Fraser Northwest - Primary Care Network Registered Nurse ...€¦ · Revision Date: October 2, 2019...

Revision Date: October 2, 2019

Fraser Northwest - Primary Care Network

Registered Nurse in Practice

2019

Onboarding Process

Manual

Disclaimer: This program is in the launch phases and will undergo continuous improvement. Please contact Fraser

Northwest Division of Family Practice for the most up to date version at [email protected]

mailto:[email protected]


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Table of Contents

Acknowledgements:.......................................................................................................................3

Program Introduction.....................................................................................................................4

Case for Business Process Standardization ......................................................................................4

Total Project Stakeholders .............................................................................................................5

Summary of Process Steps ..............................................................................................................5

Process Detail Steps: ......................................................................................................................5 Step 1: Expression of Interest (EOI) Form: .......................................................................................................... 5 Step 2: Recruitment ............................................................................................................................................. 8 Step 4: Orientation, Training & Development .................................................................................................. 11 Step 5: Monitoring & Evaluation ....................................................................................................................... 14

Appendix A: Expression of Interest (EOI) Form (Step: 1) ................................................................ 15

Appendix B: GP Supporting Documentation .................................................................................. 17

Appendix C: Potential Training Activities Available for RN in Practice ............................................ 17

Appendix E: RN Core Competencies List ........................................................................................ 18

Appendix F: Hazard Assessment Results Example.......................................................................... 20

Appendix G: Example Agenda for Visioning Meeting ..................................................................... 20

Appendix H: Example of Job Description ....................................................................................... 21

Appendix I: RN & PCCRN Comparison ........................................................................................... 24

Appendix J: Adding a User in Oscar ............................................................................................... 25

Appendix K: Frequently Asked Questions...................................................................................... 29


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Acknowledgements

The Registered Nurse in Practice conversation began in 2014 under the GPforMe initiative but

was further developed in the summer of 2018 during the PCN Service Plan development.

Meeting minutes and professional insights drawn from the following meetings and events helped

shape the RN in Practice Program into what it is today:

1. Monthly FNW Board of Directors Meetings (In person)

2. Monthly PCN Advisory Committee Meetings (In person)

3. Monthly PCN Steering Committee Meetings (In Person)

4. Bi-weekly RN in Practice Working Group Meetings at Eagle Ridge Hospital (In person)

5. Bi-weekly FNW Division Team Meetings (In person)

6. Weekly RN in Practice Check-in Between FHA & FNW Division (Skype Meeting)

7. Annual General Meeting, Thursday June 22nd, 2017

8. Annual General Meeting, Wednesday June 27th, 2018

9. PMH Engagement – September 21st, 2017

10. MOA Resource Fair – Wednesday, June 6th, 2018

11. PCN Launch Event – May 21st, 2019

We want to acknowledge our place of work is within the ancestral, traditional and unceded

territory of the Kʷikʷəƛ̓əm (Kwikwetlem), Qiqéyt (Key-Kayt) and Coast Salish Nations.

In addition, a special thanks goes to all teams that dedicated their time to this program:

Physicians, RNs and MOAs

Fraser Northwest Division of Family Practice

Fraser Health Authority (FHA)

Ministry of Health – Primary Care Division

General Practice Service Committee (GPSC)


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Program Introduction

The Fraser Northwest Division of Family Practice (FNW DoFP) will be working with the Fraser

Health Authority (FHA), and Family Practice Clinics to introduce 32 Registered Nurses in

Practice (RN in Practice) by Fall of 2020. The following document has been created to aid in the

standardization of the onboarding process.

Case for Business Process Standardization

When making changes in an organization, particularly when embarking on a new endeavor, the

process can be slow and may result in unintentional consequences (lessons learned). Business

Process Standardization (Accenture LLP, 2013)1:

1. Improves Quality

2. Reduces Cost

3. Reduces Time Requirements

4. Defines Collaboration Requirements Across Tasks & Stakeholders

5. Delivers Process Transparency

We recognize this is an iterative process and will require continuous improvement through a

PDSA cycle. However, as we complete Phase 1 (3 RNs), we have been made aware of aspects of

the implementation that will be standard throughout the entire project.

Notice:

This an interactive document. If you are viewing it virtually, you are able to click on hyperlinks

signified in RED and Underlined. These act as shortcuts to the field that you’re interested in

learning more about.

