David W. Byres, Natasha Prodan-Bhalla,
Joanne Maclaren, Carolyn Solomon,
Minna Miller, Danielle Daigle, Gwyn McIntosh
The Nursing Policy Secretariat (NPS) was formally established in 2017 by the ministry as per a Memorandum of Understanding in the Nurses Bargaining Association Collective Agreement. This ministerial commitment was intended to support collaboration between the ministry, health authorities, professional colleges, the Nurses Bargaining Association, and other partners, to consider issues related to the scopes of practice for licensed practical nurses, registered nurses, nurse practitioners and registered psychiatric nurses across the province, as well as to develop priority policy for the nursing profession.
In January 2018, the report on the recommendation was released (refer to: Nursing Policy Secretariat: Priority Recommendations report available at: www.health.gov.bc.ca/library/publications/year/2018/nursing-policy-cons….
The report contains 50 priority recommendations focused in 13 thematic areas to provide strategic direction to the Ministry of Health and system partners to optimize nursing practice, better support patients, and achieve health system goals overall. The themes included: role of nurses in primary care; nurse practitioners; scope of practice; surgical model; nursing representation; quality practice environments; education; health human resources; collective agreement; documentation; nursing expert access and advice; leadership; and rural and remote practice.
In 2018, the NPS established the Provincial Nursing Network (PNN), comprised of representatives from all health authorities and key partner groups, to provide advice on nursing practice, education, regulation, policy, and research; and support the implementation of the priority recommendations (including priority sequencing). A parallel governance structure, the Nurse Practitioner Advisory Network was also established to advance the NPS recommendations pertaining to nurse practitioners (NPs) and to focus on cross-system integration of NPs. To date, 76 percent of the recommendations have been completed or are in progress. Two key initiatives undertaken by the NPS that relate to the advancement of universal access to primary care are described below:
Improving Access to Team-Based Primary Care
The ministry has developed strategic policy direction to support the implementation of team-based primary care in B.C. The policy affirms that effective health care delivery in the B.C. health system requires collaboration and coordination of care by multiple health care disciplines on behalf of the patient. It also outlines definitions and policy guidelines for the establishment of effective health care teams.
To support enhanced attachment and access to primary care, the ministry has funded additional educational seats for nurse practitioners. A new compensation model has been created for NPs in these settings to enable them to provide longitudinal primary care services and work to their optimal scope of practice under an independent contract. Additionally, an innovative model of team-based care, i.e., Nurse Practitioner Primary Care Clinics (comprised of an interdisciplinary team, e.g., NPs, registered nurses, mental health worker, midwife, and general practitioner) has been launched at three sites across the province. It is anticipated that these clinics will address a significant attachment gap over the next three years.
Nursing Education and Transition Model
The ministry in collaboration with the Nursing Education Planning Council will be developing, implementing and evaluating a new, innovative model for baccalaureate nursing practice education and transition to practice program to better prepare newly graduated nurses; to support cost containment of escalating health care costs related to high attrition and turnover in the nursing workforce; address nursing faculty shortages; and effectively build capacity and infrastructure to meet government’s commitment to improve and strengthen health services (including primary and community care).
The new model to address attrition rates and effectively support newly graduated nurses and nursing faculty will entail the following:
1. Learning Pathways: Baccalaureate nursing students enter a learning pathway in their final practicum that aligns their practice area of interest with potential for regular employment after graduation along with health system workforce needs.
2. Provincial Transition Support Program: All new graduates would be hired and supported beyond graduation through a provincial transition to practice program that would support NGNs from the end of their undergraduate program practicum up to 12 months post hire.
3. Hybrid Faculty Educator Roles: New hybrid roles that span academic and practice sectors along with faculty mentorship support would be employed to support faculty and clinical educators to effectively implement the model and to address the faculty workforce shortage.
Two health authorities have demonstrated proof of concept of the efficacy of transition programs; having achieved a turnover rate below 5% in practice areas where it is implemented.
Nurse Practitioners Improve Access to Primary Care in British Columbia, Canada
The Nurse Practitioner (NP) role has existed in Canada since the 1960s. In the province of British Columbia (BC), the first master’s degree prepared NPs graduated in 2005. NP scope of practice is regulated by the Ministry of Health under the Health Professions Act. The Nurses (Registered) and Nurse Practitioners Regulation under the Health Professions Act provides the legal authority for the NP scope of practice. The BC College of Nursing Professionals, BCCNP (previously called the College of Registered Nurses of British Columbia) has established the scope of practice for NPs with the necessary standards, limits and conditions of practice.
In order to support the integration of NPs into the BC healthcare system, the Ministry of Health has provided funding for NP positions throughout the province. NPs work autonomously without physician oversight in diverse settings improving access to health care services by contributing to a health care system that is responsive to the needs of British Columbians. NPs provide comprehensive primary care, including health promotion and disease prevention, diagnosis and management of disease/illness, prescribing medications, ordering/interpreting laboratory/diagnostic tests, and initiating referrals to physician specialists and other health care professionals. NPs provide care in both primary, acute and palliative care settings, including rural, remote, and urban centers.
There are over 603 Nurse Practitioners in British Columbia (BCCNP data), of whom 60% provide primary care services, most in community-based settings. Thirty percent of primary care NPs provide specialized services to the most vulnerable, including marginalized women and children, new immigrants/refugees, the homeless, those with HIV/Hepatitis C, or with mental illness/addictions.