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The Impact of Funding Models on the Integration of Registered Nurses in Primary Health Care Teams

Principal investigators

Maria Matthews, Lindsay Kathleen Hedden, Julia Lukewich

Pre Marie-Eve Poitras is in charge of the study in Quebec.


604 350 $

Canadian Institutes of Health Research (CIHR)

Study setting

Four Quebec provinces

Ontario, Quebec, Nova Scotia, British Colombia


Nursing practice, optimization, primary health care, funding models


Primary health care reforms across Canada have introduced various funding models designed to promote interdisciplinary teams who share responsibilities for managing the care of patients (i.e. co-management).  Despite the recognition that appropriate funding models are critical to support collaborative primary health care teams, few studies have described how these funding models affect the roles and functions of non-physician health care providers. Family practice nurses are Registered Nurses (FP-RNs) who work in primary health care settings.  Although FP-RNs form the core of interdisciplinary primary health care teams across many jurisdictions in Canada, relatively little is known about the impact of funding models on their integration in primary health care.

In an initial study in Newfoundland and Labrador, we found the funding models influenced the professional practice (i.e. roles, domains, and activities) of FP-RNs, the skills and training needed by FP-RNs, and team functioning. This initial study examined only traditional fee-for-service and global funding and did not explore the funding models introduced in primary health care reform in other provinces. 

What are our objectives?

  1. Describe and compare the various financial models used in Canada to integrate FP-RNs in primary health care

  2. Explore the variation of nursing professional practice, training and skill set needed by FP-RNs, and team functioning in primary health care settings funded by traditional fee-for service, enhanced fee-for-service, capitation, and global funding in Ontario, Quebec, British Colombia and Nova Scotia

  3. Examine the relationship between funding model, variation in nursing professional practice, training and skill sets needed by FP-RNs, team functioning, and patient care co-management of FP-RNs in primary health care settings in Canada


The project employs a multiphase, mixed-methods design, and consists of three studies:

  1. Funding model analysis : identify relevant funding models we will review websites of provincial/territorial departments of health, nursing organizations (unions, regulators), and physician unions (e.g. Ontario Medical Association).

  2. Case studies : consist of qualitative interviews and FP-RN activity logs.  We will conduct 3-4 case studies of each funding type in each province.

  3. FP-RN survey : We will conduct a cross-sectional, online (Qualtrics) survey of FP-RNs in Canada. 

What results we aim for?

This project will address a gap in Canadian literature and aid provincial governments in structuring funding models that best optimize the roles of FP-RNs and realize benefits from team-based care. The results of the project will shed light on how funding models impact healthcare services and optimal professional practice deployment. The results will be useful to provinces that have already introduced funding reforms to integrate FP-RNs into primary health care settings as well as provinces (such as Newfoundland and Labrador or British Columbia) that have yet to introduce similar reforms.

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