Nurse practitioners play an essential role in the Canadian healthcare ecosystem. Like physicians, they have the ability to diagnose conditions, prescribe medications, and manage ongoing conditions. In this interview, Amra Dizdarevic, Nurse Practitioner at TELUS Health Care Centres, shares what her day-to-day looks like, why she became a nurse practitioner, and her thoughts on virtual care.
Why did you go into nursing?
I came to Canada as a refugee from a war-torn country, Bosnia and Herzegovina, where I saw much human suffering. I was 13 years old when the war started and I saw the enormous role doctors and nurses played during that time. It left an indelible impression on me and directed my choice of profession.
What does your role look like as a nurse practitioner?
As a nurse practitioner at our Care Centres, I provide comprehensive primary care to families. I diagnose and treat common and predictable diseases, order and interpret laboratory tests and diagnostic imaging (such as x-rays, ultrasounds, MRIs), prescribe medications, and make referrals to specialists, as needed.
Health promotion and prevention of disease and injury also play a large and important role in my practice. While nurse practitioners practice autonomously and independently, we collaborate with other clinicians: physicians, dietitians, kinesiologists and psychologists, to name a few, and that further enriches our practice. While I provide care to individuals of all ages, the majority of my patients are children, adolescents and young adults.
What is your day-to-day like?
Every day is different, and that variety is something I quite enjoy. I may start my day by seeing a newborn for their first assessment and physical examination following their discharge from the hospital, then I could see an older child for their comprehensive annual assessment and developmental check.
In between my scheduled appointments, I may make phone calls to check on progress of a healing wound or to inform patients of their test results. Many of our patients communicate by email with questions ranging from COVID-19 to screen time for their children - so any spare moment between scheduled patients is typically spent answering the emails I receive.
After that, there may be a virtual consultation with a teen who I am treating for symptoms of anxiety and depression or ADHD. I completed a mini-fellowship in pediatric psychopharmacology and it gives me additional competence and confidence in managing common mental health conditions. I have seen an increase in mental health concerns since the start of the pandemic, and taking the time to provide supportive counselling was especially important when access to psychologists and counsellors was limited due to increased demand.
My role makes for interesting work because I never know what the next visit will be. Prior to the pandemic, I provided travel medicine consults and immunizations, and I quite miss that aspect of my practice. Collaboration with colleagues is another part of my job I enjoy: sometimes it means connecting with a dietitian about a patient who is displaying signs of disordered eating, or presenting an education session to our nurses to enrich their practice.
What is your favourite part of your role?
My favourite part of my role is definitely the meaningful connections I have with my patients. Each person has a story and unique needs. Rather than having my own agenda on what to focus on and “fix”, I listen to their story, find out what their health goals and priorities are and support them in that. This creates a strong and genuine connection and a meaningful partnership as we work together on enhancing their health. I focus on personalized care that is tailored to fit patients’ needs, and believe in the importance of continuity of care in the ongoing relationships I have with my patients. Both personalized care and continuity of care can lead to better health outcomes for patients.
How do you feel Canadian patients are benefitting from virtual care?
Virtual care both enhances the care we provide and improves access to care. Virtual care became so crucial throughout the COVID-19 pandemic, especially during the early days as it allowed Canadians to access care from home and reduced visits to emergency rooms and hospitals - allowing healthcare professionals to focus on patients who needed urgent care and reducing potential transmission of COVID-19 in in-person care settings.
Before the pandemic, I provided care by phone and email when needed, but I now use video calls to care for my patients as well. Virtual care improves access to care; for example, a young adult with anxiety who is in the middle of their final exams may be too stressed and time-pressed to drive to an in office visit, but is usually very open to a video call during which I can assess their mood and affect, progress on medication and provide supportive counselling. Virtual care can also reduce costs, travel and time spent in the waiting room. I recently read a study that showed that virtual care can also help our environment, primarily by reduction in transport-associated emissions.1 So I am hopeful that we can continue to integrate many aspects of virtual care in our practice even after the pandemic.
1 Future Healthcare Journal: Does telemedicine reduce the carbon footprint of healthcare? A systematic review. https://www.rcpjournals.org/content/futurehosp/8/1/e85