RNSP Saves Northern Communities From Devastating Impact of COVID-19

Looking back to March 2020, many of us can recall the uncertainty that travelled through Saskatchewan as the first COVID-19 cases were confirmed. What the virus was, how it worked and the potential impact it would have, was yet to be seen, and throughout the province, particularly in northern and isolated communities, there were grave concerns about how to prepare and execute a successful and safe response. Throughout the pandemic we have learned a great deal about how to respond to the needs of the people of Saskatchewan. This includes putting RN Specialty Practices (RNSP) in place to optimize RN practice in a nimble and effective way to meet these needs.

Looking back to March 2020, many of us can recall the uncertainty that travelled through Saskatchewan as the first COVID-19 cases were confirmed. What the virus was, how it worked and the potential impact it would have, was yet to be seen, and throughout the province, particularly in northern and isolated communities, there were grave concerns about how to prepare and execute a successful and safe response. Throughout the pandemic we have learned a great deal about how to respond to the needs of the people of Saskatchewan. This includes putting RN Specialty Practices (RNSP) in place to optimize RN practice in a nimble and effective way to meet these needs.

Wilma Buchanan, RN, has been an RN for 43 years and has spent much of her career working with First Nations peoples. She has worked in Alberta, the Territories and Northern Saskatchewan, and currently supports RNs to meet the needs of the people in her role at the head office of the Peter Ballantyne Cree Nation Health Services.

Together with her other fellow health care professionals, Wilma shared concern with the CRNS for the people in isolated communities as cases began to rise in the spring of 2020. Two of the greatest concerns were about how quickly the virus could spread in the communities and how slowly the COVID-19 test results were being processed. Because of being remote and isolated, and perhaps because of the number of tests being conducted in the province, it could take considerable time to receive COVID-19 results from the provincial lab. It seemed that, “Isolated communities had a very distinct disadvantage because it was taking us so long to get our swabs down to a tertiary clinic or lab to have them tested.” Wilma emphasized that, “If you look at the context of where we live and work, we knew that it was imperative that we have a quicker response to doing the COVID-19 swabs and receiving the results.”

As the virus began to spread in the northern part of the province, swabs were transported from communities in the Peter Ballantyne Cree Nation to Prince Albert, and then taken to Regina to be processed at the provincial lab. Wilma noted that, “A person would leave Southend and drive all the way to Regina to get those tests done.” The turnaround time was so long that there could be a positive COVID-19 case and no one would realize it or have it confirmed for five or six days. This made containment and contact tracing both unreliable and extremely difficult.

It quickly became apparent that countless lives could be lost if there was not a faster way of obtaining test results. Peter Ballantyne Cree Nation soon became aware that the GeneXpert machine was available and could provide quick test result response time directly in the communities. They approached the Northern Inter-Tribal Health Authority (NITHA) to see if obtaining a GeneXpert machine was something they could pursue. Rapid COVID-19 testing in the Peter Ballantyne Cree Nation communities could provide more information to slow the spread of the virus within these isolated areas. Creation of an RNSP Clinical Protocol, for use of the GeneXpert machines would allow RNs to move forward with a positive result without having to wait for the provincial lab to confirm it. Authority to do lab work is required for RNs to utilize the machines. Through the RNSP model, RNs can treat client populations when a directive signed by a physician or Nurse Practitioner is in place to provide the authority – in this case, the laboratory requisition for COVID-19 testing. Additionally, the RNSP outlines the evidence, process and competency requirements for the RNs to ensure that the practice is in the interest of the client in their surrounding environment.

Once it was confirmed that it was possible to acquire the GeneXpert machines, Wilma got to work to put everything in place for the RNs by creating an RN Clinical Protocol by applying the RNSP model. Wilma collaborated with NITHA, the Saskatchewan Health Authority (SHA), Roy Romanow Provincial Laboratory and the College of Registered Nurses of Saskatchewan (CRNS) (then the Saskatchewan Registered Nurses Association) to get everything in place. A total of three GeneXpert machines were made available to the Peter Ballantyne Cree Nation. All parties agreed that creating the opportunity for RNs to use these machines within the context of their practice, could dramatically change the outcomes in their communities. Wilma proudly shared that, “It didn’t take more than a week for everybody to say that we were right – these machines are going to be critical. Everybody that I talked to was right on board with it and helped to expedite it.”

With everyone working together, the first GeneXpert machine was secured, an RN Clinical Protocol for an RNSP was created, and relevant training took place, all within one month. The first GeneXpert machine was placed in Pelican Narrows because it was the largest community. Within six weeks the second machine arrived, being placed in Deschambault and the third placed in Southend.

The addition of the GeneXpert machines and implementation of the RN Clinical Protocol meant that the timeline for obtaining COVID-19 results was reduced from five or six days to only a few minutes! Engaging RNs in the community to test for COVID-19, receive instant results and advise the peoples in the communities helped support the containment of COVID-19 and protect the peoples of Peter Ballantyne Cree Nation. Wilma played a key role as an RN leader in coordinating, collaborating, communicating, and advocating for the people in these communities.

The benefit of the Peter Ballantyne Cree Nation RN Clinical Protocol for use of the GeneXpert was best demonstrated in October 2020 when Southend was the first community in the North to declare an official outbreak. Wilma says having the GeneXpert machine prior to an official outbreak was a saving grace. “If we did not have access to the GeneXperts in all three of our communities we would have had many, many more cases of COVID-19. The GeneXpert and rapid results meant that within half an hour we could isolate that person, we could isolate their family, we could do contact tracing which was very accurate and contain the virus.” Without these machines, and the RNSP that allowed for RNs to facilitate the lab work and testing, the reach of COVID-19 in these communities would have been devastating. Wilma believes that these machines changed the course of the pandemic in the isolated communities of Peter Ballantyne Cree Nation: “If we did not have access to the GeneXperts and were waiting on the labs to run up and down the highway and get to Regina and get reported and stuff, there would have likely been a tragedy in all three of our communities. I truly believe that. Because COVID-19 spreads so easily and people would’ve been in a terrible situation.”

Wilma expressed her gratitude that everyone worked so well together to make the project happen and secure the machines. She shared that, “I don’t know how we would’ve ever managed without the GeneXperts. They saved our lives. Literally, they saved lives.” She concluded by noting that, “RNSP guidelines gave us the legitimacy to work in our scope to its highest potential. They were developed to ensure that the residents we look after are all able to have equitable access to testing and nursing expertise.”

“RNSP guidelines gave us the legitimacy to work in our scope to its highest potential. They were developed to ensure that the residents we look after are all able to have equitable access to testing and nursing expertise.” Wilma Buchanan, RN

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