Health Transition Fund Final Report - Projects Listed By Subject Area

The On-Site Data Collection occurred in urban, rural and remote settings with variant
collaborative practice models and levels of autonomous practice. Information was gathered from
registered nurses working in extended/expanded roles, physicians working with these nurses, and
patients who received care from these nurses. The key themes emerging from the interview data
obtained from physicians and nurses’ included: practical knowing, collaborative versus independent
practice models, role confusion, and barriers to and facilitators of collaborative practice models.
A brief summary is presented on each of these themes, as well as patient perceptions of the
extended/expanded nursing role and observational sessions conducted with extended/expanded
role nurses .
With regard to Practical Knowing, both physicians and nurses voiced concerns about the
adequacy of knowledge levels and practical skills of extended/expanded role nurses when first
assuming the role. The diversities in knowledge and skills observed by physicians and low feelings
of confidence and competence expressed by nurses, as well as the improvements noted after
acquiring an experiential base, led both groups to recommend the following: 1) standardize entry
requirements into programs preparing nurses for extended/expanded practice, 2) increase the
clinical component of these programs, 3) access to continuing education opportunities to promote
necessary competencies in expected primary care functions and, 4) establish well-defined and
universal standards for extended/expanded nursing practice.
With regard to the Collaborative versus Independent Practice Models theme, both physicians
and nurses favoured team work or strong inter-disciplinary collaboration over independent practice
for extended/expanded role nurses. Physicians supported autonomous practice so long as nurses
working in these roles adhered to scope of practice guidelines and worked under collaborative
practice arrangements with physicians. Nurses also felt that collaborative, as opposed to
independent, practice arrangements offered the best care to patients, and facilitated full acceptance
of extended/expanded nursing practice by physicians and patients.
Role Confusion by patients was a concern of both physicians and nurses. The consensus was
that patients experience difficulty differentiating extended/expanded nursing roles from medical
roles. Despite this confusion, physicians and nurses believed that patients seemed to be satisfied
with the level of care provided by the nurses in the extended/expanded role.
The Centre for Nursing Studies in collaboration with
The Institute for the Advancement of Public Policy, Inc.