Better health for all could be had by focusing efforts on primary care
Feb 7, 2022, By: Hannah Ricketts
Family practice nursing and family practice care, also known as primary care nursing and primary care, are important contributors to better health for all Canadians. However, poor access to primary health care services is a problem dating back many years (Government of Canada, 2012). According to the Canadian Institute for Health Information (2019), there are over 300,000 registered nurses (RNs) in Canada, making them the largest group of health professionals in the country. Educating, training and encouraging nursing students and RNs to work in family practice nursing could therefore prove highly beneficial for Canadians’ health and well-being.
I am a new RN, but while I was a student, I was unaware of the existence of family practice nursing. In my nursing program, I had learned about community health, home care and public health nursing. But I was not aware that RNs who work in clinics with family physicians are considered part of the community health nursing discipline.
Family practice nursing in Canada can be strengthened by incorporating curricula specific to this area throughout undergraduate nursing education. Although there are no additional education requirements for RNs to work in primary care, there are development opportunities for family practice nursing, including a 16-week certificate course offered to RNs in Nova Scotia.
Confronting the need for RNs in primary care
In September 2020, I became aware of the dire need for nurses in family practice settings when I went to see my family physician. My appointment was scheduled for 2 p.m.; however, I waited an additional 40 minutes in the examination room, and when my family physician did arrive, the visit was very brief.
The inexplicably long waiting time for such a brief medical assessment troubled me. If RNs were working in this clinic, would I have been seen faster? Would I have had a less hurried and more comprehensive assessment? The evidence suggests yes.
I was not aware that RNs who work in clinics with family physicians are considered part of the community health nursing discipline.
Primary care is an “entry point for patients into the health care system” (Canadian Family Practice Nurses Association [CFPNA], 2019, p. 4). It focuses on health promotion, illness and injury prevention and the diagnosis and treatment of illness and injury (Government of Canada, 2012). Family practice nurses work in primary care settings in partnership with physicians, nurse practitioners and other health-care team members. These nurses provide extensive services, such as prenatal care, preventive screening, illness management, health education and referrals to other health professionals (CFPNA, 2019).
In 2019, there were over 41,000 RNs working in Canadian community-based settings, which includes the primary care sector (Canadian Institute for Health Information, 2019). Across Canada, there has been an increase in RNs being hired to work within this sector. However, their role is not standardized, and there is no formal education for nurses in this specialty (Lukewich et al., 2020).
In Canada, primary care nursing falls under the umbrella term community health nursing, which also includes home care, public health and community care (typically found in northern or rural geographic locations) (Lukewich, Taylor, Poitras, & Martin-Misener, 2018). In the past decade, several nursing associations — including the Canadian Nurses Association, the Canadian Family Practice Nurses Association, and the Registered Nurses’ Association of Ontario — have made efforts to develop resources to support further integration of primary care nurses into the health-care system.
Primary care in Newfoundland and Labrador
Newfoundland and Labrador lags behind other provinces when it comes to integrating family practice nursing and team-based models of primary care. There is a need for reformed health-care delivery models that support nurses working in family practice settings. An alarming number of individuals living in the province have limited or no access to a regular care provider (Health Intelligence Inc., 2019), and this problem is magnified by the province’s vast rural landscape. Many residents from small coastal communities, the majority of whom are elderly, travel long distances for care and are faced with long wait times. In the capital city of St. John’s, many individuals seek care in the hospital emergency department for issues that could easily be assessed, diagnosed and treated in the primary care setting.
Recently, the government of Newfoundland and Labrador developed a strategic plan entitled The Way Forward to promote a healthy and prosperous province. This plan includes an initiative focused on the expansion of primary health care teams that include nurses (Government of Newfoundland and Labrador, 2018). The government has also established a primary health care task force to help reimagine the province’s health-care system to better provide needed services (Government of Newfoundland and Labrador, 2020).
An example of primary care in Newfoundland and Labrador
A key role of RNs in primary care is prevention and management of chronic conditions such as diabetes and hypertension. Newfoundland and Labrador has the highest rates of diabetes and hypertension across all the provinces, with 9.5 per cent of the adult population having diabetes (Government of Newfoundland and Labrador, 2019).
A family member of mine in the province has diabetes and hypertension and is seen by an endocrinologist every three months to discuss blood test results. He has experienced first-hand the challenges of accessing health care in our province. If he is unable to make his appointment, which is normally scheduled three months in advance, a new appointment cannot usually be booked for at least another three months. Under such circumstances, this means his condition is not being monitored by a health professional for up to six months. Family practice nurses could be part of the solution to clinics offering more appointments and monitoring clients more closely.
Choosing family practice as an RN
Community health, health promotion and clinical courses should offer opportunities to learn about family practice nursing to better prepare students to work in this role after graduation. Exposing students to this specialty area of nursing would give it greater visibility and help strengthen primary care in Canada. I would have had limited knowledge of the role of RNs in family practice nursing without my experience as a research assistant for Julia Lukewich at Memorial University’s Faculty of Nursing; she sparked my curiosity by introducing me to the concept.
As a new RN, I can picture myself working as a family practice nurse. I hope that opportunities are created to better support the health of our country through this important role. The benefits of family practice nursing should not be overlooked.
Canadian Family Practice Nurses Association. (2019). National competencies for registered nurses in primary care. Available from https://www.cfpna.ca/copy-of-resources-1
Canadian Institute for Health Information. (2019). Nursing in Canada, 2019: A lens on supply and workforce. Retrieved from https://www.cihi.ca/sites/default/files/rot/nursing-report-2019-en-web.pdf
Government of Canada. (2012). About primary health care. Retrieved from https://www.canada.ca/en/health-canada/services/primary-health-care/about-primary-health-care.html
Government of Newfoundland and Labrador. (2018). The way forward. Retrieved from https://www.gov.nl.ca/thewayforward/
Government of Newfoundland and Labrador. (2019). The way forward: Chronic disease action plan. Retrieved from https://www.gov.nl.ca/hcs/files/chronicdisease-pdf-chronic-illness.pdf
Government of Newfoundland and Labrador. (2020). Six committees established for health accord NL [news release]. Retrieved from https://www.gov.nl.ca/releases/2020/exec/1112n02/
Health Intelligence Inc. (2019). Physician resource forecast for family medicine: Newfoundland and Labrador. Retrieved from http://nlma.nl.ca/FileManager/Documents/docs/2019.12.09_Physician_Resource_Forecast_Family_Medicine_FINAL_reduced.pdf
Lukewich, J., Allard, M., Ashley, L., Aubrey-Bassler, K., Bryant-Lukosius, D., Klassen, T., Magee, T., Martin-Misener, R., Mathews, M., Poitras, M.-E., Roussel, J., Ryan, D., Schofield, R., Tranmer, J., Valaitis, R., & Wong, S. T. (2020). National competencies for registered nurses in primary care: A Delphi study. Western Journal of Nursing Research, 42(12), 1078–1087. https://doi-org.qe2a-proxy.mun.ca/10.1177/0193945920935590
Lukewich, J., Taylor, S., Poitras, M. E., & Martin-Misener, R. (2018). Advancing family practice nursing in Canada: An environmental scan of international literature and national efforts towards competency development. Nursing Leadership, 31(2), 66–78. https://doi-org.qe2a-proxy.mun.ca/10.12927/cjnl.2018.25602
Hannah Ricketts is a newly registered nurse and graduate of Memorial University Centre for Nursing Studies. Her main interests include, primary prevention, primary care nursing and acute care.