1.0 Background to this Research Study

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The nursing profession is experiencing significant pressures from a number of fronts. There is a shortage of nurses available to the health care system at a time when skilled professionals are in demand. Further, the nursing profession is attempting to define the boundaries/parameters of its practice and, most importantly, struggling to ensure that its practitioners are providing care that is supported by sound research. Finally, there is a general desire by the profession to ensure that its members receive recognition for and legitimization of the true extent of the roles and functions assumed by nurses often carried out under delegation from medical and other professional disciplines. This is particularly the case with respect to northern, rural and remote areas where physicians and pharmacists are often in short supply and nurses are the only health care provider on-site to serve the residents.

There is a growing view among nurses that particular functions could, and should, be included within the scope of nursing practice and not be seen as functions delegated from medicine or pharmacy. This position has and will continue to have far reaching implications for the regulatory regimes for nursing and those of other health professions. This is a view held that sees delegation of function as a method of control for a given profession over another. Further, questions have been raised as to whether it is the best method to provide competent health care to the public.

There have been numerous demonstration and pilot projects undertaken throughout Canada which have shown that nurses are capable of performing primary care roles effectively and efficiently in diverse settings. These projects usually have been legitimized through working relations with other health professionals by way of protocols, primarily with physicians, which allow nurses to undertake specific additional functions. Meanwhile, there is considerable frustration due to the lack of funding to support these initiatives on an ongoing basis.

At a time when the profession is evolving, important issues are being raised concerning nursing roles that are guided by nursing competencies. Where nurses are practising beyond the generally accepted traditional scope of nursing practice, i.e. through delegation of function, concerns respecting public protection arise. Additional regulation to incorporate those functions into nursing practice may be advisable.

This evaluation is being undertaken at a time when extended/expanded nursing functions are in various stages of being legitimized through legislation in some provinces or territories. There is a state of flux existing within the nursing profession on this and related matters. There are significant external factors that are having an impact on the nursing profession and its ability to undertake new directions. Thus this paper is intended to present a profile of the policy and legislative frameworks and the organizational structure of nursing practice associated with extended/expanded practice roles.