1 Business Process Standardization benefits provided by Accenture LLP – for full article, click here

https://www.accenture.com/vn-en/~/media/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Industries_6/Accenture-Federal-Implementing-Business-Process-Standardization-in-Government-Organizations.pdf




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Total Project Stakeholders

1. Participating FNW DoFP Family

Practices

2. FNW Divisions of Family Practice

3. Fraser Health Authority

4. Registered Nurse

5. Kwikwetlem First Nation

6. BC Nurses Union

Summary of Process Steps

*Timeline:

*Note: This is based on Phase 1 - FHA & the FNW Division have already taken measures to reduce the time implication.

Process Detail Steps

Step 1: Expression of Interest (EOI) Form:

Estimated time commitment for clinic: 1 hour

Step 1 - Stakeholders:

1. Clinic (Physician Champion) 2. FNW Division

Step 5:

Monitoring &

Evaluation

Step 1:

Expression of

Interest (EOI)

Step 2:

Recruitment

Step 3:

Site

Preparation

Step 4:

Orientation,

Training &

Development

1 Month 1.5 Months 1 Month Ongoing

https://www.divisionsbc.ca/fraser-northwest

https://www.fraserhealth.ca/

http://www.kwikwetlem.com/

https://www.bcnu.org/


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Clinic Eligibility Requirements:

The first step to onboarding an RN in Practice is for the clinic to complete an EOI Form, see

appendix A. To be eligible for an RN in Practice, clinics must first ensure the following:

All physicians in the clinic must have completed or be registered in the GPSC Panel

Development Incentive program which pays physicians $6000 to review the patients

listed under their care and bring their information up to date (Panel Cleanup)

Must be using an EMR

Clinic has a dedicated workspace for a nurse to practice

All clinic Physicians must be members of Fraser Northwest Division of Family Practice

and practicing in New Westminster, Coquitlam, Port Coquitlam or Port Moody, Belcarra,

or Anmore.

Agree to participate in practice-level evaluation and reporting

Nominate a Physician Champion. One physician will receive a monthly stipend to act as

the clinic’s point of contact, ensure accountability within the practice and, oversee

delivery of information to the Division and health authority as needed

If a Panel Cleanup is required, there are a few options for completing this work with additional

support. The Division Practice Improvement Program Manager will meet with the clinic and

determine the best option to assist. Options at this time include:

1. Complex Care Management Program (Division & PSP initiative) which is a group format

that takes approximately 6 months to complete

2. PSP liaison in practice support which is individualized and goes at the physician pace.

3. Panel Assistants, which are available remotely or in practice, will assist in the clean-up.

Works with the physician and office staff to accomplish the work at an accelerated pace.


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Step 1 - Process Overview:

Step 1 - Process Detail:2

2 For a full Six Sigma Process Map, contact [email protected]

Clinic

Completes

Eligibility &

Submits EOI

Clinic

Completes

Panel Cleanup

EOI is

Approved



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Step 2: Recruitment3

Estimated timeline: 1 month

Once the EOI is approved, the recruitment process can begin. In preparation for the posting, the

clinic will provide the address, the days and times they will need the position to fill. RN

recruitment will be conducted by FH as the RN is a FH employee. For internal candidates, due to

the collective agreement, positions are filled based on seniority. In the event that positions aren’t

3 For a list of possible training courses, see Appendix C

Lessons Learned:

1. PANEL CLEANUP: Some clinics had expressed concern regarding the amount of time

panel cleanup would take and how it would create lengthy delays for onboarding an RN.

Therefore, the process has been adjusted to allow clinics to be “in progress” of panel cleanup

to be considered for approval. The Division has worked with the provincial PSP team to

identify these clinics and add additional resources where/when necessary.

2. MOU/ PIA: During the initial planning phase of this initiative, FHA conducted a Privacy

Impact Assessment with their Legal and Privacy department to assess any privacy, legal or

confidentiality concerns. This resulted in the development of the MOU which acts as an

agreement between FHA and each clinic. The MOU is further discussed in Step 2.

3. STEP 2 & 3 COMBINED: We learned that once the EOI is approved, Recruitment and

Site Preparation can happen simultaneously.

4. Discovery Meeting: The FNW Division learned that hosting a Discovery Meeting before

the EOI was submitted, enabled the clinic to generate a more fulsome EOI that was approved

much quicker. At this meeting we discuss; the onboarding process, orientation, billing/

billing codes, tasks of the RN, hours, supplies, OH&S Walkthrough, and the role of the

Division and FHA.


