https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/05/06/infirmieres-infirmiers-solution-soins-primaires
CNA president lays out case for modernizing funding formulas and improving access to community care
By Sylvain Brousseau
May 6, 2024
istockphoto.com/Sunan Wongsa-nga
“We must work to amplify the contribution of all categories of nurses, particularly because they have a holistic approach to health care, with unique expertise and experience. Because they are the largest group of health-care professionals in Canada, nurses represent the most logical way forward in our efforts to reverse the difficulties of accessing primary care,” CNA president Sylvain Brousseau says.
Happy National Nursing Week! This year’s theme is Changing Lives. Shaping Tomorrow. In the spirit of the theme, I would like to use this article to focus on how we can revitalize primary health care.
In particular, I want to focus on the importance of using Canada’s nursing professionals — licensed practical nurses* (LPNs), registered nurses (RNs), registered psychiatric nurses (RPNs), clinical nurse specialists (CNSs), and nurse practitioners (NPs) — to their maximum effect. Taking such an approach will modernize and increase access to primary care by making it more efficient and cost-effective. In short, the primary care system will perform the way it’s intended.
Amplifying primary care using nursing competencies
Before examining the problems and potential solutions facing primary health care and the health system in Canada, it is essential to consider the place of nursing and the innovative models of care that are achievable.
Canada’s health-care system faces many serious and longstanding challenges, particularly when it comes to the ability to access primary care. Health systems are facing an unprecedented shortage of health professionals, which is the biggest contributing factor in the erosion of accessibility to primary care. Data from the 2024 Primary Care Needs OurCare report, for example, revealed that 21.8% of Canadians reported not having access to a primary health care provider.
To improve accessibility to primary health care, we must increase and modernize the investments in this sector. Moreover, we must expand the scopes of practice of LPNs, amplify the role of RNs, RPNs, and CNSs by giving them the right to prescribe, and enhance the scope of prescribing of NPs. Combined, this will unleash the talent and skill of all nurses to work to their full potential.
There is no doubt that the traditional model of care no longer works and we are only at the beginning of this change in health-care systems across the country. This state of affairs highlights that we must work to amplify the contribution of all categories of nurses, particularly because they have a holistic approach to health care, with unique expertise and experience. Because they are the largest group of health-care professionals in Canada, nurses represent the most logical way forward in our efforts to reverse the difficulties of accessing primary care.
How we can build on the momentum of nurse-led primary care clinics
Although not new, it is necessary to repeat the principle that the right health-care provider, for the right patient, at the right time, and at an effective cost must be applied once and for all. According to this principle, the expertise of all types of nurses, when they are working to their full abilities, will help improve the health outcomes of everyone seeking care in a public system (Lukewich et al., 2022; Valaitis et al., 2022) while fulfilling the needs of communities.
If we wish to move away from the status quo of our health system, it is imperative to drive change by, first, increasing the number of clinics self-managed by nurses and, second, rethinking how primary care services can be offered in a system that embodies intra- and interprofessional collaboration (Duhoux et al., 2022). The increase in these self-managed and publicly funded clinics will help meet the needs of communities across the country by combining the use of diverse nursing skills in collaboration with other care service providers.
The contribution of various nursing roles to primary care
- Licensed practical nurses* — LPNs play an essential role in the delivery of primary care in collaboration with other health-care professionals. LPNs also assess clients/family needs and contribute to health promotion and illness prevention. They are members of an integrated primary health care team and provide direct nursing care to patients both before and after procedures being performed in the primary care clinic. They act as a patient advocate and facilitate communication between the patient, family, practitioners, and other health-care professionals.
- Registered nurses — RNs provide primary care in collaboration with a broad range of health professionals, including LPNs, as well as with the individuals and populations they serve to promote and support population health (i.e., people receiving care, families and community groups). RNs screen and evaluate people as well as engage in prevention and health promotion activities (e.g., vaccination/prevention of communicable diseases, and education in individual/group health promotion to help prevent chronic diseases).
- Registered psychiatric nurses — RPNs play an essential role in primary care for people with complex mental health problems. They mainly assess the needs of clients and patients and develop treatment plans. RPNs’ interventions are aimed at stabilizing patients with health-care needs and ensuring followup in the community (where people live and work), rather than in a hospital setting.
- Clinical nurse specialists — Community CNSs would help teams provide specialized care (e.g. wound-ostomy-continence care, cardiology care and palliative care) by conducting detailed clinical assessments and creating care intervention plans in specific health situations. They can provide specific clinical support to nurses working in primary care and play an important role in such settings for people with complex health problems.
