For the past year, Ellen Gretsinger, a nurse practitioner in Niagara, Ontario, has provided patients with medical a*sistance in dying – without being paid for it.
She has a full-time nursing job and a side job providing virtual care. In the evenings and weekends, she evaluates patients for medical a*sistance in dying – known as MAID – and administers the procedure.
Like many provinces, Ontario does not have a mechanism for nurse practitioners to take on independent work and be paid for it, such as a fee-for-service structure often in place for doctors.
And the demand for MAID is increasing across the country. Gretsinger therefore does the work for free. She believes in it, especially after seeing her mother suffer before dying of cancer.
“I just think that when people are suffering, and they’ve been told they can access it, then the access needs to be there,” Gretsinger said in a recent interview. “That’s why I decided to do everything I can.”
The number of doctors and nurse practitioners available to administer MAID in Canada has not kept pace with growing demand.
A report released last month by Health Canada shows that the number of medical a*sistance in dying providers has increased by an average of 18 per cent each year, but the number of medical a*sistance in dying – often called a benefit – has increased by nearly 33 percent each year. Under federal law, MAiD benefits and evaluations may be performed by nurse practitioners or physicians, and each application must be evaluated by at least two providers.
There are a multitude of reasons health professionals may not agree to requests for MAID, from overwork in a strained system to hesitancy about MAID itself, said Dr. Tim Holland, head of bioethics at Dalhousie University. He considers medical a*sistance in dying the greatest cultural change related to medicine since abortion.
But there are nurse practitioners like Gretsinger who are eager to do this work.
“Finding a model that would allow nurse practitioners to do that, in addition to their regular practice, would go a long way toward increasing capacity,” Holland said in an interview. “Every time we have a MAID conference, (the question) comes up every time? “How are we all going to advocate for nurse practitioners to be paid? »
Stan Marchuk, president of the Canadian Nurse Practitioners Association, said he knows “a number” of nurse practitioners who do unpaid work under MAID.
In fashion now
“I think it speaks to the fact that we just don’t have good compensation mechanisms in Canada for nurse practitioners,” he said in a recent interview. “We need more flexible compensation models to allow nurse practitioners to be able to practice fully in Canada.
Nurse practitioner compensation models have remained largely unchanged for decades, despite significant innovations in medicine and health system reforms, Marchuk said. In most provinces, nurses are salaried and tied to health authorities, with no way of being paid for work done outside of their job.
Physicians, meanwhile, bill health authorities for any work they do, Marchuk said, adding that his organization advocates for more flexible compensation models that would allow nurse practitioners to offer more services — or even to create independent firms providing MAID a*sessments and services.
“I think that’s really shameful? people are providing a service for which they are not paid,” he said.
British Columbia has made progress in offering different compensation models, and Alberta is considering it, Marchuk added.
In Newfoundland and Labrador, nurse practitioners can report up to five hours of overtime to complete an a*sessment or provide MAID outside of regular shifts. This is a new rule that is part of the collective agreement between registered nurses and the provincial government, signed in July. Before that, nurse practitioners did their work for free, on their own time, just like Gretsinger, said Yvette Coffey, president of the Registered Nurses Union of Newfoundland and Labrador.
“They saw the need,” Coffey said in a recent interview. “And at the end of the day, it’s the patients’ needs that trump everything else.”
Gretsinger said she would like to see Ontario health officials offer nurse practitioners a billing code for the work she does on medical a*sistance in dying. In the meantime, she will continue. She fears that if she refuses these evaluation requests, patients will suffer longer. She said a woman had to adjust her desired day to die four times because it was difficult to find providers.
“She suffered for two more months,” Gretsinger said. “It breaks my heart.”
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