Integrating a nurse into practice

This virtual guide offers valuable resources, including a webinar series to support the Ministry of Health's Nurse in Practice program. Curated resources from FPSC's Practice Support Program, Doctors of BC's Business Pathways, Nurse and Nurse Practitioners of BC, Ministry of Health, Health Quality BC, and UBC Innovation Support Unit provide step-by-step advice on navigating the Nurse in Practice program.

Nurses are autonomous care providers who practice nursing. Acting as a nurse employer requires more than working alongside nurses as colleagues in health care. Doctors of BC and the Nurses and Nurse Practitioners of BC (NNPBC) are working together to ensure physicians and nurses have the support needed to take on this new relationship collaboratively, respectfully, and in the interest of the patients and communities we serve. 

Topics in the guide include finding the right nurse for your family practice, preparing the practice team, and helping the nurse integrate into the practice's team-based care setting.

About the Ministry of Health's Nurse in Practice Program

The Nurse in Practice Program offers longitudinal family practices, and focused primary care clinics owned and operated by a family physician (FP) or nurse practitioner (NP), the option to directly recruit and hire registered nurses (RNs) and licensed practical nurses (LPNs) as part of the core clinical practice team to expand team-based care. For further information about eligibility criteria and service expectations please see the Nurse in Practice Application Guide (PDF).

The program is open to:

  • Family physicians and nurse practitioners, including those who already privately employ RNs and LPNs.
  • Longitudinal primary care practices that deliver targeted care to priority populations.
  • Participants in the Panel Registry in the Provincial Attachment System.

Family physicians and nurse practitioners participating in the program must agree to submissions of a monthly invoice and encounter coding.

Application deadlines

Application assessments for the Nurse in Practice program occur quarterly:

  • April 1, July 1, October 1, January 1.

Eligible clinics may apply for funding by completing the Nurse in Practice application form (PDF) and submitting it to the Ministry of Health at NurseInPractice@gov.bc.ca.

Register for a kick-off meeting

Primary care practices approved for Nurse in Practice funding can register for a kick-off meeting. Participants will share experiences, connect with peer mentors, and learn about the program including:

  • Program overview and introduction to available supports.
  • Setting up to successfully integrate a nurse into practice.

Registration coming soon. 

Attend virtual team-based care webinar series

Introducing a nurse into a primary care practice is a gradual process, guided by interactive webinars tailored to support steps in the process.

These learning opportunities are offered in collaboration with NNPBC, who are partners in enabling nurses employed through the Nurse in Practice program.

  • Session 1: Integrating a nurse into a primary care team.
  • Session 2: Processes and workflows to optimize nurse integration.
  • Session 3: Communication and person-centred care.

Participants will receive webinar registration information after attending a kick-off session.  

Team-Based Care webinar series

Step 1: Prepare practice and team

  1. Register for a kick-off meeting.

    Register here

  2. Service Expectations

    Nursing resources funded under this program are intended to be used only for medically necessary services (e.g., not for non-insured services). RNs and LPNs are expected to work to their full scope of practice for clinically related services (e.g., not to be used as a substitute for an MOA or similar administrative roles).

  3. Review patient panel

    Panel management is a process of proactively managing a defined population of patients. Using EMR (electronic medical record) data to identify and access better information about patients leads to better care. Consider reviewing your patient panel to gain insight into what care your patients need, and how to best incorporate an RN or LPN into your team:

    • Get an accurate list of active patients.
    • Create up-to-date clinical registries for prevalent and chronic health conditions.
    • Identify proactive and preventative care needs and consider how adding an RN or LPN can best support patient care.

    Listen to the TeamUp! podcast "Part 1: Where to start with team-based care" for a physician’s perspective on using EMR data to plan practice goals.

    Visit the Practice Support Program (PSP) for more information on panel management.

  4. Define practice needs

    Discuss with the practice team how a nurse can help, what key areas and duties they can support or lead, and the measurements used to assess potential benefits, including:

    • Access to care.
    • Appointment cycle.
    • Practice team experience.
    • Patient experience.

