Will B.C.'s new Nurse in Practice model meet expectations?

The B.C. Ministry of Health has launched a new Nurse in Practice program offered to longitudinal care family physicians and nurse practitioners.

It provides financial support so that doctors and nurses practitioners can hire their own registered nurses or licensed practical nurses to help with patient care. Its objective is to provide timely access to primary care services and follow-up care.

I truly believe the Nurse in Practice program is a step in the right direction for B.C. healthcare, but there are several issues that need to be considered.

For 10 years, I have researched how to incorporate nurses and allied healthcare professionals into outpatient care in my Penticton rheumatology clinic. This column is based on my extensive team-based care experience.

Nurse in Practice is based on the learnings from pilot sites in the Okanagan. I believe the model will increase the efficiencies for specific visits, such as scheduled injections, wound care, patient education and counselling. Nurses with advanced training, like certified practice nurses, can independently manage certain infections and prescribe treatments, as well as dealing with women’s health and minor procedures.

The Nurse in Practice program comes with limitations. Nurses are expected to provide a significant proportion of appointments without the presence of the family physician or a nurse practitioner. I believe that only a small proportion of patients see their family physicians or nurse practitioners for nursing care. That means meeting the requirements of the Nurse in Practice program becomes the priority over caring for patients and that could limit the family physicians’ and nurse practitioners’ flexibility to set up their practice in the most efficient way to meet the needs of their patients.

The greatest concern physicians have with team-based care is delegating responsibilities. When a diagnosis or treatment plan is made by a physician or nurse practitioner, they are medically and legally responsible for its management and implementation.

Nurses can play an incredible role in facilitating patient care, but for the physician or nurse practitioner to be comfortable enough to delegate important elements of patient care, there must be a high level of trust and competence, otherwise, they will repeat the nurse’s work. This is the greatest challenge I see when coaching team-based care clinics.

There is no framework in the Nurse in Practice program to address this through additional training and support.

Administrative, redundant, and inefficient processes play a major role in healthcare worker burn out. The Nurse in Practice program does not address physician and nurse practitioner burdens. They are expected to care for more patients, provide same day urgent care and provide oversight for their nurse in practice. A nurse in practice can significantly help reduce physician- and nurse practitioner-related burdens, but not when the he or she is allotted only one hour per day to do their own paperwork as per the program.

Creating high-functioning and effective team-based care is not something that just happens. I base that on my team’s experience, as well as that of the specialists team care pilot sites (nine different specialties) who implemented my model.

Their results were an average 100% patient capacity increase in six months, with 90% patient satisfaction, which has proven to be sustainable.

The Nurse in Practice program does not provide critical education for hiring, training, employee retention, lateral leadership, delegation and team accountability. My research, and that of the specialists team care sites, showed these are essential for building a strong successful team-based care environment.

An estimated 700,000 to 1 million British Columbians do not have access to primary care. We need to focus on patients accessing the expertise of physicians and nurse practitioners with nurses and allied health professionals supporting that care.

I commend the Ministry of Health for the Nurse in Practice initiative, as the future of medicine involves team-based care. But you can’t buy a high-functioning team, it must be properly trained and nurtured at the start to achieve its full potential.

Dr. Michelle Teo is a rheumatologist in Penticton,