Health Transition Fund Final Report - Projects Listed By Subject Area

1.3 Background - Nursing
In Canada, issues concerning the definition, role and functions of registered nurses engaged in
extended/expanded practice are being raised at the national, provincial and regional levels. The titles of
nurse practitioner, extended class and expanded practice are reflective of common terms used to refer to
registered nurses working in primary health care settings and performing primary care functions outside the
traditional scope of nursing practice. The nursing profession is struggling to define the
boundaries/parameters of its practice while ensuring that its members are providing quality care supported
by sound research. An integral component of this process is to develop a national co-ordinated approach
to advanced nursing practice that accommodates provincial and territorial variations. There is also a
general desire by the nursing profession to ensure that its members receive recognition for and legitimization
of the full scope of nursing roles and functions.
Clinical and research data support the positive effects (e.g., increased availability of health services,
achievement of health outcomes equal to or superior to physicians, decreased impact on physician
workload, increased patient satisfaction, etc.) of extended/expanded nursing practice (Brown & Grimes,
1995; Chambers & West, 1978; Spitzer et al., 1974, Feldman, Ventura & Crosby, 1987; Reveley, 1998).
What is less clear is how the environmental context facilitates the utilization of registered nurses in
extended/expanded roles. Several studies have investigated the influence of clinical settings on
extended/expanded nursing practice and, to a lesser extent, the job expectations and satisfaction of
registered nurses. The most consistent barriers to and facilitators of role development and performance
identified from the research literature were:
< resistance/acceptance by other health care providers, especially physicians (Crosby,
Ventura & Feldman, 1987; Hupcey, 1993; Reveley, 1998),
< efforts expended by the organization/agency to formalize the role (Crosby et al., 1987;
Hupcey, 1993; Reveley, 1998), and
< legal/legitimate status of the role (Reveley, 1998; Torn & McNichol, 1998).
The scope of patient care activities, degree of autonomous and independent practice, sense of
achievement/accomplishment, and funding models are additional aspects of the practice setting that
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc. 3