Appendix F

[Table of Contents]

APPENDIX F

Summary of Survey Data: Agency Administrative Personnel

Province	Newfoundland and Labrador
Location	Site 1 (rural & remote)
Position title	Nurse Practitioner
Client populations	Regular caseload is a mixture of clients with acute and chronic illness, as well as women's wellness and the elderly.
Common practice settings	Hospital clinics and emergency department, as well as nurse-operated clinics in remote areas.
Physician services	Health care centres - physicians on-site; nursing clinics - physicians not on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload and manage total care in nurse-run clinics. Collaborative practice with physicians and other health care providers.
Access to resources	Initiates referrals and has access to most community resources; no hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Director of Patient and Resident Care Services at local hospital. Physicians do not supervise nurses' practice.
Job requirements	Extensive clinical experience in rural health care and a graduate of a certified Nurse Practitioner Program.
Core competencies	Emphasis is placed on experience with a proven record of skills and abilities, sound clinical judgments, and dedication.
Continuing education	Opportunities are provided via video-teleconference.
Authorities and protocol	Nurse Practitioner Primary Health Care Regulations.

Province	Newfoundland and Labrador
Location	Site 2 (rural & remote)
Position title	Regional Nurse I & Nurse Practitioner
Client populations	Regular caseload is a mixture of clients with acute and chronic illness.
Common practice settings	Community clinics, health care centres (HCCs), and the local hospital emergency department.
Physician services	Physicians are on-site at the HCCs but not community clinics.
Expectations regarding level of autonomous and collaborative practice	Collaborative practice with physicians at HCCs. Independent caseload and routine assessments at community clinics.
Access to resources	Initiates referrals and may access most community resources; no hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Regional nurses Þ immediate supervisor Þ regional supervisor Þ district coordinator Þ assistant CEO of nursing services.
Job requirements	Regional nurses: BN degree and 2 years of critical care experience preferred but not always met due to recruitment difficulties. Nurse Practitioner: Extensive clinical experience in rural health and graduate of a certified Nurse Practitioner Program.
Core competencies	Intensive 6-week orientation to promote competency re skills/abilities, and soundness of clinical judgments.
Continuing education	Expected to participate on a regular basis.
Authorities and protocol	Medical directives for regional nurses. Nurse Practitioner Primary Health Care Regulations.

Province	Newfoundland and Labrador
Location	Site 3 (remote)
Position title	Regional Nurse I
Client populations	Regular caseload is a mixture of clients with acute and chronic illness.
Common practice settings	Community clinic.
Physician services	Physicians are not on-site, visit every 8 weeks.
Expectations regarding level of autonomous and collaborative practice	Independent caseload and routine assessments at community clinics. The emphasis is on collaboration, with team conferences held regularly to review patient caseload.
Access to resources	Initiates referrals and may access most community resources; no hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Regional nurses Þ regional nursing supervisor (nurse II) Þ district coordinator Þ assistant CEO of nursing services.
Job requirements	Regional nurses: BN degree and 2 years of critical care experience preferred but not always met due to recruitment difficulties.
Core competencies	Intensive 6-week orientation to promote competency re skills/abilities, and soundness of clinical judgments. Expected to have excellent assessment skills, and capable of working independently of, as well as collaboratively with, other providers.
Continuing education	Mostly restricted to team conferencing.
Authorities and protocol	Medical directives.

Province	Newfoundland and Labrador
Location	Site 4 (rural)
Position title	Nurse Practitioner
Client populations	Regular caseload is a mixture of clients from all age groups with acute and chronic illness. .
Common practice settings	Health care clinics.
Physician services	Alternates clinics in 5 communities spread over a large geographic area with 2 physicians.
Expectations regarding level of autonomous and collaborative practice	Collaborative practice with physicians (i.e., runs clinics independently, but shares a caseload and consults with physicians by telephone when beyond scope of practice).
Access to resources	Initiates referrals and has access to most community resources; no hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Immediate supervisor is head nurse at local hospital but mostly physician supervision for clinical activities.
Job requirements	Expected to have a wide-range of skills/abilities. Frequently expected to work beyond defined scope with clinical guidance provided by physicians.
Core competencies	Access to continuing medical education activities which are available every month.
Continuing education	Extensive clinical experience in rural health care and a graduate of a certified Nurse Practitioner Program.
Authorities and protocol	Nurse Practitioner Primary Health Care Regulations.

