Becoming a Registered Nurse

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Providing the Right Care at the Right Time

“This is an exciting time to be working in health care, with lots of opportunities for nurses in all kinds of fields, to be a part of the change and evolution in nursing.”

– Marianne Stewart, Capital Health (Edmonton Area)

March is diabetes month. To mark the occasion, CNA salutes Marianne Stewart, a nurse and vice- president and chief operating officer, primary care division at Capital Health (Edmonton Area).

Edmonton has an aging population and obesity epidemic. As the Executive lead for the redesign of Capital Health’s Regional Diabetes Program, Stewart is well aware of the issues facing those with diabetes. In her words: “The problem is access to treatment.” Stewart and her team introduced a new model of service delivery. The new service model’s focus is on providing an integrated, standardized approach for treating people with Type 2 diabetes. The emphasis of the new model is to support clients in managing their condition. Referrals from family physicians are coordinated through one central service. For education and assessments, clients work with various providers including a nurse, dietitian and physician.

From Stewart’s perspective, “The success of our redesign work is demonstrated by the fact that people are no longer experiencing long waits for their care. Success is also evident in the way the staff now work with one another. The professionals are a tighter, more cohesive team; they are more effective and efficient; and they have a greater appreciation of how all professions contribute to better patient care.”

Stewart’s work at Capital Health highlights the importance of bringing together the right provider at the right place and the right time, with the patient as the primary focus. CNA believes that is one of the fundamental first steps in much-needed health-care reform.

Stewart began her journey in health care with a bachelor of nursing degree from Queen’s University. She held a number of clinical positions as a children’s psychiatric nurse, a community health nurse and a maternal and child nurse consultant. Stewart feels the best part of clinical work is working with patients and their families. “One of the greatest rewards in nursing is helping clients along a healthier continuum, to seeing them blossom as they take hold of their health,” she says.

Stewart went on to do her master’s of health science administration at the University of Alberta, a degree that positioned her to take on administrative roles. Her most satisfying position is the one she now holds, which enables her to make the changes she has longed to see in the health system. “The most rewarding part of my daily work is thinking through and implementing system change and cultural shifts that advance the primary health care reform agenda and improve health system delivery to enhance patient care,” says Stewart. “This happens within the context of the great team of dedicated professionals with whom I work.”

As the Health Council of Canada states in its March 2007 report Why Health Care Renewal Matters: Lessons from Diabetes, health providers will need to move from a “find it and fix it” method to a “prevent it, find it, manage it” approach to primary care in Canada. The council has made the following three recommendations to combat diabetes incidents: (1) change the way we organize and deliver health care for people with chronic health conditions such as diabetes; (2) provide better care for high-risk populations; and (3) coordinate sustained action on prevention.

Capital Health (Edmonton Area) has already put these recommendations into practice through its redesigned diabetes program. The organization is now applying what it learned to other areas. “Successful reprocess engineering for diabetes has given us the confidence to tackle the delivery of chronic disease management program within Capital Health,” says Stewart. “The organization supports effective and efficient linkages to specialist care.”

Stewart’s work takes her beyond Edmonton and Capital Health with opportunities to speak at international conferences. She presented the context and issues facing the treatment of diabetes at the first annual Taming of the Queue conference in 2004. With a track record of success and hard work, Stewart is well aware of the essential role nurses play in patient care. “This is an exciting time to be working in health care,” she reflects, “with lots of opportunities for nurses in all kinds of fields to be a part of the change and evolution in nursing.”