appropriate. Our social worker is integral the patient flow of the hospital. Over capacity in the facility or lack of flight team due to various reasons frequently delays treatment for patients in the outskirts of the province. Sometimes alternative plans must be made with paramedicine. So many teams are involved in ensuring patient flow.

My work experience guided by my professional bodies CRNNL and CNA and by the policies created for Eastern health by the government department of Health and Community services help me perform my role in this health care system. My role involves a lot of autonomy but with guidance from colleagues and values reinforced by nursing's professional bodies I am able to make clinically responsible decisions, and hopefully some day even effect real change.

The College of Registered Nurses of Newfoundland and Labrador. (2014) What is the CRNNL. Retrieved September 28/2021. https://www.crnnl.ca/what-crnnl

The Canadian Nurses Association. (2015) Framework for the Practice of Registered Nurses in Canada. https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/framework-for-the-pracice-of-registered-nurses-in-canada.pdf?la=en&hash=55716DC66A8C15D13972F9E45BE4AC7AE0461620.

Government of Canada (2019, Aug 17) Canada's Health Care System, canada.ca https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html#a3

Site Clinical Manager job descriptions.pdf

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