We're Hiring! Third LPN post now open to applications

We are looking for a dynamic Licensed Practical Nurse to join our Primary Care Team as a Practice Nurse.

We have a busy, exciting, paperless practice with over 3,000 patients in brand new premises in the Sherwood Medical Center in Charlottetown. The three Practice Nurses have their own clinics seeing patients in conjunction with or under the supervision of the Family Physician. They also implement our computerized Annual Health Checks, run Initial Appointment clinics for new patients, and staff a daily Walk In Nurse Clinic for procedures and investigations.

Duties include: 

• General measurements
• Use of electronic medical record
• Spirometry
• 12 lead ECGs
• Chronic disease monitoring
• Overnight oximetry
• Health screening
• 24 hour BP machine
• Taking blood
• INR near patient testing
• i.m. injections
• Audiometry
• Syringing ears
• PAP smear tests
• Travel advice
• Wound care
• Preparing investigations and organizing referrals
• Health promotion

The Practice Nurse will work within her or his scope of practice to the protocols in our Practice Nurse Procedures manual and will receive in-house training and competencies certification where appropriate from the R.N. and Family Physician.

The rate of pay is $22.50 per hour with excellent contract terms including an annual study budget and generous paid vacation time. The post is initially for 9 months with the possibility of permanent employment after that. The start date is March 2010.

The successful candidate will have excellent people skills, a positive outlook, good computer skills, a love of learning, a desire to embrace positive change, and a personality that will fit in well with our close, informal team.

Please download an application form and job description and return your completed application by email, fax, or post.  The closing date for applications is 1st March 2010.

New Members of Staff

We'd like to welcome our new Practice Nurse, Dawn Rodd, and our new receptionist, Margaret Pippy, who have recently joined the practice.  They are an excellent addition to our growing team, and we are delighted to have them in the team.

Oxycodone and Hydromorphone

We don't prescribe oxycodone and hydromorphone.

Virtually all the patients who have joined the clinic taking one of these drugs will be moved over to safer alternatives over the next six months.

Chronic pain is a common problem for primary care doctors - disabling arthritis, back pain, nerve pain.  When choosing a medication that will treat long term pain, it is important to choose ones that are effective and continue to work over long periods of time.

The best choices are a combination of acetaminophen, anti-inflammatories, gabapentin (an anti-epileptic), and amitriptylline (an antidepressant).  It is also very important to treat depression in chronic pain patients, as virtually all such patients will become depressed over time which makes their pain worse.

The worst choices are hydromorphone and oxycodone.  These are extremely dangerous drugs, and a very poor choice for long term pain.  The reasons are 1. they produce a 'buzz' or 'high' which is extremely addictive, and 2. patients become rapidly tolerant to them and need higher and higher doses for the same effect.

The street value for these drugs is very high as a result, and they are now the most common drug of addiction in Canada.  They now cause far more damage than heroin or cocain and because the dangers are not widely known they are addicting a wide range of people who would not normally be exposed to dangerous drugs.  Once exposed to these drugs, the less dangerous drugs are less effective because the 'buzz' is missing.

It is rare to see oxycodone prescribed in Scotland.  I've only seen them used in terminal care of dying patients.  There are two reasons for this:  1. the heavy marketing of the drug in the US by the manufacturers, and 2. the widespread use of pharmacy advisors who monitor the prescribing of drugs in the UK.   Yet, I see far more chronic pain problems here than I do in Scotland.   It could be that the use of these drugs is actually increasing the chronic pain problem by addicting patients rather than treating them.

If an opiate drug is required, then it is vital to use one that produces less 'buzz' or 'high' as these are less addictive.  For example, tramadol.

Sadly, PEI Medicare currently covers the dangerous opiates but does not cover the less dangerous ones, although the prices are similar.   I would encourage the PEI Department of Health to review this decision.

For terminal care patients addiction is obviously not an issue and we will continue to use all the drugs available to us to relieve pain in these patients.

Patients bringing lists of problems to the clinic

We have been experiencing long waits in our clinics recently, which have been running over an hour behind frequently.

There are lots of reasons why doctors run behind - for example, they may receive an urgent phone call, an emergency may occur, or a patient may be much sicker than they realised and may require a lot of time.

However, the main cause of our clinics running late just now is patients bringing long lists of problems with them to their appointments.  Quite a few patients have been attending with lists of between 5 and 10 problems that they want to discuss!

This is understandable - many of our patients have been without a family doctor for years.  They have many issues they wish to discuss.  We are very busy, and they may not want to wait again to discuss those issues. 

We don't want to impose a 'one visit, one problem' limit on our patients.  And we have several nurses/technicians helping with each clinic to make sure we deal with as much as possible in the time available.

But, we only have between 5 and 20 minutes per patient, and it really just is not possible to deal with more than one or two problems in that time.

To avoid long waits, and to provide safe care, we will now be prioritizing the problems when there is more than one.  Patients bringing long lists will find that simply organizing the list will take up the first appointment, and they will then be advised how many appointments we think will be required to work through their list.