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A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.
Sarah: Are you reflecting on everything
we've covered this season in Team Up?
Are you wondering what's next?
Yeah, us too.
Morgan SM7b-MixPre: Sarah, this is it.
Uh, we're wrapping up season seven.
this is the, so a nurse is
joining your practice season.
I'm really pleased to have this one
out, and I hope this season helps
our colleagues and friends as they
move forward in team based care,
particularly those who are applying
for the nurse in practice program.
Sarah: And I hope it continues to
be useful for primary care teams as
they start and grow in BC and beyond.
We know right now that a whole bunch
of new nurse in practice teams are
getting off and running here in BC.
And we know this is happening
kind of across Canada as well.
Morgan SM7b-MixPre: Yeah, it's
definitely a positive move primary
care to build more capacity, and it's
great to see, and I'm glad we were
able to talk about it this season.
Sarah, I'm curious for you, as we wrap up,
And you've worked with a bunch of teams
and even just this week you've been doing
a whole bunch of workshops with teams.
What are some of the takeaways
for you that you wanted to
highlight from this season?
Sarah: So for me, I think there's
been great learning, about nursing
as a profession, you know, my own
focus about culture and thinking
about how teams work together.
I hadn't really pulled
together everything in my head.
I hadn't been thinking about the
different emphasis or perspectives that
nursing roles can bring into a team in
particular, you know, thinking about
the four domains of nursing, bedside
caring, also leadership, education, and
research, that had never really been,
as clearly kind of articulated to me.
I think it was Angela Wignall
who really brought that in
in the first couple episodes.
that was some real learning for me
in terms of kind of the background.
Also, you know, breaking down some nursing
misconceptions that I realized I had.
I, I always am thinking about
power dynamics and hierarchy.
And I think, Nursing is one of the
more, hierarchical aspects of the
healthcare professions and if you
think about the history of medicine,
how that sits in our system.
and some of that is deeply ingrained in my
own way of thinking about, primary care.
I think recognizing that, , Each different
kind of nursing has specific scopes and
areas of expertise that can be applied
in different ways, depending on how a
team wants to work, has been a really,
interesting area of learning for me.
And, breaking down some of those,
background ideas that I have, The
third area and, really probably
the most interesting was the
idea of a nursing diagnosis.
I did not even know that this existed
before we started this season.
I thought a diagnosis was a diagnosis
regardless of who it came from.
So really understanding, that, a nursing
diagnosis is different from a medical
diagnosis that a physician will make.
how a nursing diagnosis emphasizes
patient experience and outcomes for a
patient in a different way, and really
can add value to a team from that
perspective, I think was a real learning.
Morgan SM7b-MixPre: And Sarah, I
think, It's similar in some ways, and
yet, as you said, different in others
that adds a value and a diversity
to how we think about our patients.
Sarah: And Morgan, as a physician
who works with nurses, what did
you take away from this season?
Morgan SM7b-MixPre: Well, I kind of
thought at the beginning that I would
be, I've done this with, you know,
worked with nurses for 20 years,
I know, but I learned a lot too.
I do think that the takeaways for me and
And I hope by extension for some of my,
physician colleagues that knowing your
scope and knowing each of your scopes and
your special skills and interests is a
really important part of working together.
And then once you know that
you can take the time to really
maximize and create the supports
to maximize the scopes of practice.
I think in that context, for me, something
I didn't know was, how clinical policies
can really help with achieving that scope.
Sarah, for, me as a physician, I have my,
policies, my scope, but I don't have to
write them down for an individual clinic.
And for many nurses, that's an important
part is to know what the different
escalation pathways are locally.
I have a greater appreciation
for that today than I did at
the beginning of this season.
Sarah: Right.
And I think we really learned that getting
those policy documents written down makes
a huge difference for nurses in practice.
Morgan SM7b-MixPre: It does.
It actually just came up.
I was doing a workshop two days ago, and
it just came up at another clinic where
they've had nurses working for years in a
certain way, and a newer nurse was saying
they could actually do more because they
have, expertise in other areas, but they
just need the policies to enable it in
the practice, and it was an eye opener
for my colleagues And then lastly, I was
heartened hearing about how, teaming up
helps both at the point of care and in,
planning and retention of clinicians.
