By Catherine Danko
Courtney Lindsay never envisioned that her work as a nurse practitioner (NP) would one day be conducted through a computer screen.
As an NP who splits her time between UHN's online and in-person Emergency Department (ED), learning to consult patients virtually has become an integral part of her work duties.
"It was a learning curve because as an emergency provider, I've always worked in the hospital in a face-to-face environment," says Courtney, who meets with patients via video calls twice a week to help treat and diagnose a variety of urgent conditions that are not life threatening such as rashes, sprains and minor injuries, eye infections and cold and flu viruses.
For Courtney, one advantage of working in the virtual ED is its UHN-centralized approach. This means the patients she treats are already familiar with the internal specialized services, making it easier for her to help guide them through their medical situations.
"As UHN emergency providers, we have specialized knowledge in treating some of our UHN sub-specialized populations across the province, which may be more challenging in a peripheral Emergency Department or walk-in clinic," says Courtney, whose role encompasses the same scope as that of a physician when it comes to assessment, treatment and diagnosis in the ED.
"This means that we can provide timely and efficient care to all patients through our virtual platform, whether the condition is an episodic complaint or complex," she says.
Nov. 10 to 16 is Nurse Practitioner Week across Canada, a time to recognize the vital role they play in health care. Whether primary, acute or specialty, NPs provide care to many patients across the lifespan, alleviating some stresses caused by a primary care shortage.
At UHN, there are about 160 NPs across all five hospitals providing a wide range of services, including assessing and triaging patients, ordering and interpreting diagnostic tests, diagnosing illnesses, developing treatment plans and referring as required.
Investing in the expansion of NPs is a key solution in advancing UHN's mission of A Healthier World.
"Discovering innovative solutions to decrease wait times and increase access in the EDs and provide primary and specialized care to patients is a key priority at UHN," says Tara Bolden, Nurse Practitioner Lead, Collaborative Academic Practice.
Tara emphasizes this investment in NPs is ongoing, with UHN continually exploring inventive ways to ensure they work to their full scope of practice to optimize contributions to patient care, scholarship, education and leadership across the organization.
"NPs are integral to these solutions, as they play such a crucial role in the areas they work in, bringing a holistic perspective that isn't solely focused on a single pathological issue," she says. "Giving consideration to all elements and factors that impact a patient's health and wellness is key in providing high quality, comprehensive care."
Toronto's Virtual Emergency Department, which includes UHN and Sunnybrook Health Sciences Centre, is a virtual care program supported by Ontario Health that offers online urgent care services from emergency nurse practitioners and physicians across the city.
Initially operated solely by physicians, the program has evolved significantly since its inception in 2020. In 2023, the Ontario Ministry of Health provided funding to expand the program to be NP-led.
NPs often work in collaboration with physicians and other health care professionals to deliver comprehensive care, and they play a crucial role in promoting health and preventing disease.
Since the virtual ED is staffed by just one NP at any given time, skills such as autonomy and independence are crucial.
"It's an interesting role because nurse practitioners typically work within a large team where there's lots of direct consultation available," says Courtney.
"Those of us working virtually have excelled in maintaining a NP-led program, which has involved establishing standard operating procedures and protocols for managing patients, developing training documents and resources for our newer NPs joining the team, and providing a pathway for follow-up from our EDs."
What Courtney loves most about working in emergency medicine — whether virtually on in-person — is the "hands-on skills" that she gets to do, exercising her full scope of practice and seeing a diverse portfolio of patients independently.
"What's been most rewarding virtually is being able to find innovative ways to provide care to patients, especially when we know that many people don't have great access to primary care," she says.
"Being able to expand our urgent care services and expertise beyond the walls of the hospital and demonstrate that a virtual ED can be NP-led is something I am very proud of."
