November 15, 2014
Shawn Dookie, NP-PHC
I work at the Anishnawbe Mushkiki Nurse Practitioner Led Clinic in Thunder Bay
I graduated from the Primary Health Care Nurse Practitioner Program at Lakehead University in 2012. After graduating, I started working at the Anishnawbe Mushkiki Nurse Practitioner Led Clinic in Thunder Bay, Ontario. I have built up a busy roster of just over 800 active clients since starting here. I consider myself lucky because with the help of my team, I was able to start fresh and focus on building a strong rapport with every one of my clients, helping them to develop their own plans to improved health.
Our clinic is unique because it is an interdisciplinary, nurse practitioner-led team that focuses primarily on managing complex chronic diseases. We are part of a First Nations-led organization, but our services are available to anyone who does not have access to primary care: my clients are an eclectic mix of cultural, socio-economic and ethnic backgrounds. A lot of my patients travel far to attend appointments, from isolated First Nations to remote communities surrounding Thunder Bay. Many of my clients are individuals who have had a hard time finding appropriate care elsewhere, especially those with complex mental health conditions, addictions, the homeless or under-housed, and our diverse urban Aboriginal population. For a new graduate NP in this environment, the learning curve was closer to a cliff, two years later I am still challenged with new experiences every day.
On a typical day, I see around 10-12 clients in-person. In order to accommodate the diversity of our clientele, my day is a mix of pre-booked appointments, advanced access and same-day appointments that range from 15 minutes to one hour. As a lot of my colleagues can attest, most of chronic disease management happens behind the scenes: I spend a significant amount of time every day collaborating with colleagues, building partnerships with community allies, and working to ensure that I am providing the safest, most efficient and effective, evidence-based care for my clients. I also try and make the best of the technology available to us, I encourage clients to communicate by email and often have phone follow-ups with clients. Because of this, days tend to be quite unpredictable, and our entire team has to be flexible to meet the demand. I work in tandem with an amazing group of professionals in our clinic (nurses, a dietician, a social worker, administrative support and our consulting physician), as well as support from various community agencies, to help individuals promote health, manage their acute illnesses and chronic diseases.
There are many ways that I measure outcomes in my practice; I look at the improvement in a diabetic clients’ blood sugar control after adjusting therapies, or a decrease in someone’s low density lipids, or “bad” cholesterol after lifestyle counselling, or number of COPD exacerbations… and on paper, it is good to know that I am working effectively. I’m sure it’s the nurse in me that looks for the more subjective signs of improvement: I find the most rewarding and encouraging outcome to measure is my clients’ feedback at the end of their visits. I know I am doing something right when my clients leave the clinic happy with their plan. I am confident that with flexible access and the time spent on relationship-building, my clients will let me know if something is awry. I think that alone, helps to improve overall health outcomes.
