How Nova Scotia Health’s COVID-19 care directive informed the province’s swabbing strategy

Alison MacNeil is an emergency support aide (ESA) in Cape Breton who is responsible for swabbing under the guidance and direction of a regulated health care professional as determined by the COVID-19 care directive.
Alison MacNeil is an emergency support aide (ESA) in Cape Breton who is responsible for swabbing under the guidance and direction of a regulated health care professional as determined by the COVID-19 care directive.

The success of Nova Scotia’s ongoing COVID-19 testing strategy that has gained praise from jurisdictions across Canada can be attributed in part to the COVID-19 care directive that was put in place in March of 2020 when the pandemic began.

A care directive provides consent to a care provider to initiate a task within their scope of practice without a physician order, because the care directive serves as a physician order.

“In the eye of the pandemic, we had to ensure we were maximizing our resources, keeping our patients safe, keeping our care providers safe, and creating a scope of employment that would allow more professionals to have the authorization to swab and test for COVID-19,” said Jennifer MacDougall, Director Interprofessional Practice and Learning for Eastern Zone, which spans Cape Breton, Guysborough and Antigonish area.

The COVID-19 care directive, along with care directives in general, offer the benefit of expedited care to the patient.

The COVID-19 care directive expands the eligibility of providers who can swab for COVID-19, enabling regulated and unregulated care providers to broaden their job duties. In addition to having more providers trained to swab, other health care providers such as registered nurses (RNs) and licensed practical nurses (LPNs) are able to remain at the point-of-care and expand their scope of practice as it relates to fighting the COVID-19 pandemic.

“When the pandemic broke out, it really came down to us having to say: Our RNs and LPNs cannot be the only option we have to swab Nova Scotians for COVID-19. We need them to stay in their care settings as much as possible,” said MacDougall. “We needed to figure out how to incorporate other providers, especially unregulated/unlicensed professionals into the swabbing strategy, because if we didn’t, we would be denying patients care and putting them in harm’s way.”

The professionals who enact the COVID-19 care directive must have certain competencies, skills and abilities. There is an algorithm for the care directive which provides a clear process for the professionals enacting the care directive in terms of what it is they are allowed to do, and what happens if a patient falls outside of the inclusion/exclusion criteria of the care directive.

As the pandemic situation continues to evolve, so does the COVID-19 care directive. Since its inception almost two years ago, the care directive has undergone many changes to adapt to the ever-changing situation in the province. Based on what Nova Scotians were experiencing at the point-of-care and what providers obtaining the swabs were experiencing, changes to the directive were implemented.

“Initially, the COVID-19 care directive was for primary assessment centres, and it has morphed into virtually every setting where a Nova Scotian is getting swabbed for COVID-19,” she said. “Now, we see the COVID-19 care directive applied to airport testing and take home COVID-19 kits.”

Alison MacNeil is an emergency support aide (ESA) in Cape Breton who is responsible for swabbing under the guidance and direction of a regulated health care professional as determined by the COVID-19 care directive.

MacNeil became a Nova Scotia Health employee in August of 2020 and was trained right away on how to swab. She commenced her employment at Cape Breton University (CBU) where she swabbed students all fall. Now, MacNeil can be found swabbing at the Grand Lake assessment centre in Sydney.

“With ESAs such as myself and other unregulated care providers trained on how to swab, not as many regulated staff are needed at the sites – so they can return to their regular positions,” said MacNeil.

MacNeil loves her job as a COVID-19 swabber. It brings her great joy to have the opportunity each day to talk to, coach and support Cape Bretoners through the swabbing process if they are nervous.

“It has been remarkable to see the power in team work and the role that unregulated care providers can supply in the health care system,” said MacNeil. “Now that we have seen the involvement of unregulated care providers, maybe there are other things we can assist with in the health system in a big way.”

Thank you to everyone involved with Nova Scotia’s testing strategy and COVID-19 care directive.