This commentary, informed by the lived experience and expertise of two patients, provides insights into the future of registered nurses (RNs) in primary care. The patient perspective is crucial if the healthcare system aims for patient-partnered care to be paramount. This article highlights the envisioned success of an effective partnership between patients and RNs in primary care and illustrates how they can become experts in care together. This reciprocal relationship between the patient partner and the RN demonstrates the importance of combining the expanded role of the RN and patient perspective to drive change in primary care.

Introduction

This commentary is informed by the lived experience and expertise of two patients and provides insight into the future of registered nurses (RNs) in primary care. It explores the partnership between patients and RNs in primary care and discusses implications for nursing leaders, decision makers and educators as an interdisciplinary example of expert patient collaboration.

For many years, Canadians have been fortunate to count on the care of great persons who have left their mark on the history of nursing. Marie de l'Incarnation comes to our mind in Quebec and Myra Bennett in Newfoundland and Labrador. Even today, nurses make a difference in the lives of many patients by being present in remote areas or in primary care clinics. RNs in primary care, in collaboration with family doctors, are often the gateway to the front line of our health system. Nursing is constantly evolving, just like society and healthcare needs. If RNs fully occupy their scope of practice, they can help improve access to care as well as the continuity and comprehensive care needed to meet current societal challenges such as the aging population, chronic diseases and mental health needs (Lukewich et al. 2022; Mathieu 2019; OIIQ 2014). With these societal challenges, it is required that patients and their loved ones develop their autonomy in their care. The advent of tools to promote access to care, such as telehealth, is another reason to emphasize patient engagement (WHO 2016).

The Partnership of the Patient and the RN in Primary Care

Many factors can influence patients' health outcomes. One important factor is the relationship of trust between patients and nurses (Pozhar et al. 2019; Rørtveit et al. 2015). The literature indicates that without trust, it becomes impossible to effectively meet patients' needs, ensure their satisfaction with nursing care and create a healthy society in the long term (Olshansky 2011).

In our experience, this relationship of trust develops when RNs follow their patients in primary care throughout the continuum of their care. This relationship, initially, is fuelled by patients' need to be listened to, accompanied and understood. The duration of the relationship promotes patient engagement and commitment to their health and wellness. We have observed that the support provided by RNs in primary care allows patients to gradually engage in the changes required to improve their health condition and their life trajectory with illness – changes that they often have difficulty navigating alone. Instead of patients being subjects of care (RNs doing the care for/to them), patients become active partners with RNs in managing their care. This patient engagement comes little by little through small successes, which, when added together, will allow patients to be experts in their care. Patients, by their lived experience, are the true experts in their care journey. RNs in primary care, through helping patients navigate the health system and its varying resources, make them empowered and reinforce their autonomy. Considering patients as “whole” persons, rather than solely treating their illness/ailment, facilitates a connection between primary care RNs and patients that focuses on comprehensive health and wellness. This relationship also empowers RNs in primary care to consider patients more holistically, without believing that their illness defines them. It is essential to consider that the patients are persons who define their own life trajectories through their choices and engagement in their own care. When RNs in primary care and patients can associate with this humanity, they become true partners in care.

Patients and RNs in Primary Care – Experts Together

Combining both RNs' and patients' expertise is necessary to foster intentional collaboration. This partnership can create meaningful, reciprocal learning between patients and RNs in primary care. Moreover, it creates mutual respect and appreciation for their differing but complementary roles.

By exercising their full scope of practice in accordance with the national competencies for RNs in primary care (CFPNA 2019), RNs in primary care are the experts in providing the knowledge, including explanations, reinforcing therapeutic strategies and demonstrating the use of the necessary equipment for self-management at home (CNA 2015). This knowledge transfer allows patients to integrate the knowledge of RNs in primary care into tangible actions and changes in their everyday lives.

All patients need the autonomy to choose the extent of their involvement in their care, and RNs have an essential role in supporting the level of engagement in care that best fits the patient. This support implies the respect for patients that is developed through their evolving relationship. RNs who develop expertise in patient engagement will respect that, for some patients, not being intensely involved in their care is also a choice.

Indeed, the literature on patient partnership reports different levels of engagement, from information to co-construction (Couturier et al. 2023). The participation and involvement of RNs will be different in these circumstances but just as important and comprehensive. It can be difficult for RNs to shed the expectation of the type of care that “should” be provided to the patient, but meeting patients where they are on their health journey is essential for patient-partnered care. RNs in primary care should value every patient's choice and support them in the process of engaging in their care.

By considering patients as a whole, RNs in primary care can better capture certain aspects of patients' lives and gain a greater understanding of their situation. This allows RNs to make relevant suggestions for extending patients' care, including referring to other services offered within the primary care clinic and beyond. Moreover, RNs in primary care who follow patients' health journeys ensure a smooth transition between care providers and allow services to expertly meet patients' needs (Poitras et al. 2016, 2018).

In our experience of collaboration with RNs in primary care, their knowledge about patients' characteristics also allows the clinic to provide targeted interventions, guiding the clinic's future endeavours to meet the needs of its patient population. For example, if the clinic has many young women, they will deduce that, in a few years, it will be necessary to offer services dedicated to them (e.g., well-women care, sexual healthcare, pre-natal care). They will also be able to plan for future inclusion of services related to menopause and preventative healthcare for aging women.