We didn't talk about that so much, but
it's come out in some of the work that's
happened for us in parallel, that people
are staying in practice longer because
they're working together as teams.
Sarah: So Morgan, that's
actually a great segue.
I wanted to talk a little bit about
some of the other things that we
didn't talk about so much this season.
I know you were the driver behind this
season and I wanted to ask you about the
things that we chose maybe not to cover.
Morgan SM7b-MixPre: So Sarah, there was a
lot that we could have covered, I mean, we
already had a fairly long season for us.
We didn't get into the weeds of electronic
medical records and quality improvement.
Sarah: And we know you love
those.
Morgan SM7b-MixPre: I do.
I do.
I probably could have done several
episodes on either one of those and
the pivotal role that nurses can
have in QI, quality improvement and
evaluation and research in a clinic.
I think that's, a whole area to explore.
Sarah: would be interesting,
but why didn't we cover that?
Morgan SM7b-MixPre: Well,
I think it's important.
I think, perhaps at the beginning of
practice, that's not the time to start
talking about all the research projects
you can do and, and rather focus on the,
the working together part of things.
and maybe later we'll talk more
about, some of those other things.
Sarah: Fair enough.
So we started with kind of
what you need to know when a
nurse is joining your practice.
So this could be something we
come back to in the future,
maybe.
Morgan SM7b-MixPre: Yeah, if
there's interest, I would love to.
Sarah: Now, Morgan, I noticed when
you started planning the season,
you excluded talking about nurse
practitioners as a nursing role.
Why did we make that choice?
Morgan SM7b-MixPre: Yeah, we didn't,
we didn't exclude talking about nurse
practitioners, and hopefully we were
clear when we were talking about family
doctors and nurse practitioners, we were
talking about primary care providers.
Because in BC, in primary care,
most nurse practitioners are
acting as primary care providers.
So they're working perhaps alongside
a family doctor, but each having
their own practice in the same
space as opposed to sharing a panel.
And so I see it more as a group
practice with physicians and nurse
practitioners than that sort of
sharing a panel with distinct roles
within a team lit, if you will.
Sarah: And that really made sense
to me, you know, when I asked what
we were planning to do and realized
we hadn't really made it clear up
front for our audience, they may be
asking why we didn't talk about NPs.
I think this came up in a
session we were doing last week,
like, you know, what about NPs?
And when we say primary care provider,
we're thinking physicians and nurses.
Nurse practitioners under
Morgan SM7b-MixPre: Yeah.
And that's a good point.
Like, we didn't make it explicit at
the beginning that We were focused
on nurses that are going to work more
tightly in terms of a, team lit model.
Sarah: So what else do we not focus on?
Morgan SM7b-MixPre: I feel like we
didn't do anything, you keep asking me.
we didn't, we didn't do a deep
dive into cultural competency and
nurses and cultural competencies.
that's something that we,
we didn't cover this season.
Sarah: Why not?
Morgan SM7b-MixPre: Again, I
think it was what did we choose
to cover at the beginning?
I do think that cultural
competencies, trauma informed
care, incredibly important.
It doesn't necessarily mean incredibly
important just to a nurse or just when
you're bringing a nurse into practice.
I think it's all healthcare providers,
all teams should explore this.
Sarah: It's not just a nurse
focus.
Morgan SM7b-MixPre: It's not.
I don't think so.
And, I think it's important to
have as part of the onboarding
process, it also needs to be fully
integrated for everybody on the team.
Sarah: I agree.
Like something that really needs to
be integrated into kind of lifelong
learning and practice when we think
about how we're working together
and how we're supporting patients.
And then I mean, over the course of
this season of Team Up, you also became
an honorary nurse in your clinic.
Morgan SM7b-MixPre: I did and I kind
of glossed over it along the way.
don't think Sarah that it, was
directly related to doing the season.
