https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/11/17/andrea-gretchev-chercheuse-genomique
‘Everything I am learning about genomics is exciting and I am constantly making connections to how this fits into nursing practice and education,’ Andrea Gretchev says
By Laura Eggertson
November 17, 2025
Andrea Gretchev has devoted herself to advocating for changes to both nursing education and health policy, so nurses and other members of the interprofessional team can learn more about the way genetics influences health and incorporate that knowledge into their practices.
Editor’s note: Canadian Nursing and Genomics and the Canadian Association of Nurses in Oncology recently released the position statement Genomics-Informed Oncology Nursing, Canada’s first national policy document for genomics nursing.
When Andrea Gretchev’s 75-year-old mother needed medication after her uncontrolled lipids contributed to a heart attack, Gretchev knew the answer lay in her mother’s genetic profile.
That’s because Gretchev, a registered nurse, PhD candidate, researcher, and faculty instructor in the Health Sciences program at Douglas College in Coquitlam, B.C., has spent the past two years emersed in studying genomics.
The emerging field, which has become increasingly significant in nursing since the Human Genome Project sequenced the entire human DNA in 2003, is vital to precision health care, and Gretchev is compelled to contribute to the growing body of evidence to support this.
After 19 years in nursing, a bachelor of science in nursing degree from McGill University, and a master’s in nursing from the University of Victoria, Gretchev decided to pursue a PhD in genomics at Clemson University in South Carolina in the Healthcare Genetics and Genomics program. She chose genomics because she could see the relevance of this field in all aspects of health care, but particularly oncology, pediatrics, mental health, and cardiology. In addition, she saw the potential for nurses to contribute to its application and the benefits for improved patient outcomes.
“I just find it so fascinating,” she says. “Everything I am learning about genomics is exciting and I am constantly making connections to how this fits into nursing practice and education.”
Gretchev also works as a research associate at Athabasca University, where she and a team of other researchers, backed by funding from the Canadian Institutes of Health Research, study how to integrate genomics-informed nursing into health-care systems. As a member of the Canadian Nursing and Genomics steering committee, she’s devoted herself to advocating for changes to both nursing education and health policy, so nurses and other members of the interprofessional team can learn more about the way genetics influences health and incorporate that knowledge into their practices.
Helping save lives
Her mother’s story gives Gretchev a personal anecdote she can now share about why genomics is helping to save lives.
Gretchev’s mother, Sue Campbell, had previously tried two first-line statin medications to control her lipids, which at high levels contribute to a buildup of plaque in the arteries that can cause cardiovascular disease.
But after Campbell had severe reactions to both medications, her doctor took her off them and was uncertain what to prescribe.
After her mother’s resultant heart attack, Gretchev suggested sending a sample of her mother’s DNA to a private company — a process called direct-to-consumer genetic testing.
As an increasing number of Canadians are doing, Gretchev had her mother’s DNA sequenced and analyzed. The health report the company sent back correctly predicted that Campbell would better tolerate a different type of statin medication, rather than the first-line ones she’d tried.
“Not everyone responds to medications in the same way. A given drug can produce markedly different effects in two individuals due to genetic variations in genes involved in drug metabolism. Pharmacogenomics examines these genetic differences to guide the selection of the most effective and safest medication for each individual.”
Doctors and nurse practitioners in primary care are starting to learn about the benefits of pharmacogenomics. In specialty practices like cardiology, there is increased awareness. For example, Campbell’s cardiologist appreciated the importance of pharmacogenetic testing.
“He was glad we had done it, and he used the pharmacogenetic report to guide his prescribing decisions,” Gretchev says. “Now my mother is on a new statin after her genetic profile suggested she was able to metabolize it, and she’s had no reactions to it.”
Benefits of genomics in pediatrics
Being able to anticipate the children who will react well and those who will have an adverse reaction to a medication is especially important in pediatrics, says Gretchev.
“These are very little bodies, and the side effects can have devastating consequences,” she says.
When she worked as a pediatric nurse, Gretchev treated many children who lost their hearing because they experienced an adverse reaction to a specific class of antibiotics called aminoglycosides.
“If we had pharmacogenetic testing, they might have been spared from that devasting side effect.”
