What is the role of non-invasive prenatal testing (NIPT) within provincial health care frameworks?

By Maeghan Toews

Three things to know about the role of NIPT in provincial health care systems:

1. NIPT is used to detect fetuses with an increased chance of having certain genetic disorders, such as Down syndrome, as well as fetal sex. It involves a blood test taken during pregnancy (at around 10 weeks) that analyzes fragments of fetal DNA that are present in maternal blood.


2. Provincial prenatal testing frameworks involve screening tests (eg. maternal serum testing) available to all pregnant women to identify pregnancies at increased risk of carrying a fetus with certain disorders, followed by invasive diagnostic testing (ie. amniocentesis and CVS) available to those who screen positive or are otherwise at ‘high risk’. NIPT is currently only recommended for use as a secondary screening test for ‘high risk’ pregnancies. Risk factors include maternal age, family history, and positive results from the primary screening tests.


3. With the exception of Ontario, NIPT is not publically funded, but available to those ‘high risk’ women who want the test and can afford to pay for it.

Three myths about NIPT’s integration with publically funded prenatal tests:

Myth #1: NIPT will replace amniocentesis in the very near future.

The Reality: NIPT is highly accurate at detecting certain disorders in ‘high risk’ pregnancies and may therefore reduce the number of women undergoing the more invasive tests which carry a small risk of fetal loss. However, NIPT is currently less accurate and only capable of detecting a very limited number of genetic abnormalities, and invasive testing is therefore recommended to confirm positive NIPT results.

Myth #2: NIPT will/should become a routine part of prenatal blood work.

The Reality: There are concerns that the routinization of this blood test may impact patients’ ability to fully comprehend the nature, limitations and implications of genetic testing. Patients should be fully informed about these issues and the availability of genetic counselling.

Myth #3: NIPT is universally welcomed as a positive development.

The Reality: Although the benefits of NIPT have been widely emphasised, NIPT has also attracted controversy, specifically with respect to its ability to be used for sex selection and its potential impact on the disability community.  

Maeghan Toews is a Research Associate at the Health Law Institute at the University of Alberta with a research focus on the legal and policy implications of emerging health technologies in Canada

Is there a place for nurses in government?

by Jamie Shaw

Three things you need to know about nursing in government…

1. Nurses can serve in a wide variety of roles within government.  Some positions exist specifically for health care practitioners, for example Nurse Consultants in the Communicable Diseases Unit or Immunization. However, there are also some great non-traditional roles for nurses, like mine. To see what kind of work you can do in government, search “Health” on the Governments of Canada and Alberta websites.
2. There are many opportunities to expand your knowledge and skills in government.  If you have a more traditional nursing role in government, there are opportunities to learn how those policies that you use daily are developed and implemented.  If you have a less traditional role you can learn about aspects of the healthcare system that you never even considered before.


3. Work-life balance does exist.  These may be things that many government workers take for granted, but perks that nurses will appreciate include more than two weekends off per month, spending every Christmas Day with your family, and no night shifts.  

Three myths about nursing in government…

Myth #1: Working in government means that you are no longer a real nurse.

Reality: Your clinical knowledge and practical experience in the health care system is valued in government and can be applied on a daily basis.  Also, you do not have to give up your nursing license when you work in government, even if your job does not absolutely require registration.  You can work with your supervisor to ensure that your continuing competence program activities mesh with your government performance plan.  Also, the College and Association of Registered Nurses of Alberta encourages nurses to engage in policy work.


Myth #2: Government bureaucrats don’t know anything about how the health care system really works.

Reality: The majority of the people I work with are not health practitioners.  I am a part of a team that has a physician, a social worker, many people with Master’s degrees and PhDs in various health fields, and people without any letters behind their names, but a wealth of knowledge and experience in Alberta’s health care system. While nurses have valuable information about how things work on the ground, nurses also see only pieces of the whole health care system and can benefit from listening to other perspectives.  


Myth #3: There is no ability to affect real change in government.

Reality: After working in fast-paced clinical environments, this feels true, because government change tends to happen much slower than in a hospital or clinic.  You also do not get the satisfaction of seeing the effects of your changes in patient interactions.   However, changes made in government have the potential to impact all Albertans as opposed to just the few patients that you can see in clinical practice,  and it is an opportunity to fix those systemic problems that health care providers often complain about.  So, if you, like many of my nursing friends, have ever caught yourself saying “Why doesn't the government just…” – then government work might be for you!

Jamie Shaw serves as a Policy Analyst in the Government of Alberta’s Ministry of Health, working on health care provider compensation.  Prior to joining government, she worked as a registered nurse in a variety of acute care units in Calgary and Winnipeg, including surgical oncology, cardiac surgery and intensive care.  She earned her BA (History) from the University of Alberta and Bachelor of Nursing (BN) after degree from the University of Calgary.