“I’d been working as a hospital nurse for more than 30 years,” she explains, “and in 2000 I saw a large gap in health services. People weren’t getting the help they needed because they weren’t ‘seen’ by the health-care system.” (Cathy Nickel 2012)Street people are too often "unseen" because health care human resources are naturally over-concentrated in doctor-run medical clinics and hospitals--the two areas that are most easily funded under our fee-for-service health care system. Tracey, who is currently a primary care/psychiatric outreach nurse practitioner based out of St. John’s Community Kitchen in Kitchener, Ontario, has as her core idea improving services delivery outreach: “I work with the psychiatric outreach team to go where needed, when needed to provide care and facilitate connections to the many services this population needs,” she says.
As a British Columbian, I can see how this adds a whole other dimension to the value of training more nurse practitioners, especially among the aboriginal population. Not only are they needed to improve health services delivery in small or remote communities that don't have full time resident physicians (this is a commonplace observation made by politicians), but also to improve services delivery to the street people of downtown Prince George, Kamloops, Williams Lake, Nanaimo and East Vancouver. Another implication: more First Nations nurse practitioners are simply worth their weight in gold, wherever they choose to reside.
There is a federalism dimension to this as well. as my colleague Katherine Fierlbeck has commented, the decline in conditional funding in recent years has meant that provinces don’t have to worry about channeling their money into these kinds of programs; now provincial governments have the discretion to use health care money as they see fit, rather than being limited by the Canada Health Act. So don't thank Harper's "open federalism" (i.e. less money and looser reins except for the Onsite Clinic?) for what Tracey Collins has accomplished. Blame recent federal governments for creating conditions that make innovative programs such as this less likely to occur.