Clinical roles
Primary Care Registered Nurses provide comprehensive nursing services to the patient population in physician clinics. Primary Registered Care Nurses assess, manage and support patients. They direct patients to the care they need, from the appropriate health professional or program, freeing up physician time to meet the increased medical needs of our community. Primary Care Nurses work to full scope of practice with an emphasis on providing comprehensive care and education and a focus on chronic disease management.
Primary Care Nurses work closely with physicians to provide chronic disease management and facilitate the comprehensive delivery of chronic disease self-management education with clients and families.
They perform and document a comprehensive history and in-depth assessment of the health status including physiological, psychosocial, economic, learning, cultural and spiritual factors affecting well-being/health. Primary Care Nurses initiate and implement management strategies and provide appropriate evaluation, follow up and modifications to care plans. They maintain up to date and accurate documentation in the patients’ medical records.
Primary Care Registered Nurses are co-located in physician members’ clinics. As travel is necessary between clinics within the CWC PCN area, a reliable vehicle and valid driver’s license are required.
Primary Care Registered Nurses may be carrying a laptop and other resources when they travel to clinics.
Primary Care Nurses work in a full-time or part-time capacity, and shifts are scheduled during the core business hours of 8 a.m. to 5 p.m., Monday to Friday.
Registered Nurses - Senior Services provide an advanced level of nursing practice that maximizes the application of in-depth nursing theory, knowledge and skills to meet the complex health care needs of individuals, families and communities. Registered Nurses function as nursing practice leaders and expert practitioners and educators to provide holistic and comprehensive care to the more complex geriatric population.
Registered Nurses perform and document a comprehensive history and in-depth assessment of the patient’s health status including physiological, psychosocial, economic, learning, cultural and spiritual factors affecting well-being/health. They initiate and implement management strategies and provides appropriate evaluation, follow up and modifications to care plans. Registered Nurses provide chronic disease management and mental health services within the context of geriatric care, incorporating monitoring progress, response to treatment, and promoting the preventive aspects of patient care.
Registered Nurses may work in various settings to assess and evaluate the needs of patients. This may include visits to the patient’s home, working at CWC PCN member clinics, and working from the Primary Care Centre which is CWC PCN’s appointment-based clinic offering enhanced access to health care on a short-term basis. A reliable vehicle is required for home visits.
The work environment may be physically demanding during home visits. This includes being able to lift or support a patient and transport small equipment to carry out an assessment.
Depending on business needs, Registered Nurses may work in a full-time or part-time capacity. Shifts are scheduled during the core business hours of 8 a.m. to 5 p.m., Monday to Friday. Registered Nurses may be co-located in multiple member clinics and patient’s homes.
Licensed Practical Nurses work with physicians and other health professionals to provide a high quality of evidence-based health care to CWC PCN’s patient population. They have the knowledge, skill, judgment, and abilities to contribute in all phases of the continuum of care from prevention to acute treatment and management, to long term and palliative care.
Licensed Practical Nurses assess, manage and support patients, providing appropriate documentation and working collaboratively with physicians to develop and implement care plans, evaluate outcomes and provide follow-up to the patients. They assist in the delivery of disease management and health promotion programs and provide appropriate care and treatment. Licensed Practical Nurses utilize the EMR system in maintaining accurate and timely records, and documenting all phases of client care.
Licensed Practical Nurses work from the Primary Care Centre, CWC PCN’s appointment-based clinic offering enhanced access to health care on a short-term basis.
Licensed Practical Nurses are walking and standing on their feet for long periods of time and may need to assist with moving patients.
Licensed Practical Nurses may work in a full-time, part-time, casual, permanent, or temporary capacity depending on the needs of the business. Various shift schedules could be available including those that fall within the core business hours of 8 a.m. to 5 p.m., Monday to Friday, as well as evening, weekend and holiday coverage.
Primary Care Registered Psychologists (PCRPs) works with patients to address a wide range of mental health concerns with the goals of early identification, quick resolution, long term-prevention, and health promotion. As part of an interprofessional healthcare team, PCRPs collaborate, innovate, and support Patient Medical Homes within the Calgary West Central Primary Care Network.
The Primary Care Registered Psychologist works collaboratively with physicians to provide patient care within the Patient Medical Home. The PCRP supports patients presenting with:
Using evidence-based strategies and treatments, the PCRP provides outcome-focused patient care. The PCRP also works with physicians and other PMH team members to ensure that patients are referred to specialized services within the community if necessary.
Primary Care Registered Psychologists work from home and provide care virtually to patients using digital technologies (telephone, video call, etc.).
Primary Care Registered Psychologists work in a full-time capacity. The standard hours of work are Monday – Friday from 8:30 a.m. – 4:30 p.m., with no evening or weekend work required.
Licensing
Registered Psychologist in good standing with CAP (College of Alberta Psychologists) is required.
Social Workers are involved in the provision of services to clients and families including psychosocial assessment, crisis intervention, education, treatment, advocacy, finding resources, consulting, making appropriate referrals and liaising with community agencies/programs.
