Health Transition Fund Final Report - Projects Listed By Subject Area

3.2 Organizational Structure: Administrative Personnel Perceptions (see SDI)
The purpose of this phase of the project was to identify and describe the practice models under
which registered nurses in extended/expanded roles perform primary care functions. Particular consideration
was given to the following: scope of roles and responsibilities, position title, client populations served, most
common practice settings, job requirements and expected core competencies, expectations regarding
autonomous and collaborative practice, scope of referrals to other providers, and extent of independent
access to other available resources. A second purpose was to describe organizational lines of authority for
supervising/monitoring registered nurses working in extended/expanded roles. A final purpose was to
identify organizational mechanisms for assessing the quality of extended/expanded nursing services and their
impact on client outcomes and organizational costs.
The findings reported are exploratory in nature, although common links were observed between an
organization’s mandate and the nature of extended/expanded nursing practice. The findings are presented
in four major sections. The first section presents a descriptive profile of different models of practice. The
second section describes the lines of authority in different jurisdictions. The third section reviews quality of
care initiatives and evaluation mechanism for assessing organizational and client outcomes. The final section
presents a summary of the key issues.
3.2.1 Models of Practice
The findings from the forty-four sites surveyed for this study indicated that registered nurses working
in extended/expanded roles provide a wide array of services under similar, as well as disparate, collaborative
practice arrangements. Despite observed variations, the norm was for nurses and physicians, as well as other
health professionals, to engage in an interactive process of joint decision-making and problem-solving based
on mutual respect and appreciation for each others knowledge, skills and abilities. This sharing of information
and knowledge helped all providers develop better insight into clients’ health needs and provide appropriate
and efficient primary health care to various population groups.
The findings also indicated that there are significant variations within and between
provinces/territories with regard to the enactment of primary care functions by registered nurses. The
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc. 25