Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study

Abstract

rimary health care reforms in many countries include paying attention to increasing access to health care. One approach to improving access in Canada is integration of nurse practitioners (NPs) into primary care, particularly in rural settings, where NPs are more likely to work in the community rather than in a hospital. 1 This study focuses on the practices of NPs working in northern British Columbia, where factors influencing integration of NP roles can include the combination of changing patterns in the family physician workforce, 2 increasing patient medical and social complexity 3,4 and uptake of the message by decisionmakers that "NPs increase access to care." 5 Nurse practitioners have been regulated primary care providers in British Columbia since 2005.Access to health care is dependent on interrelated dimensions of the health system and abilities of patients, 6 and although evidence supports that NPs do increase access to care, 7,8 few studies have evaluated how this is accomplished. [6][7][8][9][10] As advanced practice nurses, NPs have competencies that extend beyond direct patient care to encompass proficiencies related to research, education and leadership. 11 Therefore, NPs are poised to contribute to a shift toward delivery of comprehensive, interprofessional, community-based primary health care, 12,13 and away from selective or niche models of primary care that may not address patient or community needs in a thorough manner. 7,14 The message that NPs increase access is consistently offered as a rationale for NP role creation, [15][16][17] but there may be more nuanced aspects of NP practice that can be explicated to support further successful integration of NP roles and strengthen the primary health care system.The aim of this study was to evaluate how NPs are engaged in primary health care practices in the context of their work settings as salaried health authority employees who are part of interprofessional primary care teams in northern BC primary care clinics. Methods DesignThe study was a qualitative-dominant mixed-methods study, 18 using a survey and interviews. The study team included 3 members whose roles encompass research and clinical work

A structural equation modelling analysis: interprofessional team collaboration, organizational career management, and post competency of community nurses

“…Team practices are gradually replacing individual practices; the management of many diseases can rely not only on a single person but also on more cross-disciplinary teamwork [ 45 , 57 ]. In a team formed by doctors, nurses, pharmacists and managers, nurses are the core force and even leaders of the team [ 36 , 37 , 52 , 58 ], and the interprofessional team collaborative ability of nurses is directly related to success or failure. Interprofessional team collaboration is important to achieve high-quality care and positive patient outcomes [ 59 ].…”

“…However, the role of community nurses in health care cannot be underestimated. Moreover, nurses' interprofessional team collaborative ability is very important to the quality of the primary health care services they provide [ 34 – 37 ]. In addition, organizational career management provided by community medical institutions may affect nurses’ post competency through psychology and behaviour [ 29 , 38 ].…”

A structural equation modeling analysis:Post competency, interprofessional team collaboration ability, organizational career management of community nurses.

“…Single-handed practices are gradually being replaced by team practices; that is, the management of many diseases can rely not only on a single person but also on more cross-disciplinary teamwork [32,44]. In a team formed by doctors, nurses, pharmacists and managers, nurses are core force and even leaders of the team [23,24,39,45], and interprofessional team collaboration ability of nurses is directly related to the success or failure. Interprofessional team collaboration is important to achieve high-quality care and positive patient outcomes [46].…”

“…However, the role of community nurses in health care cannot be underestimated. Moreover, the interprofessional team collaboration ability of nurses is very important to the quality of the primary health care services they provide [21][22][23][24]. In addition, organizational career management provided by community medical institutions may affect their post competence through community nurses' psychology and behavior [19,25].…”

Are remote health clinics primary health care focused? Validation of the Primary Health Care Engagement (PHCE) Scale for the Australian remote primary health care setting

“…The PHCE scale was shown to have good internal consistency reliability and construct validity. Only one instance of use of the PHCE scale other than instrument development could be found in the published literature and that was part of a mixed-methods study to evaluate the work of nurse practitioners (NPs) in rural regions of Canada (Wilson et al., 2021 ). Further validation of the scale is required (Kosteniuk et al., 2017 ).…”