Health Transition Fund Final Report - Projects Listed By Subject Area

these functions. In fact, registered nurses who perform primary care functions in New Brunswick do so
under the authority of delegated medical acts which are site-specific, for example the MacAdam project and
demonstration projects in remote areas.
To gain an appreciation for the mechanisms which facilitate implementation of extended/expanded
roles, the legislation governing nursing cannot be read without reference to the Medical Act, the Pharmacy
Act and related statutes. The interrelationship among the scopes of practice of physicians, pharmacists and
registered nurses is a key consideration. For example, in Nova Scotia the function of diagnosis is clearly
within the medical profession’s scope of practice. The Medical Act contains legislative authority to delegate
functions to nursing which is usually accomplished through protocols negotiated by the relevant regulatory
bodies. Thus, the delegated authorities are negotiated by the respective professional licensing bodies.
Amending the legislation relevant to nursing only represents one side of the issue. There must also
be amendments to other legislation if nurses are to fully implement the extended/expanded role. In
jurisdictions where legislation has been enacted, there are situations were consequential amendments to
related statutes have not been pursued as part of the legislative package (e.g., the Hospital Act, Pharmacy
Act, Vital Statistics Act, etc.). To illustrate this point nurses working in extended/expanded roles may not
have the necessary authority to order certain diagnostic tests (e.g., Newfoundland regulations governing
radiology do not grant authority to nurse practitioners for certain x-rays), or are subject to restrictions on
their prescriptive authority (e.g., a formulary with an approved list of medications, not able to access
narcotics, etc.). However, this raises another issue relating to the potential costs of authorizing another
provider to access scare resources.
3.1.3 Educational Preparation - Policy Framework
Education programs preparing registered nurses for extended/expanded roles have been present
in Canada for a period of time. In the early years advanced preparation for the role was primarily delivered
through employers, such as the Medical Services Branch. Basically, the educational requirements of nurses
working in extended/expanded roles were determined by the particular circumstances of individual settings,
as well as the availability of medical personnel on-site.
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc. 21