    Listen to the TeamUp! podcast "Part 2: Team Building," where physicians outline the essential steps for implementing team-based care.

  5. Enhance team-based care

    Successfully implementing team-based care is an ongoing process that takes time. Expanding the practice team to include a nurse will further develop person-centred team-based care and can help to:

    • Understand your patient community and support continuity of care.
    • Assist practice teams in planning care for patients with complex and chronic health conditions.
    • Engage patients and foster relationships (e.g., information sharing, check-ins, patient group sessions, patient materials).
    • Solicit patient input about their preferences and goals for treatment, and share information with providers.
    • Streamline appointment workflows and improve patient access to care.

    The team-based care model involves health care professionals working together to support patients' needs. Visit FPSC's Team-Based Care page for additional tools and resources to assist in improving team culture, communication, shared purpose and more.

    Listen to the TeamUp! podcast “Building Relationships" to discover the importance of planning and setting common goals in shared-care teams.

    PSP offers customized support for team-based care and guides primary care teams through changes. Contact PSP for further assistance.

Step 2: Engage a nurse

  1. Create a job description

    Incorporating a nurse into the team supports patients and enhances the capacity of a primary care practice. Adding a nurse will help dedicate more time to patient care, minimize wait times, and expand access to new services, while boosting job satisfaction and reducing stress and burnout. Find the right person for your practice by creating the job description that meets your clinic’s needs.

    • Review Appendix B of the Nurse in Practice Application Guide (PDF) to help select relevant competencies and preferred skills.
    • Use Nurse Compass to review nursing care activities common in primary care and in compliance with scopes of practice for nurses in BC.
    • Create a job description. Use the RN template (docx) or the LPN template (docx).
    • Determine work requirements: scope, duties and responsibilities, major and minor activities.
    • Identify performance behaviours and essential competencies—what is essential, what is less important, what can be learned on the job.
    • Include necessary requirements (e.g., licensing, certifications).
    • Determine applicable working conditions (e.g., hours of work, location, parking space).
    • Include information about benefits. Contact Doctors of BC's Insurance Department for advice on benefits and insurance options that are best for your type of practice. Email insurance@doctorsofbc.ca or call toll free at 1 800 665-2262.
    • Determine realistic hiring timeline.

    Listen to the TeamUp! podcast “Nurses: The Swiss Army Knives of Teams?" to hear nurses share diverse examples of their roles in primary care.

    Email a Doctors of BC Business Advisor for further assistance with the hiring process.

  2. Post the job and conduct interviews

    Ambiguous job postings may attract candidates who are not qualified to meet the practice needs. Ensure the job posting adequately reflects your expectations and lists the minimum requirements of the role.

    Use credible websites to advertise vacant nursing positions.
    Recommended job posting sites:

    The selection process must treat all applicants for a given position similarly. Ask the same questions in the same way and under similar conditions to create a fair selection process.

    For guidance, see the Nurse in Practice Interview Guide (PDF).

  3. Prepare the offer letter

  4. Prepare for day 1

    This guide offers templates to be easily converted into a practice-specific checklist to help integrate a nurse into a family practice team:

    Contact your local primary care network (PCN) for more information about primary care services in your community.

    If you are not connected to your local PCN, please email PCN@doctorsofbc.ca and the FPSC team can facilitate a connection.

Step 3: Onboard a nurse

  1. (Participants will receive webinar registration information after attending a kick-off session.)

    Attend the "Integrating a nurse into a primary care team" webinar.

    This interactive webinar is facilitated by a physician peer mentor who has successfully integrated a nurse into a practice team and PSP. The webinar offers practice teams a chance to collaborate on:

    • Core concepts of team-based care, shared purpose, and goals for patient care.
    • Role clarity, responsibilities, and collaboration.
    • Team development, fostering relationships, and commitment to inclusive and safe culture.
    • How to introduce and support change in practice.

