Health Transition Fund Final Report - Projects Listed By Subject Area

3.0 Results
3.1 Policy and Legislative Frameworks for Extended/Expanded Nursing Roles
Diverse models have been used across Canada to provide authority to registered nurses performing
extended/expanded roles. Diagnostic and treatment functions have been delegated by government to the
medical profession through legislation. Registered nurses have been assessing, diagnosing and treating
acute, episodic and chronic illness and injury under the authority of delegated medical functions in remote
and rural areas of Canada, as well as in a few more populace areas.
The delegation of medical functions is normally through protocol arrangements negotiated between
the professional bodies, the employer and sometimes government. Saskatchewan tried to ensure greater
consistency across primary health care sites by developing province-wide protocols to facilitate the transfer
of medical functions and to clarify the parameters of the extended/expanded nursing role. Although this type
of protocol may reduce role uncertainty, the downside is that it does not bring the functions within nursing’s
scope of practice as defined by the professional legislation. Some nursing associations indicated that the
provincial/territorial legislation/regulations governing nursing practice are of sufficient breadth to
accommodate extended/expanded nursing roles. In contrast, other associations raised concerns about the
inconsistency between the scope of nursing practice outlined in the professional legislation and employer
expectations of nurses.
Over the past decade, certain jurisdictions have opted to legitimize the extended/expanded nursing
role beyond protocol arrangements by enacting legislation (i.e., Ontario, Newfoundland and Labrador,
Alberta and Manitoba). The regimes in Ontario and Newfoundland and Labrador are very similar with
both requiring that nurses practice in a collaborative relationship with physicians and receive advanced
preparation for the primary care role. Registered nurses regulated within the extended/expanded class have
the authority to engage in autonomous decision-making, perform primary care functions in a variety of health
care settings (e.g., community health centres, long-term care facilities, nurse-managed clinics, etc.), and
access resources within defined limits. When encountering problems beyond their scope of practice, nurses
are required to consult with a participating physician.
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc. 15