Testing, implementation and integration in health-care practice
Most health-care providers receive only “minimal” training in genomics as part of their medical education, Gretchev says. Provincial health-care plans also vary widely across Canada in terms of what type of genetic testing they will cover and how practitioners implement testing in their practices.
British Columbia, for example, where Gretchev lives and works, has established a goal that all cancer patients have their tumours genetically sequenced. That’s not the case in all other provinces, however, many of which cover limited uses for DNA sequencing, or require patients to pay out-of-pocket.
If health-care providers receive information from DNA sequencing, the analyses can help them predict how their patients will respond to a particular drug or treatment, Gretchev points out. Then they can weigh the likely effectiveness of different options, based on the gene variants the patient’s DNA analysis has identified.
Gretchev is currently participating in a study the B.C. government is conducting to examine how health-care providers in the province are integrating pharmacogenetics in their practices. She’s providing her insights into the way primary care providers respond when patients arrive in their offices with the results of these direct-to-consumer tests.
Practitioners can now consult these tests to help determine whether their patient is likely to respond well to a medication, but people have to pay for the tests themselves, which leads inequitable treatment. “That’s part of what the Ministry of Health is trying to figure out — how we can help people who can’t access these tests,” Gretchev says.
As the author of an open-access textbook called Precision Healthcare: Genomics-Informed Nursing, Gretchev is well-qualified to consider ways to add components about genomics into nurses’ education. The book was written for a course at Georgian College by the same name. She’d like to see all nurses educated to probe more deeply into patients’ histories to consider risk factors, the potential effects of genetic disorders and how they could affect health outcomes.
“If somebody had cancer, for example, there are hereditary cancers and non-hereditary cancers,” she says. “You need to do some digging into whether that needs further investigation. We need to think about that in our assessments, and we need to be educated to make those connections.”
Every nurse needs foundational knowledge about genomics, Gretchev believes, and nurses who work in specialty areas, such as oncology or pediatrics, might need more specialized knowledge, she suggests. Her Precision Healthcare book and other tools and resources are available on the Canadian Nursing and Genomics website.
New nursing roles
In the not-too-distant future, Gretchev envisions roles for nurse practitioners in staffing interprofessional genetics’ clinics, where they conduct assessments and order tests, alongside genetics’ counsellors, medical geneticists, clinical nurse specialists, and other nurses with specialized genomics education who link people with genetic disorders to services and engage patients in research to further advance the science.
“There are just so many things we could be doing in this field to practise at the top of our scope” Gretchev says of nurses.
She’d also like to see a national body emerge to unite provincial genomics’ organizations, to help push for more standardized coverage of genetic testing and DNA sequencing that is covered through medicare. She is hoping, as well, for health information management systems that will one day share electronic data from province to province, so if a patient moves from one jurisdiction to another, their information moves with them.
Although the work to incorporate more genomics into nursing and interprofessional health-care practice needs to start with education, Gretchev also urges leaders and administrators in health-care systems across Canada to anticipate the way this field will change health care and increase demands from patients to tailor treatments to their individual genetic profiles.
These changes will put even more pressure on an already strained workforce, she says. To ease that strain, “we need to be creative and develop new roles for nurses within the genomics sphere.”
Devoted to genomics in nursing
When Gretchev is not teaching, writing, leading or participating in research projects, she is taking a welcome break by sailing or scuba-diving with her husband, Justin Brown, on their 36-foot Catalina sailboat. Along with her stepchildren Georgia and Peter Brown, her son Luka Endisch and her two rescued dogs, Gretchev enjoys as much time outdoors as she can.
But once she’s back inside, she’s consumed with determining the best ways to make sure genomics becomes central to the care nurses can provide, so more patients can benefit from the field’s potential to transform health care and improve patient outcomes.
“We want nurses to contribute to policy as it is developed, and to shaping these roles, because we pride ourselves on being a profession that is current with emerging health-care knowledge and is innovative,” Gretchev says, adding that Canadian Nursing and Genomics and the Canadian Association of Nurses in Oncology will soon release Canada’s first national policy document for genomics nursing. “This is an area where nurses can have a significant impact on the science and practice.”
Laura Eggertson is a freelance journalist based in Wolfville, N.S.
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