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For nearly two decades, Nurse Practitioner (NP) Kristal MacLean has been at the forefront of primary care in Pictou County, Nova Scotia.
Starting in the halls of the Aberdeen School of Nursing, MacLean’s dedication to healthcare grew into a deep commitment to primary care. Today, she serves as the primary provider for more than 800 patients at the Westside Health Centre in New Glasgow.
“I love what I do, plain and simple,” she shared. “I've been a nurse for 32 years, working in the Emergency Department before becoming a Nurse Practitioner. For me, the greatest part of this work is the privilege of being involved in people's lives every day.”
MacLean’s path to primary care began during her clinical placement to become a NP back in 2005.
At that time, collaborative care was still relatively new to Nova Scotia, and MacLean was only the second NP to serve in Pictou County. During her practicum, she worked alongside Dr. Aulayne Jeans, Dr. Ania Kwasnik, and Dr. Patricia Craig at Westside Health Centre in New Glasgow. Together, they pioneered a collaborative care model that expanded patient care options.
“I knew I wanted to work in Pictou County since it’s where I’m from,” MacLean recalled. “Dr. Craig, Dr. Jeans, Dr. Kwasnik, and I all agreed we wanted to establish a collaborative model, as it seemed to be working well, and patients appreciated having a Nurse Practitioner involved.”
The three physicians, along with the primary care coordinator and director, advocated to secure funding for the role. Once that was successful, MacLean officially began practicing at Westside in 2007, laying the foundation for future NPs to follow.
In those early years, the NP role was strictly defined by regulations that limited her scope of practice. “The role looked very different then,” she explained. “I wasn’t considered the ‘most responsible provider’ since I didn’t have my own patient roster, and there were only certain diagnostic imaging tests and medications I could order. It was very black-and-white, with clear guidelines on what we could and couldn’t do.”
Over the years, MacLean has witnessed tremendous changes as health authorities gradually recognized NPs as primary care providers, expanding their prescriptive authority and scope.
“Eventually, Nurse Practitioners gained the ability to prescribe basically all medications and treatments, with few exceptions, and can order the full gamut of diagnostic imaging and lab tests,” MacLean said.
By 2018, after more than a decade in practice, she officially began rostering her own patients, taking more than 600 from a departing physician and adding many long-term patients she’d been seeing for years.
Today, her roster includes more than 800 patients, with MacLean providing comprehensive care that spans all stages of life. “I work to full scope, meaning I manage prenatal care, see newborns, and provide care for various needs. Primary health care means addressing the diverse needs of my patients at each stage of life, so every day is different.”
In family practice, this variety is central to the work, and MacLean appreciates the opportunity to support patients through multiple life events. “As an emergency nurse, I would often meet people on one of the worst days of their lives. As a family practice NP, I get to be there for my patients over their lifetimes. That continuity is truly amazing to me.”
One of MacLean’s longtime patients described the unique support she brings to the role, “Kristal never ceases to amaze me with her active listening, her lightning-quick critical thinking, and her ability to deliver top-notch care with a warm, engaging approach. She meets patients where they are in their health and lives, and partners in a way that ensures patients feel heard, respected, and equipped to make decisions with her excellent guidance and support.”
Building a community of practice for NPs
Beyond her dedication to patient care, MacLean has been a driving force in building a strong network for local NPs. When she first started in 2007, she was the only NP in Pictou County.
“I was fortunate to have a fantastic network of physicians who helped me learn how to become a provider and how to advocate for myself,” she recalled. “Dalhousie University also really fostered that advocacy for Nurse Practitioners, so that confidence stayed with me. But back then, we felt a bit like ‘unicorns’ because we didn’t really fit into the traditional roles of registered nurses. When more Nurse Practitioners joined, around four or five of us, we started to realize we needed to be sitting together, supporting each other to make sure our roles would be successful.”
MacLean helped initiate regular gatherings, creating a Community of Practice with the support of primary healthcare managers, but these meetings paused when COVID-19 disrupted in-person events.
“Then one day, Robin Baker, who was our health services lead at the time, came into my office and asked if I’d consider bringing back the quarterly meetings,” said MacLean. “I was thrilled. This time, there were 12 or 13 of us. We needed an actual meeting space—it wasn’t just a few of us around a kitchen table anymore!”
The number of NPs in Pictou County had grown significantly, with many new to practice and others bringing a diverse array of skills and experience to the table.
“The Community of Practice has been instrumental in fostering these connections and creating learning opportunities for this growing group,” said Baker, now a manager of Planning and Development, Rapid Onboarding for the Primary Health Care Network. “Meeting every three months gives Nurse Practitioners in Pictou County the ability to collaborate, draw from each other’s expertise, and bring forward practice-level challenges and successes to management. What Kristal has created has been essential for building a stronger, more connected community.”
“It’s very organic, how it does all of that—there’s strength in our numbers,” added MacLean. “It’s important to know you’re not just alone in your office, thinking, How am I going to manage this? Sometimes it’s just about talking to each other and finding better ways to do things. When we bring issues to management, they know we’ve discussed them as a group, and they’re not just specific to one Nurse Practitioner but support the entire community.”
For MacLean, the Community of Practice fosters a culture of mentorship and camaraderie. “There are some Nurse Practitioners at the table who I precepted when they were students, so it really feels like family,” she said. “Hopefully, we’re building something that will continue for many years to come.”
Looking ahead, MacLean is hopeful for continued growth. “As Nurse Practitioners, we've made tremendous progress in the last 20 to 25 years. Sometimes I worry that if we become too complacent, we might not keep evolving,” she reflected. “Looking 20 to 25 years ahead, I hope we’ll continue to see the Nurse Practitioner role adapt to meet the changing needs of our patients, as they should always be our primary focus.”
For MacLean, the role of NPs have been about far more than providing medical care; it has meant building community, guiding patients across their lifespans, and shaping a compassionate future for primary care in Nova Scotia.
In the photo: Kristal MacLean (middle), Nurse Practitioner at Westside Health Centre, with NP colleagues Rachel MacKenzie (right) and Kristen Peddle (left).