Registered Nurse in Primary Care Practice - Maple Ridge/Pitt Meadows

Fraser Health is responsible for the delivery of hospital and community-based health services from Burnaby to Fraser Canyon on the traditional, ancestral and unceded territories of the Coast Salish and Nlaka’pamux Nations, and is home to six Métis Chartered Communities.

Our team of 43,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, best in health care. Learn more.

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Fraser Health is proudly recognized as a BC Top Employer. Joining our team offers you opportunities to work in a rapidly growing organization with health professionals who are excellent in their respective fields, career growth and advancement, a competitive compensation package (including four weeks of vacation to start, comprehensive health benefits, and pension plan), and the rewarding opportunity to make a difference every single day in health care.

Effective October 26, 2021 all staff for all positions across health care in British Columbia are required to be fully vaccinated against COVID-19 (have received a full series of a World Health Organization “WHO” approved vaccine against infection by SARS-COV-2, or a combination of approved WHO vaccines). Please note this applies to all postings, and there are no exceptions.

Fraser Health values diversity in the work force and strives to maintain an environment of Respect, Caring and Trust. Fraser Health’s hiring practices aspire to ensure all individuals are treated in an inclusive, equitable, and culturally safe manner.

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In accordance with the British Columbia College of Nurses and Midwives (BCCNM) scope of practice, standards of practice and the Mission and Values of Fraser Health, works collaboratively as a member of an interprofessional team to provide direct patient care to clients of family practice clinics within the Primary Care Network. The role of the Registered Nurse in Primary Care Practice is to partner with and complement that of the family physician.

Provides initial client consultation, assessment, triage, coaching and teaching, health promotion and intervention, client care services and follow-up based on the client's needs, urgency of request and best practices, to ensure clients, families and caregivers are provided with ease of access to timely, person-centred, continuous and culturally safe quality health services. Care may be provided in the clinic setting, over the phone, or in the community setting. Facilitates and manages client transitions across the healthcare continuum to optimize health and well-being and adapts to changes in the client's condition to minimize avoidable admission to healthcare facilities; collaborates with the client and ensures linkages with acute, primary and community care healthcare providers including the client's primary care provider (Nurse Practitioner, Physician), other specialists and family supports with respect to client care planning to facilitate the flow of information through a variety of settings including FH and non-FH community services.

Provides client and family-centered care through a trauma-informed approach and evidence-informed practice. Establishes a dignifying, purposeful and trusting relationship with clients, promoting self-determination and independence. Encourages knowledge exchange in day-to day activities, and empowers clients to engage and connect within their communities. Ensures clients and their family members are supported in navigating the health care system.