Social Workers complete formal and informal assessments of patient needs under the direction of the physician of record and in collaboration with members of the patient care team. They lead and participate in the preparation, implementation, and modification of care/treatment plans and provide an interpretation of assessment findings and treatment recommendations to client, family members, other caregivers and educators as appropriate.
Social Workers function as the primary case manager for identified clients by providing short-term counselling and crisis intervention, by facilitating caregiver and other supports and acting as a liaison to education or support groups. They identify and implement strategies to improve the clients and/or family member’s medical, emotional, mental and physical health, and they guide and encourage the family to move forward with recommendations. Social Workers liaise with community resources, agencies, and stakeholders to improve health outcomes.
Social Workers work mainly from the Primary Care Centre, CWC PCN’s appointment-based clinic offering enhanced access to health care on a short-term basis. They may also conduct home visits where necessary.
The work environment may be physically demanding during home visits, which can include lifting or supporting a client. Social Workers may be carrying a laptop and other resources when they conduct home visits.
Social Workers work in a full-time or part-time capacity and shifts are scheduled during the core business hours of 8 a.m. to 5 p.m., Monday to Friday.
Patient Care Coordinators support physician members in the coordination of planned care aimed at improving disease screening and treatment. They work within an integrated and coordinated care delivery team to positively impact the health of clinic patients, including those patients who are not actively seeking care, through evidence based preventative health promotion strategies. The objective of this increased focus is to enhance the patient’s quality of healthcare while supporting the day to day function of the clinic.
Under the direction of a physician, Patient Care Coordinators screen for preventable diseases, establish and maintain a system for recalling patients for preventive health screening maneuvers, and identify opportunities to engage patients and provide support and encouragement for positive action across the continuum of health care services.
Patient Care Coordinators ensure accuracy within the EMR (electronic medical record) system including an up-to-date problem list, current medications and standardized charting. They support the healthcare team by identifying at-risk patients, contacting patients with instructions prior to a visit, ensuring results of test are available for review with a physician, and referring patients to other relevant programs based on their needs. Patient Care Coordinators assist physicians effectively manage the patient panel, including those not actively seeking care.
Patient Care Coordinators work remotely.
Patient Care Coordinators work in a full-time, part-time or casual capacity and shifts are scheduled during the core business hours of 8 a.m. to 5 p.m., Monday to Friday.
Medical Office Assistants provide administrative support to the CWC PCN clinical team and play a key role in the organization and flow of clinic operations.
Medical Office Assistants book patient appointments, process referrals, assist with attaching patients to physicians, and enter information into the EMR (electronic medical record) system including new patient data, referrals, and vitals. They handle all front-desk reception activities and follow-up with patients. Medical Office Assistants handle general office administration responsibilities including receiving and distributing mail, keeping the waiting room tidy, ordering supplies, and faxing/scanning/photocopying documents.
Medical Office Assistants work from the Primary Care Centre, CWC PCN’s appointment-based clinic, offering enhanced access to health care on a short-term basis.
Medical Office Assistants may work in a full-time, part-time or casual capacity depending on the needs of the business. Various shift schedules could be available including those that fall within the core business hours of 8 a.m. to 5 p.m., Monday to Friday, as well as evening, weekend, and statutory holiday coverage.
Physician Liaisons work with CWC PCN member physicians through the promotion, facilitation and enhancement of CWC PCN programs and services. To do this, Physician Liaisons develop strong working relationships and must ensure regular contact with physicians and clinic staff. They must be familiar with the needs of the primary care physicians, as well as knowledge of current provincial initiatives, the political environment and primary care landscape. Physician Liaisons support member physicians by having a strong understanding of the programs and services that are offered by CWC PCN, and provide relevant and timely information. The Physician Liaisons are the point of contact that all member physicians and potential member physicians will have for any concerns or inquiries.
Physician Liaisons work closely with physicians and their teams, including Medical Office Assistants, Patient Care Coordinators, Health Information Coordinator, Behavioural Health Consultants, Primary Care Registered Psychologists, and Primary Care Registered Nurses, to build strong relationships and generate awareness and enhance knowledge of PCN programs in order to promote the implementation of the Patient’s Medical Home Model. They identify prospective physician members and provide initial overview of CWC PCN programs and services for interested physicians, assist with the physician onboarding and orientation process, and regularly capture physician feedback in an effort to improve the membership experience. They seek and create opportunities to engage physicians and clinic staff in program/service planning and improvement. Physician Liaisons facilitate the gathering of program evaluation data, keep accurate and up-to-date records of physician interactions and regularly research current provincial initiatives and priorities of physician organizations to maintain knowledge of the political environment and primary care landscape.
Physician Liaisons work from various locations including physician members’ clinics, the CWC PCN corporate office, and remotely. As travel is necessary between clinics within the CWC PCN area, a reliable and valid driver’s license are required.
Physician Liaisons may be carrying a laptop and other resources when they travel between clinics, the corporate office and their home office.
Physician Liaisons work in a full-time capacity and shifts are scheduled within the core business hours of 8 a.m. to 5 p.m., Monday to Friday. Flexibility is required after-hours to meet the needs of the physicians and to attend training activities and special events.
The Calgary West Central PCN is made up of 465 physicians in over 135 clinics.
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