Pembroke -- Jean Benton was a pioneer in the role of nurse practitioner (NP) in long-term care when she was hired by Renfrew County in 2000.
Thirteen years later, after serving at both Miramichi Lodge and Bonnechere Manor, she began a short-lived retirement.
Two years later, in 2015, her skills were needed to cover a maternity leave at Marianhill in Pembroke. She returned in 2017 to cover another leave there. The following year she was hired by Marianhill again, but this time for a permanent position.
As of June 3, 2022 she is once more retired, not surprising since she is now 75. But the move is leaving her with mixed feelings.
“I’m sad,” she said. “I’m leaving the best career possible.”
She acknowledges that more high-visibility fields in health care, such as pediatrics or intensive care, may appear more glamorous than long-term care.
“Nothing is more satisfying than making a difference to patients, helping to control symptoms (of disease processes) and ensuring they are not suffering,” she said.
Ms. Benton’s nursing career began more than 50 years ago, when the Alberta native entered the nursing program at Grey Nuns Hospital in Regina, Saskatchewan. She went on to earn her degree at the University of Ottawa, from where she eventually also earned her NP qualifications. At the time it was a one-year full-time program for registered nurses with extensive nursing experience.
“I was working at the time, so I took the course on a part-time basis over two years,” she said.
It is now a two-year program tied in with a Master’s degree.
In 2000, she was a key lead in a Ministry of Health pilot project to bring NPs into long-term care. The pilot evolved into a permanent position.
NPs bring to their role advanced nursing skills and knowledge, and overlap with medicine in that they are qualified to prescribe almost all medication and order most diagnostic tests – until now.
“We haven’t been able to order MRIs (magnetic resonance imaging) or CT (computed tomography) scans,” she said. “But that’s changing as of this coming July, when those also will be included (in the NP’s scope of practice).”
In the early days of the profession, NPs were much more restricted in their ability to order medication and diagnostic procedures and had to rely on doctors to carry out their recommendations arising out of their assessments of patients.
Sometimes members of the public used to compartmentalize health care professionals as either “nurses” or “doctors,” and didn’t quite know how to think of NPs.
“I had one 102-year-old resident who had a hard time remembering the term, ‘nurse practitioner’,” she said. “She used to call me the ‘near doctor’.”
She firmly believes every long-term care facility should have an NP on staff so they can monitor the residents on an ongoing basis.
“Doctors come and do clinics and then they’re gone,” she said. “Embedded in the clinical role is that of mentor to the staff to ensure that residents are getting the care they need. Improved access to care, at the time it’s needed, results in decreased transfers to hospital. The research is clear that taking cognitively impaired people to hospital results in more problems than when they are diagnosed and treated onsite.”
She has also observed that older persons don’t always get the priority that is due them in visits to hospital ERs.
An NP can also be a key part of communication with and support for families of their patients.
“In long-term care, our unit of care is the resident and their family,” she said. “We provide holistic care, not only for the person but also for the family.”
She spends a great deal of time with powers-of-care for residents and with the residents’ families.
“I help them understand the progression of chronic illnesses,” she said. “We have a lot of family meetings to educate them so that they aren’t taken by surprise when they have to make tremendous decisions.”
She said residents coming into long-term care today are much frailer with much more advanced disease processes than in earlier decades.
“The average stay in long-term care is 18 months,” she said. “People are often coming to us for palliative or comfort care.”
She acknowledges there is still a long way to go in providing client-focused and family-focused care in long-term care settings.
“Sometimes routines prescribed by the Ministry of Health get in the way of person-centered care,” she said. “But regulations are hard to change.”
She believes that, even under the best of circumstances, institutional long-term care should be a last resort when home care doesn’t work.
Prior to her times at Renfrew County homes and Marianhill, she worked at another long-term care facility, St. Vincent’s Hospital in Ottawa. That time solidified her passion for working with older persons. She initiated activities for residents which included bringing in people from the community to make gingerbread houses with the residents and engaging them in quilt-making.
“I came to realize that I was improving their lives,” she said. “People are psycho-social-spiritual beings. They (the shared activities) sparked a lot of wonderful conversations.”
Throughout her years of work in Pembroke and Renfrew, she has commuted daily from her home in west end Ottawa.
“I haven’t minded it at all,” she said. “The drive is my ‘thinking time,’ when I debrief after the day’s events or prepare for a new day. It’s in the country and I can see nature changing with the seasons.”
She is appreciative of the doctors she has worked with in her role.
“We have worked extremely well together,” she said.
She applauds the Ministry of Health’s goal of hiring more NPs for long-term care.
“The big issue is, where do you find the people?” she said.
Marianhill CEO Linda Tracey says the residence has been very fortunate to have Ms. Benton on the team these past few years.
“She has a wealth of knowledge, and she has continued her research to ensure best practice care,” she said. “The physicians and nursing staff benefitted from her experience, but the greatest impact she had was with the residents and family members. Her approach to care, and to end-of-life care particularly, combined medical expertise with care and compassion. She lived our Mission and Values in every interaction.”
There are approximately 200 residents at Marianhill.
Marie Zettler, Local Journalism Initiative Reporter, The Eganville Leader