    Resources:

  2. Day 1 orientation: Introduce the practice team

    • Present a safe, inclusive, and enjoyable workplace.
    • Introduce team members and describe individual responsibilities, skills, and strengths.
    • Sign required documents as planned with the Hiring a Nurse into Practice checklist (docx).

  3. First week orientation: Introduce tools and resources

  4. First 30 days orientation: Introduce practice workflows

    • Share and discuss the orientation and plan for the first year.
    • Describe patient triage and scheduling.
    • Share available guidelines and procedures (list of topics to be included).
    • Explain team relationships and collaboration tools and templates.

  5. Define initial responsibilities

    Explore patient data and discuss patient care priorities supported by a nurse:

    • Options for patient engagement and education materials.
    • Monitor access to care and establish processes to capture initial measurements (baseline): 3rd next available appointment, same day appointment, supply and demand, patient experience tool.
    • Document patient attachment to the primary care provider.
    • Select key areas to focus on within the scope of practice for a nurse. Ensure all members are aware of possible workflow changes.
    • Establish effective communication strategies to explain the team-based care concept and changes in practice workflow to patients.

    Resources:

  6. Conduct 30-day check-in

    Use the Nurse in Practice Orientation Plan to review the orientation process.

    • Collaborate with PSP to complete a team-based care assessment, analyze the team experience, and identify areas for development and support. Contact PSP for assistance.

Step 4: Integrate a nurse into practice

  1. (Participants will receive webinar registration information after attending a kick-off session.)

    Attend the “Processes and workflows to optimize nurse integration” webinar

    Facilitated by a physician peer mentor and PSP, this webinar guides practice teams on:

    • Using panel data for proactive and coordinated care.
    • Workflows and coordinated care.
    • Optimizing EMRs for scheduling.

  2. Conduct 90-day check-in

    Review the first three months of having a nurse in practice with the practice team. Explore what went well and what could be done differently.

    Refer to questions outlined in the Nurse in Practice Orientation Plan (docx).

  3. Identify improvement opportunities

    Discuss possible practice improvement ideas for a nurse to support or lead:

    • What goals can be set to measure the impact of integrating the nurse into practice workflows?
    • How to track and capture baseline data for ongoing quality improvement. 
    • Review the initial measurements (baseline) related to access to care: 3rd next available appointment, supply and demand, same day appointments.
    • Use the patient panel to identify patients most appropriate for care from a nurse.
    • Use the patient experience tool to expand person-centred care.

    Listen to the TeamUp! podcast “Team Performance and QI,” where physicians discuss practical strategies for setting achievable goals in today's primary care landscape.

    For more information about managing employees, see the printable package on leading teams (PDF).

  4. (Participants will receive webinar registration information after attending a kick-off session.)

    Attend the “Communication and person-centred care” webinar

    Facilitated by a physician peer mentor and PSP, this webinar assists the practice team to work toward:

    • Improving communication processes within the team.
    • Expanding support for patient-centred care and including collaborative and shared care.
    • Learning effective strategies for providing feedback and conflict resolution.

  5. Conduct a mid-year check-in

    Discuss the expansion of the role for a nurse and goals for person-centred care. Compare initial base measurements previously captured with the current status and identify areas of success and for improvement. Key areas include:

    • Access data: 3rd next available appointment, supply and demand, same day appointment.
    • Patient experience.
    • Team function and effectiveness assessment.
    • Panel data and proactive and coordinated care.

    Listen to the TeamUp! podcast "Team Evaluation" to hear physicians share their insights on how continuous evaluation enhances every stage of team-based care transformation.

    Visit Team-Based Care BC for additional tools and resources to assist in improving team culture, communication, shared purpose and more.

  6. Celebrate the first year

    Mark the successful completion of the first year of integrating a nurse into the practice team. Recognize the achievements and effort it took to get to this point. Reflect on the impact integrating a nurse has had, and work with a PSP coach for ongoing practice support.
    Request an appointment by contacting PSP.

Contact:
Doctors of BC Service Centre
contact@doctorsofbc.ca
604 736-5551
1 800 665-2265