It might've been more related to the fact
that I, Sat in our courtyard at lunchtime
on a day when there was a nurse's meeting,
and I couldn't help but participate a
little bit, but either way, I did become,
an honorary nurse in our clinic, and
it's even documented in the minutes of
our nurse's meeting, so it's official.
Sarah: Right.
Once it's a paper,
it's done.
Morgan SM7b-MixPre: And once it's
written down, it's, it's, it's for real.
Sarah: So what are the kind of key
messages we want to leave with our
audience as we think about wrapping up?
Morgan SM7b-MixPre: Well, I mean,
I'll start, you know, it's a journey,
you know, it's not a destination,
the adventure starts, blah, blah,
blah, with a single step, all that.
And we did start intentionally
with the nurse joining a practice.
So it is meant to be that start.
and we, call this team up
because team up is an action.
We do really see it as a process.
So, well, it feels like a bit
of a platitude to say that.
I do think Being a team is a daily
choice and the steps you take don't
have to be big every day, but you should
think about little actions every day.
I think that's one of the key messages.
think of all the things we've talked
about and, and how do you want to bring
those into your practice each day?
and then how do you
work together each day?
And it could be Little check ins,
different conversations, cupcakes,
cards, different things just to
connect as people, as a team.
And I think that that's the, thing
that I would want people to leave
with if they're hiring a nurse.
And if you take that stance, you're
going to start to incorporate all the
things that we've talked about in all
the different episodes this season.
And how about you, Sarah?
What do you want to
leave our audience with?
Sarah: you know me, I'm,
really big on three things,
relationships, culture, and action.
so I think I would encourage, people to
pick something, pick something to do.
We tried to put actionable
ideas into every episode.
pick something you want to
do that feels manageable and
tangible and just start changes.
Don't have to be big.
They can be small.
I think that's, the message
that I would leave you with.
Morgan SM7b-MixPre:
Yeah, that's a great one.
Sarah, this is the time to
wrap up the season of team up.
we're going to pause our, episodes
for the next little while as we plan
out our next season, season eight.
Sarah: And in the meantime, if
you liked this season, please
share a specific episode with a
colleague, a friend, or your mom.
And thank you for listening.
Morgan SM7b-MixPre: Before we go, we'd
like to thank everybody who took their
time to do interviews with us this season.
So Angela from NNPBC.
Diana, who did her master's co op with
us this summer, Hannah from Kool Aid,
who I get to work with every Thursday,
Sarah: Also, Jamie from HQBC, Nikki,
who also did her master's co op with
us this summer, and Casey from the ISU.
Morgan SM7b-MixPre: all the people
who caught me in the hallways, or
I caught them in the hallways to
share ideas and ask questions, down
at Kool Aid, including Karen, Kelly,
Emily, Tessa, Oliver, Anne, and Tam.
Sarah: And the ISU team, who've worked
on Team Up with us, and some of our
related projects like the Nurse Compass.
So, Casey, Michael, and Talil.
Morgan SM7b-MixPre: You know, we couldn't
have done this season or the Nurse Compass
without any of those people, so thank you.
Sarah: And while we're taking
a break and planning our next
season, it's a great time to send
us a review or a topic suggestion.
Morgan SM7b-MixPre: If you do have an
idea for a future season of Team Up or
an experience with team based care that
you'd like to share and want us to explore
and highlight, Please email us at isu.
familymed.
ubc.
ca.
Sarah: See you next season.
The Innovation Support Unit is a
distributed multidisciplinary team.
We work mostly remotely from communities
across the Lower Mainland and
Vancouver Island in British Columbia.
Morgan: Sarah and I are both recording
from our offices in the territories
of the Lekwungen speaking peoples, the
Songhees and Esquimalt First Nations.
Sarah: And recognizing the colonial
history and the ongoing impacts of
colonization and healthcare systems
and in Indigenous communities in
Canada and around the world, as we
move through the season, we'll work
to bring an equity lens to this work.
And we really encourage you, our
listener, to reflect on your past,
present, and future participation.
On the indigenous lands
where you are situated.
Morgan: we'll see you in
the next episode of team up.