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filled by internal candidates, positions will be posted publicly and an interview process is

required.

Once the candidate is identified, a meet and greet with the clinic physicians and team will be

arranged. The meet and greet is an opportunity for the RN and Physician group to discuss role

expectations, clinic culture and confirm on all sides that it is a good fit. If all parties agree on fit,

the candidate will be hired and will give 30 days-notice to their current position.


Step 3: Site Preparation

Stakeholders Involved:

1. Clinic (Physician Champion)

2. FNW Division

3. Fraser Health Authority (FHA)

Prior to the RN beginning work and during the recruitment phase, there are various site

preparation activities that must take place, which include:

Check Activity Responsibility Time

Meeting with Clinic Staff Division & FHA 1 Hr.

MOU FHA N/A

Hazard Assessment FHA 1 Hr.

RN Workflow Assessment Division 1 Hr.

Total time requirement: ~3 Hours

Post RN in

practice position

Review Applicants/

Meet with Most

Senior Qualified

Applicant

Hire Applicant


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Meeting with Clinic Staff

An in-person meeting with Clinic Staff (or Physician Champion) is scheduled to discuss what

they can anticipate for Step 2 and beyond. This meeting is anticipated to take 1 Hr. and will

provide the clinic with an overview of the FHA Activities, Workspace & Workflow

Optimization, and RN Duties & Scope. For an example Agenda and suggested additional topics,

see Appendix G.

The meeting is also used to identify clinic specific needs, how the scope of the RN can align with

those needs, and what training is required. An example: at one clinic the need for women’s

health procedures were identified; therefore, the RN will be receiving additional training for this.

In collaboration with FHA, FNW Division created a list of RN Core Competencies which can be

found in Appendix E.

Memorandum of Understanding (MOU):

The MOU will be signed by FHA and the hosting clinic after the initial meeting with clinic staff.

The purpose of the MOU is to establish a data sharing agreement, which would make it the

responsibility of the hosting clinic to provide the RNs clinical documentation in the event of a

performance related concern and/or request. In the event of a performance related concern, the

FHA PCN Manager and the Division Practice Improvement Manager would work together to

address the concerns raised.

OH&S Walkthrough/ Hazard Assessment:

The Hazard Assessment will be completed by the FHA Occupational Health and Safety

department. This activity is estimated to take 1 hour of time and can be assigned to an MOA. A

brief example of the Hazard Assessment recommendations can be found in Appendix F.


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Step 4: Orientation, Training & Development

Orientation:

Orientation for the nurses considers RN experiences, scope, and identified clinic needs. For the

first phase, this is the approach FHA has taken:

In Person

Meeting

Establish

Collaboration

Documents

Begin

Orientation

and Training &

Development

Lessons Learned:

1. Privacy Impact Assessment: During the planning phase of this initiative, FH conducted a

Privacy Impact Assessment (PIA) with their Legal and Privacy department. As a result, the

need for the Memorandum of Understanding (MOU) was established. This was a one-time

activity and it should occur prior to the initiative beginning.

2. Collaboration with the GPs & Division is critical to indicate that the Division is there

to advocate on their behalf and to identify concerns early.

3. Hazard Assessment: Some of the items on the Hazard Assessment were identified as

“suggested” rather than “required,” such as “reduce the amount of items on the front

counter.” It should be noted that these are suggestions to reduce the risk of injury to

employees but in some cases aren’t feasible for clinics.


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Also, an education list is being created by FHA in collaboration with Public Health. The goal is

to identify the core training activities that will take place keeping in mind that the education list

will be customized to each particular clinic.

Check Activity Responsibility Time

Set up EMR Login Credentials Clinic 1 Hr.

Train RN to use EMR Division N/A

Encounter Code Reporting (training) Division 1 Hr.

Encounter Reporting:

Nurses are required to report on their activities through Encounter Codes. The Encounter record

submission procedures can be found by clicking here. The FNW Division has assigned our

Practice Improvement Program Manager to train RNs on Encounter Reporting.

https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/3_encounter_record_submission_procedures_april_2017.pdf


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Establish attachment codes:

The Division with work in partnership with the clinic to update all their patients’ CHSA

attachment codes. The division will connect with their EMR provider to update their EMR

instance with the RN encounter codes.FHA PCN Manager will facilitate the RNs application for

a billing number.

