Nurse Practitioner Integration into Primary Care: Exploring the Enablers, Challenges and Unintended Outcomes with MSFHR Award

Dr. Diane Sawchuck, research lead and Darcy Ross, co-lead received a $15,000 award from the Michael Smith Foundation for Health Research (MSFHR) Convening & Collaborating (C2 ) Program to investigate the integration of nurse practitioners (NPs) into primary care at Island Health, in collaboration with FNHA. The MSFHR C2 Program builds capacity for the development and use of research evidence in practice, policy and further research by promoting knowledge exchange between health researchers and research users. 

Dr. Sawchuck and Darcy Ross will work closely with NPs, family physicians and stakeholders to examine the experiences, outcomes and research priorities of integrating NPs into primary care. 

In 2018, the MOH amended the compensation structure NPs and funded 200 more positions across the province. This initiative has enabled Island Health to introduce NPs into NP Primary Care Clinics, Urgent and Primary Care Centres, Community Health Centres and Primary Care Homes within the Primary Care Network, with further expansion planned.

Nurse practitioners are qualified to diagnose and treat illnesses, order and interpret medical tests, prescribe medications, and perform medical procedures. With similar scopes of practice complementary to family physician colleagues, NPs provide care across a person’s life span. Nurse practitioners are a key component for collaborative team-based primary health care and increased care access for seniors and patients with mental health and substance use issues. However, changes to primary care models impact established processes, communication and team dynamics. Dr. Sawchuck and Darcy Ross’s work will investigate the unintended consequences as well as the challenges and opportunities for integrating NPs into the traditional care model.  This investigation will generate valuable knowledge to guide future planning and implementation so that integration may occur more seamlessly with minimal impact on clinic workflow and patient care. “This work will provide valuable learnings on how to strengthen and enhance our approach to team-based care,” said Shelley Tice, Executive Director, Primary Care Strategy and team member. 

Zak Matieschyn MN, NP(F), Clinical Director, NPs, Nursing Policy Secretariat, MOH and MSFHR C2 team member states, “The proposed work will no doubt increase our understanding of the work required to integrate this unique clinic model into the primary health care system, and improve our processes and approach in the years to come.” 

This research engagement will occur over the next year. The team anticipates that findings will contribute to overall work satisfaction, and subsequently to the sustainability of the NP work force and enhanced accessibility to primary care in BC. “Nurses and Nurse Practitioners of BC [NNPBC] looks forward to collaborating with Island Health on this very important work.” said Danielle Daigle, Director, Provincial Initiatives, NNPBC and MSFHR C2 team member.

“I am very happy that this study is being done” says Dr. William Cunningham, Department Head, Primary Care at Island Health, and MSFHR C2 team member. “The timing is right especially as we move into the space of NPs and family physicians working shoulder to shoulder in the Urgent Primary Care Centres and the primary care networks.” 

This project strongly supports PhD mentorship. Angela Wignall, Director, Special Projects, Indigenous Health & Diversity, Equity and Inclusion, PhD (Nursing) student & MSFHR C2 member says, “Nurse-led primary care practices not only expand equitable access to care for patients but they also represent a significant step forward in health human resourcing by enabling nurses to work to their full scope of practice. I’m excited to be part of the important work of adding to the evidence-base for nurse practitioner contributions to health and wellness.”

Dr. Sawchuck is a registered nurse and researcher with expertise in inter-disciplinary perinatal care, evidence synthesis and health system evaluation using mixed methodologies, and holds academic appointments at both the Faculty of Medicine, UBC and the School of Nursing, University of Victoria (UVic); and is Co-Director, Centre for Evidence Informed Nursing and Healthcare, UVic. Dr. Sawchuck is Island Health’s Research Liaison Officer, and leads numerous research, QI, program evaluation, knowledge translation & academic mentorship initiatives. Darcy Ross, Co-Lead is Lead, Advanced Nursing Practice, Island Health, is a registered nurse and has been facilitating NP integration since 2007. 

A full list of the 2020 C2 award recipients may be found here: