…want to collaborate?
When nurses work in primary care settings they support individuals and communities in managing their own health. Nurses are part of a collaborative team of health-care professionals that are the everyday entry points for health-promotion, disease prevention and illness-care.
What are the benefits of having an FPN?
- Improved and more timely access to primary care
- Physicians receive support with complex and time-consuming patients
- Patients and families get more time with a health professional for education, guidance and counselling
- Enhanced chronic disease management
- Comprehensive preventive health maintenance screening
- Support and promotion of healthy lifestyle behaviours
- Improved screening, early detection and diagnosis
- Access to two or more health-care providers with complementary strengths and perspectives
- Comprehensive health records
- More health care delivered in a cost-effective manner
- Improved patient outcomes, which decreases costs to the health system in the future
- Potentially reduced emergency department visits and hospital admissions
- High career satisfaction for nurses due to greater independence, quality of team interactions and ability to achieve work-life balance
What do FPNs do?
Help manage health issues such as diabetes, asthma, COPD, high blood pressure, smoking,cholesterol and heart disease.
Provide well-baby visits and prenatal care.
Review and update medications.
Perform pap tests and yearly exams.
Provide teaching and support for healthy living. Topics could include healthy eating, physical activity, mental health, and sexual health.
Review and promote health screening.
Provide immunizations, injections, wound care, and more.
Is there enough space?
An exam room and office space are necessary. These can be combined together if need be, the point is that FPNs must have thier own dedicated space. Sometimes it is possible to get creative and utilize space that is not used by another health-care professional on a full-time basis. It may also be possible to either convert a space or rent additional space
Is there sufficient patient volume?
There must be enough patient demand and facility capacity to support the increased number of patients a physician-nurse team can see. Working alone, most physicians see four to six patients per hour; working as a team, physicians and nurses can expect to see six to nine patients per hour. It may be possible for the nurse to work part time if there was insufficient patient volume.
What equipment does an FPN need?
Consider portable equipment when possible (ie portable otoscope and BP as oppose to wall mounted)
- Blood pressure machine (with large, regular and pediatric-sized cuffs)
- Glucometer with single-use lancets (both can sometimes be provided by supplier at no cost)
- Insulin pen for demonstration purposes (can sometimes be provided by supplier at no cost)
- 10g monofilaments
- Otoscope, opthalmascope
- Scale: adult and baby.
- Exam table
- BpTRU (automatic blood pressure machine that takes a number of measurements and provides an average)
- Doppler (for prenatal exams, size 2-3 MHz; ankle brachial index, size 8-10 MHz, etc.)
- Pulse oximeter
- Steadiometer (wall mounted device to measure height)
- Recumbent height measure for infants (infantometer)
How do I find a nurse? How are they paid? (unofficial info)
How do I find a nurse?
We get a lot of questions about this but cannot comment much on different approaches and business models officially. So, here’s a very unofficial summary explanation. Pairing nurses with a collaborator and creating collaborative practices remains a challenge. First it depends if you want to hire a nurse privately (you are the employer) or to seek a funded salary for that nurse via the Nova Scotia Health Authority (NSHA is the employer). In a private situation clinics often bill MSI for patients that the nurse has seen and the nurse’s salary is thus created in this way. However, MSI has strict rules on reimbursement for visits performed independently by nurses, often requiring the collaborating physician or NP to participate in some small way during the visit. Alternatively some nurses salaries are paid directly out of a clinics collective ‘overhead’. Finding a nurse ‘privately’ is a challenge because there is no official system of advertising these types of jobs. Some collaborators advertise through our association and we forward it to our members. Others use official employment websites where nursing jobs are frequently posted such as Careerbeacon.Com. ‘Word-of-mouth’ is how many ‘private’ nurses and collaborators have found each other.
NSHA is increasingly supporting/creating collaborative practices. To officially become a collaborative practice, NSHA requires an expression of interest from the collaborator. If approved, then the position is created. The nurse’s salary is then paid by NSHA and NSHA is the employer. This has the added benefit of allowing the nurse to work within a slightly larger scope of practice as more visits can be performed completely independently by the nurse when billings do NOT need to be recouped through MSI. For more information on this contact NSHA or click here.
Finding an experienced FPN may also be difficult. The use of FPNs remains relatively new in the province and there are very few experienced FPNs who are not already employed. There is a training course for nurses to become FPNs but for the most part the participants need already be paired with a clinic or collaborator.
Clear as mud? 🙂
My Typical Day - by Jill Morse FPN
I have 4 MD’s with whom I work with on a daily basis. All have different approaches to patient care so I have learned to become flexible depending on which MD I’m working with. The doctors value my assessment and opinion on varying aspects of care and are very happy to have me give all the baby needles and most of the gynecology screening to do.
The day begins with a young lady looking for STI testing and birth control renewal. This is simple enough for a Family Practice Nurse such as myself. Swabs are easily obtained, discussion about birth control and various options reviewed. Next I move on to a happy 2 month old who is receiving their first routine vaccinations, Mom is nervous but easily educated and reassured. When I finish the vaccines I have a diabetic patient which needs his foot check and risk assessment completed, as well as various other health screens checked relevant to all those with diabetes. A lady for a routine pap smear follows, she also has a UTI which must be assessed and then diagnosed by the physician I’m working with that day. The list continues on with wart treatments, BP checks, more paps and birth control counseling.
Each office setting will be different depending on what the needs of the practice are. We have been successfully providing care for the past 14 years with 2 RN’s and 5 MD’s.