Health Transition Fund Final Report - Projects Listed By Subject Area

3.1.2 Scope of Practice - Policy Framework
Provincial nursing legislation provides guidance on the functions and activities that constitute the
scope of nursing practice. There is no one consistent definition or scope of practice for nursing across
Canadian provinces and territories. The title of “registered nurse” may not be defined but is inferred by
referencing the definition of the “practice of nursing”. The definitions of “registered nurse” or “nursing
practice” are used to set parameters around the activities undertaken by members of the profession.
Though some statutes are dated, the definitions contained therein are believed to be broad enough to
incorporate extended/expanded roles within existing scope of practice guidelines. Table 2 contains a
summary of the extended/expanded scopes of practice by jurisdiction across Canada.
The data collected from the various Ministries indicated that there is no agreement on the
parameters of the extended/expanded role across and within jurisdictions. This was particularly true for
those provincial/territorial jurisdictions which rely on delegation of medical functions as opposed to
legislation. Generally, protocol arrangements determine the breadth of delegated medical acts to registered
nurses practising in extended/expanded roles. Often accompanying this delegation is the right to access
certain health care services (e.g., ordering diagnostic tests, prescribing medications, making referrals to
other providers, etc.) which are viewed as essential for nurses to perform the extended/expanded role. One
glaring problem identified is the lack of consistency in the protocol arrangements which delegate authorities
across and, in some cases, within jurisdictions. The one exception is Saskatchewan where a province-wide
protocol is in effect for primary care settings.
During the course of the current study, it became evident that some informants believed that the
extension/expansion of nursing’s scope of practice can be achieved by “pushing the boundaries”. In New
Brunswick the legislation governing the nursing profession contains a very broad definition of nursing
practice. However, this definition does not seem to be adequate enough to allow for an extension of the
nursing role into primary care. More importantly, support for “pushing the boundaries” of nursing’s scope
of practise to cover primary care functions does not provide registered nurses with the necessary authorities
to access services required to execute
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc. 19