Clinic Overhead:

To help the clinic prepare for the RN, the PCN is providing $17,940 to the clinic for overhead

which includes:

Lease Clinic Infrastructure

Computer Work Station EMR Access

Lessons Learned:

1. Vacation Time: Vacation time is to be scheduled in accordance with FH parameters. The

FH PCN Manager will then coordinate the vacation time with the clinic. A vacation coverage

plan will be created.

2. Supplies Purchasing: Developing the logistics in providing supplies for the RN required

collaboration with FH. It has been determined that FHA will supply all supplies mandated by

their Occupational Health and Safety Team and invoice the FNW Division directly.


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Step 5: Monitoring & Evaluation

Monitoring:

The FNW Division will be meeting with participating physician champions on a bi-weekly basis

to facilitate discussion around what is going well, what isn’t going well and how would you do

things different. In addition, it gives the physicians the opportunity to collaborate with each other

and share best practices. The Division has also created a monthly online feedback form where

participating members can write down their thoughts, frustrations, questions or feedback, and

have someone from the Division or other members reply all anonymously.

Evaluation:

The FNW Division is working collaboratively with physicians, patients, practice staff, and allied

health providers to collect and guide how the Registered Nurse in Practice is affecting the day to

day work and patients’ access to their primary healthcare provider. This information is being

collected on an ongoing basis through surveys, formal and informal interviews and most

significant change stories (MSC).


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Appendix A: Expression of Interest (EOI) Form (Step: 1)

Back to Clinic Eligibility Requirements


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Appendix B: GP Supporting Documentation

1. Making Everyone Minute Count – Tools to Improve Office Efficiency

2. GPSC - Team Based Care Fee Summary Guide

3. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-

plan/3_encounter_record_submission_procedures_april_2017.pdf

Appendix C: Potential Training Activities Available for RN in Practice

• Vaccination certification (BCCDC)

• Gerontology certification (CAN)

• Foot care certification (Okanagan Collage)

• Computer training – on site

• Pelvic exam certification (BCIT)

• Mental Health child and youth (CME)

• Liability considerations in collaborative care

• (CNPS)

• Quality Improvement Introduction (GPSC)

• Dementia (CME)

• Dietary counselling training (Directed study)

• Changes in Cardiac management (CME)

• Treatment of paediatric asthma (CME)

• Diabetic education

• COPD/Asthma management

• Baby and child assessment

• Serious Illness Conversations – Dying and

• Death

• Mental health resources, supports,

• conversations

• Ear assessment and cleaning

The list above was provided by a report written by Dr. Janet Evans, MD, FCFP and Heidi Howay, RN

https://www.aafp.org/fpm/2005/0400/p61.html

https://mfiles.doctorsofbc.ca/SharedLinks.aspx?accesskey=21ac281d4accb71dad92143eb7d3dbc31686d11d1181fd009bd164ebae50c4d2&VaultGUID=D43316D7-A660-4C25-A7F3-285FB47DAEC5




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Appendix E: RN Core Competencies List


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Appendix F: Hazard Assessment Results Example

Appendix G: Example Agenda for Visioning Meeting

This meeting will also cover scheduling/ desired hours, supply requirements, logistics, billing, overhead, parking,

building access, etc.


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Appendix H: Example of Job Description


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Appendix I: RN & PCCRN Comparison


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Appendix J: Adding a User in Oscar

1. Create a new user account.

2. Add credentials - no much detail. She has no MSP#, etc., etc. But need this account to add tickler and msg function. Choose a Provider number. There was no one in the 500’s, so I chose that. Most of the Doctors are in the 100 range. You cannot use an existing Provider number.


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3. Add security log in. Choose the Create a name - first name usually. Then a temporary password - e.g. Password2019! The Provider No. Should be accessible if you did steps 1-2 properly. Set a PIN - this is for second level log-in.

4. Assign a role. This is the toughest, most confusing part. The RN in Practice will need full access, like a doctor or receptionist. And the order you add is important. a. Start with the first entry as admin. Use the drop-down box and find admin, highlight, and click update. b. The next role should be “doctor”. Click ADD this time. c. The last role should be “receptionist”. Click ADD. It should look like this:

5. Create entry in Message Group. We decided to add Jessica to a Provider group. I thought that MOA would be fine, or even Doctors. You can decide what works best. Under System Management, Messenger Group Admin - choose an existing group to add to; or create a new group.


