Integrating nurse practitioners into primary care: policy considerations from a Canadian province

Abstract

Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators

“…Integrating nurses into the PCPs' practices can be a major challenge in terms of funding, particularly in countries where PCPs are generally independent small-business owners, and function on a Fee-For-Service (FFS) model. In such contexts, it is in fact more convenient for PCPs to develop a collaboration outside the practice but with the risk of losing quality in collaboration [57].…”

Integrating Nurse Practitioners Into Long-term Care: A Call for Action

“…22 Some Canadian provinces only provide funding for NPs when their support is deemed necessary by physicians. 23 In these jurisdictions, NPs are hindered from practicing to their full scope. If physicians are allowed to dictate NP job availability, this effectively invalidates the NPs’ autonomous role in the health care system.…”

Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic

“…Nurse practitioners have a wider scope of practice than nurses including the ability to: order and interpret diagnostic tests; conduct advanced health assessments; refer patients to other professionals as needed; and diagnose, treat and perform advanced interventions. 9 It is important to note that the composition of the types and amounts of providers vary from team to team. [3][4][5][6] Collaboration in primary care teams occurs when two or more health professionals work together to provide comprehensive patient care.…”