Toolkit to support employers working to maximizing full scope of practice utilization for primary care RNs and RPNs: Full Scope - what it is and why is it important?
What is full scope?
|Full Scope of Practice||Full scope of practice refers to nurses practicing to the full extent of their competencies, knowledge and skills or full range of roles, responsibilities and functions that they are educated, competent and authorized by the College of Nurses of Ontario to perform, as outlined in Primary Solutions for Primary Care: Maximizing the Role of the Primary Care Nurse. Nurses and other health professionals practise to their full scope when they are in a practice environment that enables them to fully utilize their competencies, knowledge, and skills to provide high quality, evidence-based and patient-centred care (RNAO, 2012; White et al., 2008).|
|Primary Care||Primary care can be defined as “…that level of a health service system that provides entry into the system for clients with new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and co-ordinates or integrates care provided elsewhere by others.” (RNAO, 2012, p.4).|
|Primary care registered nurses||The Primary Care Registered Nurse practises autonomously to their full scope of practice and is an important member of the interprofessional care team. The scope of practice of RNs is consistent with assignment to care for complex clients with unpredictable outcomes, and a high risk for negative outcomes (RNAO, 2010). For example, this means that primary care RNs would be assigned to complex clients with chronic co-morbities, clients with episodic illness, clients with unknown conditions and clients who require a higher level of assessment and nursing intervention. Frequently, the primary care RN is a patient’s first point of contact. The primary care RN maintains competencies based on in-depth knowledge and skills in clinical practice, and holds the expertise required to conduct comprehensive health assessments and implement appropriate nursing interventions. The primary care RN is active within the community, assessing health needs and advocating for change and aligns her/his practice with evidence-based strategies that maintain the highest level of quality and continuity for the patient (RNAO, 2012).|
|Primary care registered practical nurses||The Primary Care Registered Practical Nurse is an important member of the interprofessional care team. The scope of RPNs is consistent with assignment to care for stable clients with predictable outcomes and a low risk for negative outcomes (RNAO, 2010). Primary care RPNs would be assigned to assess and care for more established/stable clients with identified and applied nursing care needs, and those clients requiring routine follow up and monitoring. The primary care RPN aligns her/his practice with evidence-based strategies that maintain the highest level of continuity for the patient (RNAO, 2012).|
Note: Although this toolkit focuses on the roles of RNs and RPNs, it is important that all categories of nurses be aware of the importance of practicing to full scope. Thus, the NP role also warrants examination. Please visit the Nurse Practitioners’ Association of Ontario website for more information about the NP role.