Appendix 2:
The Roles of Nurses in Family Practice / Primary Care

Interdisciplinary Collaboration

Appendix 2:

Nurses have very important roles in family practice / primary care settings. Many family doctors speak about the numerous benefits in having a family practice nurse or nurse practitioner attached to their practice. While a family practice nurse or nurse practitioner’s roles are quite distinct and different, in either role nurses can make highly valued contributions to primary care when they exercise their full scopes of practice. And as trusting relationships develop between a doctor and nurse in a practice, experience has shown that doctors often delegate greater authority to nurses in caring for their patients. Working together, there is greater opportunity to expand their services to patients, to achieve more professional satisfaction and in some circumstances, to improve the quality of care provided. Traditionally, nurses have not exercised their full potential because the system has not supported their roles in primary care. In many clinics it has been up to doctors to hire and pay for nurses out of their financial overhead. Fortunately for all professions that enjoy working in teams in primary care, this is changing and governments are recognizing the benefits of supporting nurses to work with family doctors and other team members.

In 2007, The College of Family Physicians of Canada released a Vision Statement in support of nurses. This Statement describes a preferred future in which all people in Canada have access to a family practice / primary care setting that offers each person the opportunity to have his or her care provided by a personal family doctor and a registered nurse and / or nurse practitioner. This is not to the exclusion of other valuable members of a family practice / primary care team but does recognize the value of the relationship between the family doctor and nurse working together to deliver and improve their patients’ health and care. Indeed, this Statement goes on to recognize the need for other health professionals while acknowledging that a doctor and nurse can be a very effective team in providing or ensuring the provision of a full spectrum of primary health and medical care services for patients in the practice.

In support of the nurse’s role in primary care, the Canadian Nurses Association (CNA) developed and released its web-based Primary Care Toolkit in 2009: http://www.cna-aiic.ca/cna/practice/family/default_e.aspx. This Toolkit supports the roles of nurses in primary care – both family practice nurses and nurse practitioners. In particular, it highlights various aspects of the family practice nurse’s role under such headings as:

  • Benefits of Registered Nurses Working in Primary Care – for patients, families, physicians, other nurses and the health system
  • Role Description for Registered Nurse in Primary Care
  • Business Case for Registered Nurse in Primary Care
  • Sharing Time and Space
  • Evidence-based Practice – including a broad range of clinical practice guidelines in which nurses can be involved
  • Building Collaborative Teams

The Primary Care Toolkit for Nurses also has a number of tools that those thinking of hiring nurses or already working with nurses in family practice / primary care might want to consider, e.g. sample interview guides and position descriptions.