RNs' scope of practice comprises a teaching and educational role, leading them to engage in prevention and health promotion (CNA 2015). Whether it is cancer screening, sexually transmitted infections, heart disease, diabetes, chronic obstructive pulmonary disease, healthy lifestyle habits or mental health, RNs in primary care are often the first to acknowledge and address these subjects and their importance in patients' overall health and well-being. In particular, prevention promotes access to care by detecting these illnesses promptly and minimizing the associated risks (Pender 2013; Poitras et al. 2018).

Research: Where Patients and RNs in Primary Care Drive Change

As the presence of RNs in primary care promotes access to care and is a key point of entry into the healthcare system, research is needed to support the nursing profession, and patients need education about how these changes can benefit their care.

As patient partners, we have seen too many times that patients are often simply not a part of the equation in research about healthcare and its impacts. What can we do to ensure that patients contribute to and benefit from the outcomes of health research? The key to ensuring patient-oriented research is including patient partners from the beginning (CIHR 2023). For example, we contributed to developing a national training program enabling nurses to integrate Canadian competencies in primary care (CFPNA 2019) and Patient's Medical Home (CFPC 2019) pillars that promote partnership with patients and their families into their practice. Hence, patient involvement in primary care research is constantly growing, and this commentary is another direct example.

As patient partners in primary care research in Quebec and Newfoundland and Labrador, we have provided the patient perspective throughout all aspects of primary care research in our provinces. In Newfoundland and Labrador, Toni Leamon is a long-standing NL SUPPORT Patient and Public Advisory Council member. The council members are experts in viewing projects from a patient perspective, giving guidance and support in patient health literacy and evaluating the success of patient involvement. Toni is also the immediate past-chair of the Canadian Medical Association's Patient Voice group, advocating for patients nationally. In Quebec, Marie-Dominique Poirier is a music teacher who has lived with chronic pain for many years. She is a patient partner who collaborates with the Quebec Learning Health System Support Unit, the Pôle-PASSERELLE-Hub, the Chaire CRMUS sur les pratiques professionnelles en soins primaires, the Chaire de V1sages (Chaire de recherche du Canada sur la mise en oeuvre de soins intégrés pour les personnes avec des besoins complexes) and the Engage Committee of Université de Sherbrooke. Our seat at the table is no less important than that of the RNs in primary care, researchers, policy makers or government. Our voices represent many healthcare system users who, with patients providing expertise and guidance at the table, will experience more outcomes in research that positively impact their experience with primary care and RNs in primary care.

Educating the Future of RNs in Primary Care

In the current condition of our society, and with the evolution of the RN profession, primary care is becoming increasingly important. For nurses to consider choosing to work in primary care, they need to be exposed to this type of practice right from the beginning of their education (Brzozowski et al. 2023). Nurse educators should explore the role of the RN in primary care with nursing students, promoting a generalist practice where students witness the opportunity to be a part of the patient's life and provide care outside the confines of the hospital setting. In our concurrent primary care and health workforce crisis (Casey 2023; Flood et al. 2023), access to primary care doctors for all patients will likely never be possible. RNs in primary care, by practising to their full scope of practice and role, are an asset to our health system, especially for many of us patients needing support in primary care. When RNs in primary care take leadership and commit to patient-partnered care, patients can feel secure in the quality and continuity of their care. We must consider our approach to primary care access and emphasize the need to access the right professional at the right time for the right reasons. For many of us, the right professional will surely be the expert, supportive and collaborative RN in primary care.

Discussion

Implications (For Nursing Leaders, Decision Makers, Educators)

Including RNs in primary care in the patient care journey is the perfect interdisciplinary example of expert patient collaboration. For nursing leaders, RNs in primary care exhibit the true meaning of nurses contributing their full scope and practising to the complete extent of their role. Not only can RNs feel satisfaction in this autonomy-based practice, but also patients can experience great satisfaction with having care that is comprehensive and familiar, especially when continuity of care is a vital focus.

We implore that decision makers need to understand that patients are craving consistency. With consistent care providers who understand patients as whole persons (not just their designation as patients), we feel that patients can participate and collaborate in their care within their desired level of engagement. Decision makers should consider filling in the gaps in primary care with competent and confident RNs who are experts in patient engagement rather than assuming physicians are the only option. This way, patients will have greater access to primary care. For patients, creating meaningful relationships in care is just as important as the care itself.

Educators need to understand and incorporate the roles and competencies required of RNs in primary care into entry-to-practice education. Without the knowledge of the role and the opportunities that exist in the workforce, how can students be expected to consider it as a career option? We opine that patients' experience with RNs in primary care is also an asset to the education of future nurses. We have seen the effect that nurses can have on a patient's care journey as well as the lived experience and expertise that patients share with nurses. Seeing this can show students the impactful lived outcomes of patient-partnered care.

It has been our experience that educator teams formed with patients as trainers and RNs are efficient in clinical settings to support the empowerment of the RN. A patient-as-trainer's perspective differs from an RN's above literacy, navigating the system, therapeutic education and communication, but this difference is complementary and essential. The patient-trainer is the best person to explain how a strong relationship can improve patients' life trajectory with illness. RNs and patients as trainer teams demonstrate to the decision makers the importance of patients' experiences to reinforce the role of RNs for patients and communities (Morin et al. 2023).

Conclusion

The role of RNs in primary care will continue to expand in the future. Patient partners are the best ambassadors to demonstrate the importance of sustaining RNs in primary care.

Correspondence may be directed to Toni Leamon by e-mail at tcsl62@mun.ca.

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