1. Provides direct nursing care to clients receiving scheduled or urgent/timely primary care. Assesses clients and collects information from a variety of sources using skills of observation, communication, data review and physical assessment. Triages and makes a nursing diagnosis of the client's condition and determines whether the condition can be improved or resolved by an appropriate nursing intervention or through interventions and collaboration with other clinical staff and primary care provider. Assists the Physician/NP and other team members with urgent and emergent care as necessary.
2. Performs a comprehensive and focused health assessment that includes health history and complete physical evaluation; considers the patient's psychosocial, emotional, ethnic, cultural and spiritual dimension of health, the client's goals for health, including a thorough medication assessment and best possible medication history, and his or her understanding of their health/illness experience and how their daily life is affected.
3. Processes physician or nurse practitioner orders through methods such as initiating unit standing orders, administering medications, carrying out treatments and monitoring and documenting the effects.
4. Performs nursing procedures within their scope of practice and their own level of competency both independently and in an assisting role with the Physician/NP. Establishes a therapeutic relationship with the client through the use of interpersonal and interviewing techniques, in person and/or over the telephone, to ensure the client's choice and autonomy in decision-making and care planning including the client's right to dignity and privacy. Establishes longitudinal relationships to support client and family care across the continuum and spanning all settings.
5. Screens referrals, provides individualized client assessments, and contributes to interprofessional care planning and clinical interventions. When appropriate collaborates and refers to specialized services for clients with multiple complex conditions; assists clients to achieve an optimal level of function by facilitating timely and appropriate health services (e.g. public health, social services) and utilizing a variety of resources and services; collaborates with the primary care provider, client, the family/supports/caregivers, other health care professionals, clinics, hospitals and other community resources to identify and resolve client care issues and coordinate the integration of care and services.
6. Develops a comprehensive shared client care plan, in collaboration with the interprofessional team, client and/or family, other healthcare providers and/or referring clinics which includes health promotion, sexual health, illness prevention, rehabilitation, chronic disease management, and/or palliative approaches; facilitates and supports the transition of the client care plan to the primary/community care provider and/or community agencies.
7. Provides direct planned and unplanned client care and identifies other care services required in accordance with applicable guidelines, policies and evidence-based best practice; informs and educates clients and families and provides comprehensive explanations of care to the client and family and checks for understanding, as appropriate.
8. Reviews client care plans, in collaboration with the interprofessional team/primary care provider to determine timing and referral to other services and/or interventions to improve client outcomes; initiates, monitors and evaluates the appropriateness and effectiveness of the short and long term care plan to meet specific client goals; develops next steps in collaboration with the client and family; develops and supports a transition process for achieving client care goals across the care continuum.
9. Discusses clinical findings with client/family, in collaboration with the interprofessional team to develop action plans and set goals directed at clinical needs, self-management, and improved health-related quality of life; accesses system information and resources to review client data such as medical history, progress notes, consultation reports, lab reports and incorporates findings into the care plan; plans, organizes and establishes priorities by using resources effectively and efficiently; monitors and evaluates the plan of care and responds to unanticipated events and/or changing client or service assignment needs, as needed.
10. Supports clients and their families' clinic visits by providing information through their decision-making process regarding treatment options; advocates on behalf of the client/family to support their choices and needs and provides direct care to client as they transition to another program, service or healthcare provider.
11. Arranges and participates in outreach nursing care to clients in their home setting or suitable alternative, as required; performs nursing functions such as assessment, determining physical and mental status, and evaluating response to medications administered. Formulates and explains plan of care to client/family or supportive care persons and provides advice to the client and/or caregiver about available community resources.
12. Provides health counselling to clients including education, self-management, self-monitoring and wellness/health promotion/prevention through a combination of clinic, telephone or home/outreach visits; assesses the learning needs of individuals, providing and explaining techniques and equipment, and evaluates the overall effectiveness of the selected teaching methods and outcomes of learning.
13. Maintains clinical records such as intake screens, client assessments, clinical interventions, medication documentation, care plans and progress notes; maintains statistical information on clients in accordance with established policies, standards, and procedures.
14. Maintains professional practice growth, knowledge and expertise to reflect current standards of practice by reviewing relevant literature, attending educational workshops and in-services, consulting and networking with other health care professionals based on own learning needs.
15. Participates in quality improvement and risk management activities by identifying client care issues and collecting data; participates in research opportunities, as required.
16. Provides input in the development and revision of standards of care, policies and procedures and advocates for improvements in clinical practice, health care and health care services; participates in the development, implementation and evaluation of quality improvement initiatives within the program by providing recommendations to the Manager.
17. Performs other related duties as assigned.

Education and Experience

Current practicing registration as a Registered Nurse with the British Columbia College of Nurses and Midwives (BCCNM).

One (1) year recent related clinical experience including assessing and treating children, youth, adults and/or seniors in an acute or community/outpatient care setting or an equivalent combination of education, training and experience.

Immunization additional education completed and up to date.

Valid BC Drivers license and access to a personal vehicle for business-related purposes.

Skills and Abilities

• Demonstrated ability to complete initial and ongoing client assessments and provide nursing care through therapeutic interventions
• Demonstrated ability to communicate effectively, both verbally and in writing
• Demonstrated ability to integrate and evaluate pertinent data from multiple sources to problem-solve effectively
• Working knowledge of First Nations, Metis and Inuit health, culture and traditions
• Knowledge of broad health care services, community resources agencies and their role in providing a continuum of care
• Knowledge of common chronic diseases, effects of aging on health, infection control approaches, and primary care competencies
• Knowledge of adult guardianship act and related acts for children and reporting processes
• Knowledge of basic wound care assessment and treatments 
• Ability to promote client-focused care including sensitivity to diverse cultures and preferences and utilization of harm reduction strategies
• Ability to independently manage and prioritize clients with diverse healthcare issues Ability to teach clients and others about topics essential to health care, health promotion and care self-management using care management principles
• Ability to work effectively in a dynamic environment with changing priorities
• Ability to work independently and as a member of an interprofessional team
• Ability to operate related equipment including applicable software applications
• Physical ability to perform the duties of the position