Health Transition Fund Final Report - Projects Listed By Subject Area

as full autonomous members of multi-disciplinary teams. The constant factor was the lines of authority for
supervising and monitoring these nurses: provincial legislation (i.e., Ontario and Newfoundland and
Labrador) and/or the scope of practice guidelines developed by the relevant college of nursing or nursing
association. There were definite variations, within and between provincial jurisdictions, with regard to the
person (s) responsible for overseeing nurses’ clinical practice. For both Newfoundland sites, the nurse
practitioners reported to a nurse manager. In Ontario, there were four distinct categories of responsible
persons. Some sites referenced the self-monitoring clinical team (i.e., nurse practitioners and physicians coordinating
their efforts as part of a clinical team) and its accountability to the executive director. Other sites
reported that nurse practitioners were accountable to the executive director/administrator. Still other sites
identified the responsible party as the physician. Finally, several sites emphasized the dual accountability of
nurse practitioners to the executive director/administrator and physicians.
A second scenario relates to registered nurses in extended/expanded roles who had variable levels
of preparation for performing primary care functions (e.g., masters preparation with NP certification,
advanced clinical preparation in a post-RN program, basic diploma preparation with on-site physician
direction and guidance in performing specified functions, intensive orientation to promote skill competency
and sound clinical judgments prior to entering clinical situations, etc.). Most of these nurses worked in
remote areas, as well as urban and rural areas to a lesser degree, and assumed a very autonomous role while
engaged in collaborative practice arrangements with other providers (i.e., mostly nurse colleagues and
physicians). Respondents reported wide variations in the lines of authority for supervising and monitoring
these nurses. The following are examples of such authorities/protocols: 1) delegated medical functions based
on protocols negotiated between medical and nursing associations, ministries of health and employers, 2)
amended Public Health Act (1995) and accompanying regulations covering extended practice, 3) transfer
of functions - umbrella document negotiated between medicine, nursing and pharmacy regulatory bodies,
4) delegated functions under the provincial medical act, and 5) Medical Service Branch Scope of Practice
Guidelines. The persons responsible for overseeing the clinical practice of nurses working in
extended/expanded roles were also quite variable, including immediate nursing supervisors/nurse managers
alone, physicians alone, or nursing supervisors/nurse managers and physicians.
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc. 31