- Nurse practitioners — As for NPs, they have been practising in the community in our Canadian health systems for more than 40 years. They assess, prescribe, diagnose, coordinate and manage the needs of patients in various care settings. They can also manage patients, lead primary care clinics, develop treatment plans, provide specialist referrals, facilitate health-care navigation, and admit and discharge patients from hospital.
Increasing the scope of practice of each category of nurse working in primary care will broaden the range of available services and help reduce pressure on emergency care by reducing the number of visits to emergency departments and preventing hospitalizations (CNA, 2021). More specifically, RNs, RPNs, and CNSs should have the ability to prescribe certain classes of medications and order certain diagnostic tests, and NPs’ practice role should be generally expanded; taking these steps will improve access to primary care in communities and achieve a better quality of life for everyone. Satisfaction with available care services and cost-effectiveness will increase, and lengths of hospital stays and emergency department visits will decrease.
If you want to improve your primary care skills and expertise, I suggest you look into the six-module post-licensure course offered by the Canadian Family Practice Nurses Association. The Team Primary Care Nurse program is free if you join the association.
Conclusion
We are only at the beginning of this journey, because health professionals have always worked in silos, in a system mainly dominated by physician expertise. It is for all these reasons that health professionals, including nurses, must actively share their views on the future of health care from a perspective of collaboration between care teams (Valaitis et al., 2022). To achieve transformation, it will require fundamental and innovative changes in health systems, particularly with regard to training requirements, and a fundamental overhaul of care and financing models while preserving the universal nature of health care (WHO, 2023).
To make such an overhaul a reality, provinces and territories must make investments to increase the number of clinics led by NPs, RNs and CNSs, each operating with teams of health professionals. Let’s not forget that NPs are among one of the fastest growing health professions in the country. Like LPNs, RNs, RPNs and CNSs, NPs play an essential and crucial role in access to the provision of primary care services in urban, rural and remote regions.
Several countries — notably the United States, the United Kingdom, Australia and New Zealand — have successfully adopted primary health care models that place a greater role on NPs and RNs (APNA, 2016; Moulton et al., 2022). Let’s be sure to follow their example and become leaders in our own right.
RNs and NPs: consider getting CNA-certified in community health care! Apply now for your Certified in Community Health Nursing (C)anada credential, CCHN(C).
*Known as registered practical nurses in Ontario.
References
Australian Primary Health Care Nurses Association [APNA] (2016). Nursing in primary health care (NiPHC) program – enhanced nurse clinics: a review of Australian and international models of nurse clinics in primary health care settings. https://www.apna.asn.au/files/Review%20of%20Australian%20and%20international%20models%20of%20nurse%20clinics.pdf
Canadian Nurses Association [CNA]. (2012). Regulated nursing in Canada: the landscape in 2021. https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada
Duhoux, A., Dufour, É., Sasseville, M., Laroche, D., & Contandriopoulos, D. (2022). Rethinking primary care delivery models: can integrated primary care teams improve care experience? International Journal of Integrated Care, 22(2), 1-12. doi: 10.5334/ijic.5945
Lukewich, J., Martin-Misener, R., Norful, A.A. et al. (2022). Effectiveness of registered nurses on patient outcomes in primary care: a systematic review. BMC Health Serv Res 22, 740. https://doi.org/10.1186/s12913-022-07866-x
Moulton, J., Withanage, N.N., Subasinghe, A.K., & Mazza, D. (2022). Nurse-led service delivery models in primary care: a scoping review protocol. BJGP Open, 6(3),1-6. https://pubmed.ncbi.nlm.nih.gov/35292428/
World Health Organization [WHO]. (2023). Multilateral development banks and WHO launch new investment platform to strengthen primary health care services [news release]. https://www.who.int/news/item/23-06-2023-multilateral-development-banks-and-who-launch-new-investment-platform-to-strengthen-primary-health-care-services
Valaitis, R. K., Wong, S. T., MacDonald’ M., Martin-Misener, R., O’Mara, L., Meagher-Stewart, D., Isaacs, S., Murray, N., Baumann, A., Burge, F., Green, M., Kaczorowski,J., Savage, R. (2020). Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies. BMC Public Health. 1-16 https://link.springer.com/article/10.1186/s12889-020-08610-y
Sylvain Brousseau, PhD, RN, FFNMRCSI, FAAN, is the president of the Canadian Nurses Association (2022-2024) and is an associate professor in nursing sciences at the Université du Québec en Outaouais at Saint-Jérôme campus.
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