Nurse Roles in Virtual Care Within Team-Based Primary Care: Qualitative Findings From a Multiple Case Study in Two Canadian Jurisdictions.

Introduction: Canadians, particularly those in Newfoundland and Labrador (NL) and Nova Scotia (NS), face ongoing challenges in accessing primary care. To address this concern, many jurisdictions have adopted team-based primary care that enables nurses, physicians, and other providers to collaborate in delivering care. Virtual care has been widely integrated to promote efficiency and quality across team-based primary care. Nurses in primary care teams (i.e., nurse practitioners, registered nurses, licensed practical nurses) deliver care virtually; however, details of their role enactment remain unclear. Objective: To explore virtual nursing practice within team-based primary care settings in two Canadian provinces, namely NL and NS. Methods: This study was part of a larger multiple case study that was carried out in accordance with COREQ guidelines. The researchers explored the phenomenon of virtual care delivery by nurses within urban and rural primary care teams in NL and NS, including perspectives from nurses, other team members, administrators, policymakers, and nurse regulators. They used two data sources, including qualitative interviews and documents, and performed qualitative content analysis. Results: Nurses adapted their roles using virtual care approaches across urban and rural primary care teams in NL and NS. Roles were organized into four categories: triage and assessment, care coordination, health promotion and prevention, and follow-up. Sub-categories comprised unique activities illustrating each role. Nurses assessed patients' needs/concerns; arranged patient care with the interdisciplinary team; provided education/support to promote health and prevent disease; and followed up with patients regarding treatment plans and laboratory/diagnostic tests. Most roles were carried out via telephone, though other modalities were used. Potential activities for nurses to expand their use of virtual care within primary care teams were also identified. Conclusion: There was high variability in the enactment of virtual care by primary care nurses. Virtual care role enactment varies by activity, province, and community type.