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Ontario health system not fully utilizing nurses and practitioners — report

Expanding scope of practice of health care professionals would help patients, improve cost-effectiveness of public system.

This report is a first step towards ensuring full utilization of all health professionals in OntarioJune 27, 2012: Ontario Nurses and other health professionals practice to their full scope when they are in a practice environment that enables them to fully utilize their competencies, knowledge and skills to provide high quality, evidence-based and patient-centred care.

The Commission on the Reform of Ontario's Public Services is calling for an expansion to the scope of practice of nurses and other health professionals as a sustainability strategy for Ontario's publicly funded not-for-profit health system.

College of Nurses of Ontario data estimates there are approximately 2,873 Registered Nurses (RNs) and 1,412 Registered Practical Nurses (RPNs) who practise in Ontario's primary care system, totalling 4,285 nurses.

  "The roles of the RN and RPN in primary care are misaligned to the competencies, knowledge and skills of these professionals."

Primary care can be defined as "that level of a health service system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and co-ordinates or integrates care provided elsewhere by others."

The Registered Nurses' Association of Ontario (RNAO), the professional association representing RNs working in all roles and sectors in Ontario, regularly receives anecdotal reports from the field suggesting that while nurses in all settings are working very hard and provide long hours of care, the roles of the RN and RPN in primary care are misaligned to the competencies, knowledge and skills of these professionals. These reports are validated in a study that found only 61 percent of Canadian RN respondents report practising to their full scope of practice in primary care.

Clearly there is untapped potential in Ontario's primary care system with a significant nursing workforce waiting and eager to be fully utilized and take on expanded roles. The Primary Care Nurse Task Force was launched by RNAO to explore the unique role of the RN and RPN in primary care, and to develop recommendations that optimize the full utilization of these nurses to strengthen patient outcomes and health system cost-effectiveness.

The Task Force focused on the role of both RNs and RPNs to provide differential role clarity in primary care and optimize both roles within patient-centred inter-professional teams, while strengthening continuity of care.

While the scope of this Task Force was on RNs and RPNs practising in Ontario's primary care setting, the recommendations hold tremendous potential for nurses practising in other health sectors and jurisdictions. This report represents a first step towards ensuring the full utilization of all health professionals in Ontario, which is part of Ontario's blueprint for action on inter-professional care.

Future policy must strengthen the inter-professional team's ability to provide the highest quality of care for patients, while ensuring the most appropriate use of all health professionals and resources.

The Task Force focused on two progressive phases of outcomes.

The first phase identifies the highest level of RN and RPN scope of practice utilization already present in selected primary care settings in Ontario and recommends an upward harmonization of scope of practice utilization for all primary care nurses, across all sites in Ontario.

The second phase involves identifying needed expansions to the existing scope of practice of the primary care RN and RPN that would serve further to improve access to primary care for the public. The recommendations for the second phase focus on the mechanisms required to achieve the proposed scope of practice expansions.

Links and sources
  Primary solutions for primary care

Posted: July 19, 2012

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