This national project investigated how registered nurses working in expanded and/or extended roles are helped or hindered in their delivery of primary care services. Researchers established terms and definitions, developed a profile of relevant policies and legislation in each province and territory, constructed a profile of the structures employing nurses in these roles, and gauged the perceptions of physicians, patients, and registered nurses toward such an expanded professional role. The project found great inconsistency and variation across the country in nursing practice, in legislation governing nursing practice, in the scope of practice boundaries, and in educational requirements. More restrictions on nurses’ performance exist in places where there are more physicians. When fewer nurses with appropriate preparation are available to work in remote regions, educational expectations and standards decline. The physicians surveyed said that expanded nursing roles could increase patient access to services in remote areas, increase the availability of comprehensive health care services, and improve the quality of care and health outcomes. However, they expressed concern about decreased incomes, limited access to diagnostic services, impediments to physician recruitment and retention, and compromises to the continuity of care for patients. Nurses raised concerns about restrictions imposed on the scope of practice, skill and knowledge limits, inadequate professional and public awareness, and strain and insecurity due to lack of support and resistance from physicians. The patients surveyed reported that they were “very satisfied” with the care provided by these nurses.
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.