Health care professional shortages are a reality in Ontario, and these shortages in primary care affect patients, employers, the professionals themselves, and the health care system as a whole (Romanow, 2002). The underutilization of RNs and RPNs, along with the need to address full scope of practice utilisation has been identified as an area of focus in order to improve quality of care1. Specifically, little to no attention has been given to the role of the primary care nurse (RN and RPN) by governments, employers and professional associations and as a result, this role is grossly under-utilized, to the detriment of the public and the health system2.
In line with Ontario’s Action Plan for Health Care, which seeks to support Ontarians to become healthier, provide faster access and a stronger link to family health care, and provide the right care, at the right time, in the right place, it is essential to build robust interprofessional primary care service settings that provide evidence-based care through the full utilization of primary care nurses. Primary care must be positioned and enabled to be the point of entry to the health-care system for Ontarians. To do this, we need to increase timely access to care to avoid unnecessary emergency department visits and reliance on walk-in clinics.
Full scope of practice utilization means that approximately 4,364 primary care RNs and 2,984 RPNs3 are enabled to increase access to care. Enhancing the role of the nurse can improve patient outcomes, facilitate same-day access to care, and contribute to a primary care system that is more responsive, effective and cost-efficient4. Although this toolkit focuses on maximizing the nursing role, it is really through the collaboration of all members of primary health care teams, that collective goals will be achieved. Functional teams maximising nurses’ full scope allows many benefits for all those involved in the health care system: employers and employees, and the patients themselves as outlined below5.
According to the literature and various reports6 potential outcomes of full scope of practice utilization for RNs and RPNs include:
For Clients and Families
- Improved access to primary care
- Quicker appointments available and more time with a health professional
- Increased access to health promotion and prevention education
- Access to a variety of health care providers (with various knowledge and skills) through team based care
- Improved client outcomes e.g. increased client satisfaction
For Primary Care Employers
- Increased retention and recruitment
- Interprofessional collaboration
- Increased capacity of the practice
- Improved access for patients
- Improved care co-ordination
- Improved patient outcomes
- Peer and interprofesional support, collaborative teamwork
- Better work/life balance
For Primary Care Nurses
- Increased career satisfaction from greater autonomy and utilization
- Increased role clarity, interprofessional understanding, and respect
- Fully utilizing competencies, knowledge and skills
- Improved workload and healthier work environments
For Management
- Increased retention and recruitment (helps address workplace shortage)
- increased interprofessional collaboration
- Better balance of workload
For the Health Care System
- Improved access to primary care
- More cost-effective and timely care delivery Improved patient outcomes, preventing future health care system costs
- Addresses current and predicted nursing and healthcare professional shortage
- Supports continuity of care, expanded service provision