Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study.

BACKGROUND: Nurse practitioners (NPs) have been regulated primary care providers in British Columbia since 2005; however, many practices and contributions of NPs, especially those in northern or rural regions, remain unarticulated in primary health care. The objective of this study was to evaluate NP practices in the context of providing primary health care in northern BC. METHODS: This was a qualitative-dominant mixed-methods study. We recruited NP participants working in northern BC; recruitment and data collection occurred between April and June 2018. Participants completed the validated 28-item Primary Health Care Engagement (PHCE) Scale to assess their perceptions of their workplace with 8 attributes of primary health care (quality improvement, community participation, patient-centred care, accessibility, intersectoral team, interdisciplinary collaboration, continuity and population orientation). We also interviewed NPs about their everyday practice. Transcribed data from the interviews were analyzed interpretively. RESULTS: In total, 13 of 30 (43%) eligible NPs participated in the survey and interview. The PHCE Scale results showed that all NPs perceived their workplaces to be highly engaged in patient-centred care, but none reported their workplaces as accessible. Interview data were organized into 5 headings which described how NPs see patients who are medically and socially complex, address inequities in access, practice collaboratively, address local service gaps and improve patient abilities to access care. INTERPRETATION: In interprofessional primary health care teams, NPs are key members and attend to both direct patient care and broader social conditions affecting health. Nurse practitioners can help accelerate advancements to deliver responsive community-based primary health care.

A Pathway for Implementing the Nurse Practitioner Workforce in a Rural and Remote Health Region.

Despite descriptions of nurse practitioner (NP) implementation, there is little guidance for health authorities on how to address the evolving and ongoing challenges of implementing and sustaining NP roles and practice, particularly in rural and remote communities where recruitment and retention are difficult and professional supports may be limited. This article describes a pathway through which NPs have been recruited, supported and retained in their practice in a large rural and remote health authority. The pathway's main steps were the creation of an NP lead for the health authority and the facilitation of conversations with NPs, which resulted in a new organizational model and a renewable action plan for recruitment and retention. The results are a strong NP leadership presence within the health authority, formalized role implementation within the medical staff structure, sustainable mechanisms for professional support, operational management and the strategic development of the NP portfolio. The experience of implementing and integrating the primary care NP workforce in rural and remote settings through an articulated pathway has provided insights into effective NP integration and sustainment in rural primary care settings.