The Implementation of Infection Prevention and Control Procedures in Primary Care During the COVID-19 Pandemic: A Qualitative Study of Nursing Roles

Introduction: During the COVID-19 pandemic, primary care practices felt poorly supported by existing infection prevention and control (IPAC) guidelines, which focused primarily on acute care facilities. This issue was further complicated by insufficient provision of personal protective equipment in primary care settings, which limited clinic capacity and the ability of primary care to provide in-person services. Nurses play an integral role in the implementation of IPAC procedures and the provision of ongoing primary care during a health crisis; however there is limited literature related to nurses' roles in the enactment of IPAC procedures in primary care settings. This paper aims to describe primary care nurses' experiences and roles in implementing IPAC during the COVID-19 pandemic.Design: Qualitative analysis of interviews as part of a larger mixed methods case study.Methods: We conducted semistructured qualitative interviews with primary care nurses across four Canadian regions in the provinces of British Columbia, Ontario, Nova Scotia, and Newfoundland and Labrador. During the interviews, we asked participants to describe the roles they enacted during the various stages of the pandemic, any facilitators and challenges they encountered, and the potential roles that nurses could have played. We employed a thematic analysis approach, and, for the purposes of this paper, we analyzed themes relevant to the implementation of IPAC.Results: We interviewed 76 nurses across the four regions and identified two overarching themes: (1) nurse-led transformation of clinic operations and (2) impact on workload. Primary care nurses developed and implemented IPAC policies, educated staff, and made critical decisions about patient care, often out of necessity and ahead of regional guidelines. In addition, nurses adapted workflows, managed supplies, and balanced in-person and virtual care to protect both patients and staff from COVID-19 exposure.Conclusion: Despite the additional responsibilities and challenges that nurses faced in response to evolving guidelines, their IPAC efforts were pivotal in maintaining primary care clinic operations during the pandemic. The findings from this study underscore primary care nurses' capacity to adapt and apply evidence-based practices and demonstrate the need for better pandemic planning to support primary care. IPAC guidance documents, suitable for primary care settings and informed by experiences from the COVID-19 pandemic, should be included in future pandemic plans.Implications for Nursing Management: Our findings highlight the need for stronger institutional support and preparedness for primary care nurses during a pandemic. Nursing management should ensure that IPAC responsibilities are explicitly recognized within primary care nursing roles and supported through ongoing training, resource allocation, and standardized protocols. Proactively integrating IPAC into primary care practice and strengthening these supports will enhance future health crisis preparedness while mitigating nurse burnout and promoting sustainable workforce capacity.