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Jessica is down the list a bit. Check the box next to the providers you want in the Msg Group. Then go back to the top and click “Update Group Members”.

6. There’s nothing to do for Ticklers. The RN in Practice is added automatically as long as she has an account.

7. Have the RN change to a password of her own design. Follow the restrictions posted - 8 characters, upper and lower case, and special character. Under Administration Panel, Search/Edit/Delete Security Records - search for the RN’s provider no.


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Search and then get RN to update with her personal password. Set the PIN too. And enable for remote access - so that it is required for home access. You can enable or disable local access - so that second PIN is not needed when in office. The Expiry date is used when the staff is no longer on the team, and needs the access terminated. We use this for our residents who have finished with us. The status should be changed from 1 to 0 if the staff is terminated - see #2.


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Appendix K: Frequently Asked Questions

Are Physicians able to bill a full appointment in the case the Nurse sees the patient for most of it? Physicians are able to continue billing for any MSP billable services they provide (not what the

nurses provide). The GP does not need to see every patient the RN sees, but may need to

depending on the nature of the visit and potential issues that may arise during the course of the

patient's visit with the nurse. Here's an example that might help clarify:

Scenario: A new mother calls the clinic worried about whether her baby is getting enough to

eat. The MOA suggests that she comes to the clinic. The new mother is seen by the RN who

assesses mom/baby including taking baby’s weight, checking latch, nutrition/hydration status

and also assessing maternal wellness including PPD screen.

Outcome A (not billable): Baby looks good, latch is good, and mom is tired but

otherwise well. RN determines that doctor does not need to see the patient. RN provides

reassurance to mom and makes a few self-care recommendations for new moms.

Outcome B (billable): Upon assessment, RN identifies that mom has mastitis. RN

shares findings with GP. GP meets with mom/baby and can see the patient more quickly

as a result of the RN assessment having been completed. The GP provides a

prescription to the mom. RN calls to follow up the next day to see how mom and baby

are doing.

What is the overhead amount for the RN in Practice, what is it supposed to cover, and

how can I access it?

Clinics will receive $17,940 per year for overhead costs. Each clinic will be provided a template

for a monthly invoice by the Division that outlines the monthly total and where to submit the

invoice with instructions. The overhead is to cover the cost of lease/clinic infrastructure and

EMR. Additional RN supplies will be provided by FHA and invoiced to the FNW Division.

What is a Registered Nurse in Practice (RN in Practice)?


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Registered Nurse in Practice are registered nurses that work in primary care teams. They work

alongside family physicians in clinics to produce better health outcomes, improved access to

services, more efficient use of resources and greater satisfaction for both patients and

providers.

Where will the Registered Nurse in Practice work?

The RN in Practice is dedicated to a specific family practice clinic and their job description is set

to the practice location.

What are the Registered Nurse in Practice working hours?

This is a full-time position (unless not needed by the clinic). For a FHA employee, a full-time

work week is 37.5 hours.

Can the RN in Practice work after hours?

Provided that staff are working within the terms of the applicable collective agreement and

service contract, there is no limitation on which hours are worked.

What are the roles of the Registered Nurse in Practice in a doctor’s clinic?

The roles of the RN in Practice would be closely based on the sample position description:

Canadian Nurses Association’s job description and then tailored to each clinic. Fraser Health

and the Division will work with clinics to determine the nurse’s activities within clinics. Their role

is going to be dependent upon the needs of the physician in the practice and their panel. Some

key activities could include:

● Transition visits: New baby, post discharge, new patient etc.

● Well baby exams

● Complex care planning, prevention visits

● Asynchronous visits (education, BP checks)

● Simple procedures/immunizations/dressings

● Assistance with office procedures

● Inbox review

● Patient navigation

https://www.cna-aiic.ca/-/media/nurseone/files/en/sample_role_description_e.pdf?la=en&hash=07386589D135746C0C31D120BD893D998B84D8C9

https://www.cna-aiic.ca/-/media/nurseone/files/en/sample_role_description_e.pdf?la=en&hash=07386589D135746C0C31D120BD893D998B84D8C9


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Can the RN in Practice do group medical visits?

Yes.

How will the RNs time be divided among practitioners in the same clinic?

We recommend that the RNs time be split evenly among the practitioners in the clinic; however,

it will be up to the clinic’s discretion of how they would like to divide the nurse’s time for optimal

productivity and fairness.

