2.0 Methodology

[Table of Contents]

The information in this report was gathered from a variety of sources:

• legislation related to nursing practice in provincial/territorial jurisdictions and through Legislative Counsel and/or solicitors associated with the Ministry of Health in respective jurisdictions;
• consultants from provincial/territorial nursing associations and/or the Ministries of Health in each jurisdiction(contact could not be established with Nunavut); and
• key informants (e.g. administrators/managers, nurse practitioners, etc.) affiliated with organizations/agencies that hire nurses to work in extended/expanded practice roles.

The starting point was the legislative regimes for the regulation of nursing as a profession. These range from statutes passed in the early part of the century to recent enactments. The more recent regimes reflect the significant shifts that have occurred in the field of regulating occupations and, more importantly for the purposes of this paper, the evolution of nursing practice.

The definition of ‘nurse’ in statute law is instructive as it varies by jurisdiction. The definitions of ‘nurse’ or ‘nursing practice’ assist in setting parameters around the activities undertaken by members of the profession. Though some statutes are dated, the definition may prove to be broad enough to contemplate the inclusion within the scope of practice of nursing extended/expanded roles in same statutes. The term may not be defined but be inferred by reference to the definition of the ‘practice of nursing’. See Appendix B-1 for the specific provisions governing nursing or the practice of nursing by province and territory.

The general statutory provisions are broadened by more specific provisions to determine the extent of the authorities and responsibilities of nurses in extended/expanded roles. A key component of primary care, that of assessment, diagnosis and treatment may be absent in the definition of nursing but be included in regulations made under the statute. Appendix B-2 highlights the provisions in statutes or regulations which extend authority for extended/expanded practice in the three jurisdictions with these authorities in effect and in Manitoba where the legislation has not been proclaimed.

The focus of the data collection was on identifying relevant information to assist the consultant team in constructing a profile of nursing practice models in primary health care settings. The interview schedules used to guide data collection during the telephone surveys are presented in Appendix C-1 and Appendix C-2. The data gathered from these information sources are summarized by jurisdiction in Appendix D.

The discussion that follows presents a general sense of the status of extended/expanded nursing practice across Canada. A cross Canada survey of administrators in 44 practice settings was conducted in November 1999 using the interview protocol contained in Appendix E. It is supported by tabular summation of key aspects of the data collected from legislative, regulatory, and organizational information sources; refer to Appendix F.

The reader is reminded that this study is restricted to a consideration of practice models where the primary care functions of assessment, treatment and diagnosis of episodic, acute and chronic illness and injury are performed by registered nurses in primary health care settings. Although this narrows the focus of the evaluation, it does not suggest that the other components (e.g., health promotion, illness prevention, etc.) of primary health care are not of equal significance to the delivery of quality health care.