Lori Verigin

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What is your current role, and what type of work do you engage in on a daily basis?

I currently work as a full service family nurse practitioner in a private family practice clinic. This means that I work as an employee under the health authority but have been embedded in a fee-for-service clinic. I work to full scope, which is quite a broad scope of practice. This allows me to work with all kinds of individuals across the lifespan, ranging from babies, patients receiving end-of-life care, and everything in between.

How has nurse practitioner integration evolved over time in B.C.?

Nurse practitioners were introduced in B.C. in 2005. However, integrating something new is always difficult when trying to fit into a system that is well established. We have come a long way in many regards, and some of the problems with integration have often been around others' understanding of our role and scope of practice. Many legislative and regulatory pieces are still outstanding and this has led to challenges to full integration and inclusion. I think we have learned a lot from the past, and as we move forward, we have tried to be more strategic. As the numbers of nurse practitioners grow in B.C, we will hopefully get to the tipping point, where it becomes the norm for nurse practitioners to provide primary healthcare to the people of B.C.

There are also examples of nurse practitioners working in acute care. These nurse practitioners provide specialized care and work in a consultative role. For example, a nurse practitioner can be working at a diabetes clinic or heart function program, where they are seeing patients that may have a family physician or other primary healthcare provider. These patients come to the nurse practitioner for specialized consultative service. In addition, some NPs work in trauma or orthopedics, and they provide a higher level of acute care to patients requiring these services.

What are some of the key barriers impacting the practice of nurse practitioners within B.C.?

There are many barriers in providing primary healthcare services and this can vary depending on the individual, community or geographical location. At this time, the funding model for nurse practitioners remains the most significant barrier to full integration and inclusion of nurse practitioners in the health care system. Nurse practitioners are salaried providers, trying to fit in a predominantly fee-for-service world, and it makes it difficult and challenging to foster good collaborative relationships. From my perspective, a funding model needs to foster and encourage public participation in healthcare decisions, and allow all healthcare providers to work to their patients' best interest. It becomes very difficult to keep the patient in the centre, when the funding model does not lend well to it.

While there are no formally named ‘nurse practitioner led clinics', there are nurse practitioners working independently within their own practice, providing primary healthcare to their communities. Although this model may not necessarily be ‘ideal,' if the current funding structure is not well suited for collaborative interprofessional care, then nurse practitioners are forced to work in more isolated settings.

Other barriers include some of the limits and conditions placed on the practice of nurse practitioners. With time and regular assessment of nurse practitioner practice, these barriers can and should be removed.

Do the challenges and barriers differ according to health authority?

Yes. The limitations and conditions placed on a nurse practitioners' practice vary depending on the health authority through which a nurse practitioner is employed. As a result, the challenges and barriers to working to full scope are very different between those working in urban areas and those in rural areas. The ability to speak to these differences and create dialogue around these issues is significant as the pool of nurse practitioners is still fairly small.

Rural and urban differences do exist. There are always differences in practice for any healthcare professional depending on the level of isolation and access to higher levels of care. For example, a nurse practitioner working in the northern part of the province may have less access to consultants or specialized services.

What are some potential solutions to these barriers?

Barriers will be eliminated when the system understands our role and scope, and how we do our work. While nurse practitioners have been working in B.C. for about 10 years, there are still many people who don't understand the work that nurse practitioners do. This includes decision-makers, individuals within health authorities, etc. I often still get asked: "you can write a prescription?" While many nurse practitioners cannot work to full scope, being able to demonstrate our full scope of practice, what our role is, and the positive impact that it has, is very powerful.

Role clarity is essential, especially when working in interdisciplinary teams. If our physician colleagues understand the scope of our practice, that we are responsible for the care we provide, and the ongoing follow-up, this would go a long way in terms of breaking down barriers.

However, I don't think it's a matter of people not wanting to understand the role of nurse practitioners, it just takes times to educate people.

What is working well to help facilitate nurse practitioner integration?

What works very well is collaboration, teamwork, a patient-centred lens, and when we work together as a team, not individual providers. When we do that, we have been able to increase access to care, demonstrate reductions in hospital visits and emergency room visits, and have a very engaged patient population. When we first came together at Waneta Primary Care, it was struggle. We realized that if we wanted to make an impact, we had to change the way we engage with patients, and how we engage with each other. We had to act like a team.

Our use of the electronic health records has also been a huge success. It has allowed us to take a population health approach to patient care. Recently we began to use a patient portal, which allows patients to book their own appointments and see their problem list, medications, and lab results.

Facilitating nurse practitioner integration comes back to the basic principles of building relationships with colleagues, patients, decision-makers, and organizations, even those that we find difficult to work with. Everyone should be invited to the table.

What promising models exist in other jurisdictions?

While there are many models of care that work in other jurisdictions, what our Ministry of Health is focusing on is the need to work in teams and remove silos. There are opportunities for nurse practitioners to be part of that. I think there are many models we can learn from, however, we need to remember that it's not a ‘one size fits all' solution.

What changes would you like to see?

While I would like to see a variety of nurse practitioner roles. To break through the ceiling, we need more nurse practitioners working in primary healthcare, where patients are first connecting into the healthcare system.

How can ARNBC further support nurse practitioners across B.C.?

Knowing the power of engagement and relationships, ARNBC can support nurse practitioners by building strong relationships with other organizations that interact with nurse practitioners such as the BC Nurse Practitioner Association (BCNPA) and the college (CRNBC). ARNBC can also provide opportunities to engage with nurse practitioners, and hear our stories. Relationship building is key.

With your experience practicing as a nurse practitioner, what lessons have stuck with you?

There are many stories that illustrate the impact of the nurse practitioner role. For me it has been the development of longitudinal relationships. Hearing from patients that they feel supported by a team rather than just an individual provider. As our population ages, and the demands on all care providers increase, we need to find ways to engage with each other to provide both primary care and specialized care to the people of B.C.