How is it decided which patients see the RN in Practice or the GP?

This will differ from clinic to clinic as each one has unique needs. The patients the RN in

Practice will see will be determined when the roles and responsibilities of the RN in Practice are

being developed for each clinic.

Why are Registered Nurse in Practice being integrated into doctor’s clinics?

New Westminster and the Tri-cities have approximately 128 family practitioners in longitudinal

practices to serve a total population of about 327,819. We recognize that physicians need

support to care for the population of patients. By having an RN in Practice support family

physicians in the clinics, we hope to increase the time physicians have in the day to care for

their patients. An anticipated outcome of this is an increase in the number of patients a

practice/primary care team is able to see in a day. This is by no means a requirement of

physicians, but simply a result of an efficient use of resources committed to improving

attachment and access to care.

Who will be hiring, training and employing the Registered Nurse in Practice?

Clinics will not be responsible for the recruiting and remuneration of the RN. As outlined in the

letter of intent, health authorities receive the Ministry funding to employ nursing and allied health

employees, on behalf of the PCN. Fraser Health will be responsible for payroll and benefits

administration, as well as ongoing HR management of employees. The nurses will also be

covered by WorkSafe.

Can participating physicians be involved in the hiring of the RN in Practice?


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Fraser Health will work with the Division and local clinics to recruit and select unionized staff,

following collective agreements and based on the needs outlined in the service planning

process. The process for hiring nurses will need to follow the collective agreement with the

Nurses Bargaining Association. There will generally not be a hiring panel involved, and selection

will be done from an identified pool of qualified and eligible nurses in the community. Clinics will

work with Fraser Health to identify job requirements that outlines the specific needs of the clinic,

prior to posting positions.

Which unions will nurses be part of? Have they been engaged in this process to date?

Nurses will be part of the Nurses Bargaining Association represented by BCNU.

Representatives from this association have been engaged in discussions around this model and

are supportive of team-based care. MoH will provide updates as these issues are clarified.

Will support be available for our clinic to help integrate the RN in Practice into practice

and adapt to the new changes?

Yes, the Division and Fraser Health will prepare the clinic for the RN onboarding. Support will be

provided in the beginning to ensure a smooth transition. This support will include training and

workshops on team collaboration, communication and relationship-building.

Will Fraser Health provide continuing clinical education support?

Yes, continuing clinical education and support will be provided regardless of the clinical setting.

Will there be multiple RN in Practice for one clinic?

No, each clinic will have one RN in Practice dedicated to working in their practice.

How does an RN in Practice get assigned to a clinic?

The job posting for the RN in Practice position will contain the clinic’s location. Therefore, an RN

in Practice will be applying for his/her preferred location.

What happens if my RN in Practice is ill or goes on vacation?

Designated Fraser Health staff will be responsible for ensuring that the collective agreement is

applied. Fraser Health is responsible for scheduling and backfilling of staff and will work with the


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practice to determine the appropriate schedule to meet service needs. Fraser Health will identify

the clinic and employee needs and ensure that they are met appropriately.

How can the clinic be confident that there will be continuity in staffing? Is there a risk

that health authority staff will be subject to “bumping”?

In the experience of health authorities, the occurrence of bumping in clinical professions are

rare. However, there is general staff turnover. As new opportunities present themselves, staff

may choose to exercise opportunities for career development or move on due to personal life

changes.

Fraser Health will work with the physicians/nurse practitioners to maintain continuity of service

wherever possible. Generally, bumping occurs when there are staff layoffs, significant schedule

/ rotation and position changes (e.g. part-time to full-time). Health authorities have various

mechanisms and processes to manage their workforce to minimize the risk of bumping;

however, when it does occur, the process must follow the collective agreement language.

What vacation/education leave/sick time does the RN in Practice get?

They are FHA employees, so it will depend on their seniority.

How is the performance of health authority staff within the private clinic managed? How

does the health authority manage staff when they are not on-site?

Fraser Health, in consultation with the private clinic, is responsible for clearly describing and

communicating performance standards for each role and ensuring the appropriate training and

orientation, as well as the necessary resources, supplies and equipment, are provided to staff to

enable successful performance. If there are general clinical concerns or questions that

physicians, NPs or other health providers at the clinic have about care, then they would discuss

those concerns with the employee in the same way they would with any other colleague. If

those discussions do not resolve the concern, or if the clinic has any concerns regarding

performance, the physician or other provider can reach out to the designated Fraser Health or

Division HR representative to discuss the concern(s). This approach allows physicians to focus

on providing patient care, and not on managing staff; it also provides access to a wide range of

employment and performance resources that health authorities already have established.


