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Exploring the Success of Formal Primary Care Nursing Leadership in Provincial Healthcare: An Editorial

APCNA recently interviewed Tannis Andersen, a Clinical Nurse Specialist (CNS) from Interior

Health (IH), about her work as a Primary Care CNS and the structure of this unique role within British Columbia's primary care system. In addition to this CNS position Tannis has developed and demonstrated a deep understanding of the primary care nurse role through her position as

CFPNA BC rep and Adjunct Professor University British Columbia – Okanagan Kelowna, BC.

Interior Health BC has CNS positions across 17 different programs and networks within the health authority, each reporting to the program or network directors. However, Tannis Andersen has a more complex reporting structure: she reports to both the Advanced Practice Nursing Director within the Professional Practice Office and the Primary Care Strategic Director. This dual reporting supports Tannis in implementing the full CNS role and responsibilities impacting not only primary care, but advanced practice nursing overall. Andersen et al. (2024) recently published a paper emphasizing the importance of establishing a clear structure for advanced practice nursing roles and nursing leadership roles in IH and specifically in primary care.

Paper Summary

Andersen et al. (2024) paper explores the creation and implementation of a Clinical Nurse Specialist (CNS) position for primary care within Interior Health (IH) in British Columbia, employing a joint reporting matrix that connects the primary care transformation team and the professional practice office. The paper examines how this CNS role, using the PEPPA framework and the four domains of CNS practice, addresses the challenges of primary care in IH, and it proposes solutions to improve patient outcomes, team-based care, and quality of nursing practice. The following are key aspects from the paper, emphasizing how the structure is unique compared to Alberta's current primary care system and highlighting the need for a similar approach in Alberta. In Alberta no such role exists to promote or standardize the practice of primary care nursing.

Interior Health's CNS Role in Primary Care

Interior Health's primary care system encompasses urgent primary care centers (UPCCs), primary care networks (PCNs), and IH-owned primary care clinics, providing care across urban, rural, and remote communities. The CNS position in primary care was established to support a team-based care model and offer advanced nursing practice oversight across these settings. The CNS role in IH involves clinical care, system leadership, advancement of nursing practice, and evaluation and research. To address the complexities of primary care, this position focuses on: 

  • Environmental Scans: Collecting input from stakeholders and identifying areas for improvement in primary care nursing.

  • Work Plan Development: Creating annual work plans that align with IH's strategic priorities and the CNS domains.

  • Implementation and Collaboration: Developing and tracking the CNS's work plans and fostering collaboration with other CNSs across the province.

  • Quality Improvement Initiatives: Addressing medication practices, sexual health, subcutaneous immunotherapy, and other key areas to enhance primary care nursing.

Andersen explained that Interior Health has a distinctive approach to managing nursing primary and urgent care services. Nurses are health authority employees and work within IH owned and operated clinics and Urgent and Primary Care Centers (UPCCs), as well as in primary care network private physician clinics. This supports consistency in nursing practice support, policies and procedures, education, and quality patient care. This approach does have  its challenges, particularly in data sharing, hiring processes, and relationship building between multiple partners. Additionally, because this is a relatively new setup, some complexities arise in managing the onboarding process and aligning educational resources for primary care nursing. To address these challenges, Andersen with a team of program leads and regional knowledge coordinators support the implementation of new clinical decision support tools, nursing practices, programs and training within primary care. They are able to leverage existing resources from within the health authority and provincially where content expertise is available, for example certified practice nursing, partnering with local educational institutions, and a provincial community of practice with primary care CNS and educators where there is sharing of educational resources, supports and care practices. This differs from the approach in Alberta, where primary care clinics or PCN’s often have to develop their educational programs from scratch without access to our regional health authorities (AHS) tools and education.

Differences with Alberta's Primary Care Structure

In contrast, Alberta's current primary care structure does not have a dedicated CNS or formal nursing leadership position for primary care. Alberta's system primarily relies on the team-based care initiatives proposed by the government or for modernizing primary care but lacks a clear leadership role to guide nursing practices within this context. Primary Care Nursing remains one of the largest placed team members in clinics throughout the province and there is no consistent guidance on this practice outside of the APCNA, a volunteer run association. Andersen et al. (2024) paper emphasizes that the CNS position in IH serves as a pivotal role for clinical oversight and quality improvement within the primary care system. It coordinates with multiple stakeholders, including nurses, educators, managers, and directors, providing a centralized point of expertise and leadership. This contrasts with Alberta, where primary care clinics or PCNs often need to develop their educational programs and quality improvement initiatives independently, lacking a consistent framework or support that would be formed in a dedicated Primary Care Nursing Leadership role. These programs also often lack the knowledge of nuances of scope throughout the province leading to inconsistent roles and training from PCN to PCN.

Alberta is newly forming an organized structure to guide Primary Care with the government branch as well as the establishment of Regional Primary Care Networks. This is an opportune time to ensure that programs and services provided by these Networks meet a similar level of education and scope standard to best serve the implementation of team based care and improve patient outcomes.

Recommendations for Alberta

Given the complexity and evolving nature of primary care systems, the paper written by Andersen et al. (2024) underscores the importance of a dedicated leadership role to provide oversight, lead change, and drive quality improvements. The IH model demonstrates that this position in primary care can: 

  • Define Nursing Roles and Scope: Establishing clear guidelines for primary care nursing practices.

  • Standardize Nursing Services: Ensuring consistency in care delivery across different settings.

  • Enhance Nursing Professional Development: Providing structured educational opportunities and resources to advance nursing practice.

  • Foster Collaboration and Integration: Encouraging partnerships between different health care providers and promoting a unified approach to primary care.

For Alberta to modernize its primary care system, adopting a role similar to IH's setup could offer significant benefits, providing a structured approach to team-based care and leading to improved outcomes in nursing practice and patient care. 

APCNA proudly fills this gap at planning tables at the present time. However, a formal role included in the governance structure within regionalization is required based on the evidence from BC’s success. APCNA will always be present to assist any formal structures on primary care nursing educational needs and practice recommendations. We will base this on the feedback of our membership and our large network of stakeholder connections throughout the country. We will also remain advocating for the primary care nursing position within Alberta highlighting its importance in the medical home. But formally we urge the consideration of a permanent role in Alberta to follow the success of our partners in BC, this should be accounted for prior to the establishment of regional PCN’s. It would assist to guide the team based care framework MAPS is built upon and that  primary care nursing contributes to so greatly.

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