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Fraser Health is not responsible for managing the provision of direct clinical care. It is expected

that the RN is responsible for their work and that they work with the clinic to ensure that patients

have all their clinical needs met.

What is the management/reporting model?

The RN in Practice will record their visits in a "shadow billing model" /encounter code as an

opportunity to provide feedback to the MoH on the activity and usage of RN in Practice and

more importantly so that there is an opportunity for quality assurance.

How is information sharing and confidentiality addressed for health authority staff

working in private clinics?

Under current privacy legislation, health care providers can share patient information with one

another for the purposes of clinical care. In addition, there will be access to supports to assist

with privacy issues. The Division is working is working with Fraser Health on privacy/data

sharing agreements.

What if our clinic has issues or difficulties working alongside the Registered Nurse in

Practice?

As soon as issues arise, the clinic should contact the Division and Fraser Health for assistance

to identifying solutions. The appropriate interventions and actions will follow to resolve the

conflict.

What type of office space do they require (i.e. Own desk vs shared desk)?

This will be dependent on the workflow and resources of the clinic to determine whether the RN

in Practice has their own desk or shares the space. They will need access to a station for

charting, a phone to call patients, etc.

What equipment is needed for the RN in Practice?

The $17,940/year overhead that clinics will receive with the RN in Practice will help cover

lease/clinic infrastructure and EMR. Each clinic will be provided a template for a monthly invoice


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by the Division that outlines the monthly total and where to submit the invoice. Additional RN

supplies will be provided by FHA and invoiced to the FNW Division.

How do I get a Registered Nurse in Practice in my clinic?

Please download and complete the Expression of Interest form to apply for a Registered Nurse

in Practice. Once complete, send to the FNW Division Executive Director at

[email protected]

What are the responsibilities of a physician lead/physician champion for a clinic that

would like to have a registered nurse in their practice?

The physician lead responsibilities include:

• A point person or contact for the Division to coordinate with for the practice

What happens if our clinic already employs a nurse? Would that nurse have to become a

health authority employee? Will we still be able to participate in this initiative?

No, if a clinic already employs a nurse, they would not have to become a health authority

employee. There is no restriction on clinics that already employ a nurse to participate in the

PCN process.

Can our practice contract with other, non-health authority employees?

Yes.

How can we ensure equal pay across different employers within in our clinic?

Health authority employees’ total compensation is determined through collective bargaining

between the accredited bargaining agent for health authorities (the Health Employers

Association of B.C.) and the accredited bargaining agent for health sector staff (the Health

Science Professionals Bargaining Association, the Nurses Bargaining Association, etc.). The

collective agreements are publicly available documents. Compensation for private clinic staff is

determined by the clinic employer. If pay equity is being sought, we would encourage

physicians/private clinic owners to consult these agreements when determining pay rates for

clinic staff.



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As fee-for-service physicians, will there be limits on how many nursing consultations we

can bill per day? How will billing in these instances work?

Beyond the existing billing rules for individual fee items, there is no specific limit on how many

nursing and/or allied consultations can be billed by a physician. Having said that, there must be

a formal need for the consultation directly related to the patient’s care and there must not be

duplicate billings for the same service.

What happens with the RN in Practice program when the Primary Care Network funding

ends?

The RN in Practice Program is a sustainable program that is funded through the Primary Care

Network via the Ministry of Health. The Division will need to show value to ensure sustainability:

reporting back, data collection and ongoing evaluation,.

What is the difference between the Home Health Primary Care Nurse (PCCRN) and the

Registered Nurse in Practice?

These are two separate nurses that will work closely together to support the patients, improve

communication and reduce the time that physicians have to spend on coordination. The Home

Health Primary Care Nurse (PCCRN) supports family physicians in the care of homebound frail

elderly patients by extending primary care services into patient’s homes to ensure they are

getting the care they need. Meanwhile, a Registered Nurse in Practice works in the clinic with

the family physician to improve patient access for all patients visiting the clinic.

Fraser Northwest - Primary Care Network Registered Nurse ...€¦ · Revision Date: October 2, 2019...

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Transcript of Fraser Northwest - Primary Care Network Registered Nurse ...€¦ · Revision Date: October 2, 2019...