Province	Newfoundland and Labrador
Location	Site 5 (rural & remote)
Position title	Nurse Practitioner
Client populations	Regular caseload is a mixture of clients from all age groups with acute and chronic illness.
Common practice settings	Health centre.
Physician services	Health Care Centres - physicians on-site; Nursing Clinics - physicians not on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload (i.e., booked appointments & walk-ins), as well as a collaborative practice with physicians.
Access to resources	Initiates referrals and has access to most community resources; no hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Director of Patient and Resident Care on-site who reports to a site facilitator in nearby hospital.
Job requirements	Two years clinical experience in rural health care and a graduate of a certified Nurse Practitioner Program.
Core competencies	Expected to have a wide range of skills/abilities, and capable of working independently of, as well as collaboratively with, other providers.
Continuing education	Weekly medical rounds via teleconference from the Faculty of Medicine, in-house education activities and nursing courses in a degree program.
Authorities and protocol	Nurse Practitioner Primary Health Care Regulations.

Province	Nova Scotia
Location	Sites 1 & 2 (urban)
Position title	Expanded Role Nurse*
Client populations	Hospital inpatients on cardiac, medicine, dialysis, geriatric, and neurosurgical units.
Common practice settings	Tertiary care facility.
Physician services	Physicians on-site.
Expectations regarding level of autonomous and collaborative practice	No autonomous practice. Collaborative practice with physicians and other health care providers.
Access to resources	Initiates referrals to physiotherapy and occupational therapy, as well as health care providers in the community (e.g., social work, etc.).
Lines of authority for supervising/ monitoring nurses in expanded roles	Immediate nursing supervisor, as well as physician for delegated medical functions.
Job requirements	Masters of Nursing (completed or in-progress); and 3 to 5 years of clinical experience.
Core competencies	Well developed skills acquired through knowledge and experience, as well as advanced clinical decision-making.
Continuing education	Access to teleconferences and physician mentors. Must be re-certified annually to ensure that one is competent to perform delegated functions.
Authorities and protocol	Delegated functions under the Medical Act.

* Note: Does not fit the criteria of working in primary health care settings.

Province	New Brunswick
Location	Site 1
Position title	Registered Nurse - no extended class.
Client populations	General population.
Common practice settings	Community health centres.
Physician services	Physicians on-site.
Expectations regarding level of autonomous and collaborative practice	No autonomous practice for curative functions and has limited access to diagnostic tests. Collaborative practice with physicians.
Access to resources	Restricted referrals as per protocols; no hospital admitting privileges .
Lines of authority for supervising/ monitoring nurses in expanded roles	Physicians for delegated medical functions.
Job requirements	Registered nurse.
Core competencies	Basic RN skills/abilities at present. Growing recognition that nurses with BN level education are better prepared to handle expanded role functions.
Continuing education	Strong emphasis is placed on the importance of continuous learning. There is however restricted access to continuing education resources.
Authorities and protocol	Negotiated protocols between physicians, employers, and Ministry of Health.

Province	New Brunswick
Location	Site 2 - rural & remote areas.
Position title	Registered Nurse - no extended class.
Client populations	General population.
Common practice settings	Local hospital - ambulatory clinics.
Physician services	Physicians on-site.
Expectations regarding level of autonomous and collaborative practice	No autonomous practice for curative functions and has limited access to diagnostic tests. Collaborative practice with physicians.
Access to resources	Restricted referrals as per protocols; no hospital admitting privileges .
Lines of authority for supervising/ monitoring nurses in expanded roles	Immediate nursing supervisor, as well as physicians for delegated medical functions.
Job requirements	Registered nurse.
Core competencies	Basic nursing skills/abilities plus some extra training in trauma and multi-disciplinary team work.
Continuing education	Only the training provided by employer.
Authorities and protocol	Negotiated protocols between physicians, employers, and Ministry of Health.

Province	Prince Edward Island
Location	None
Position title	No extended class
Client populations	N/A
Common practice settings	N/A
Physician services	N/A
Expectations regarding level of autonomous and collaborative practice	N/A
Access to resources	N/A
Lines of authority for supervising/ monitoring nurses in expanded roles	N/A
Job requirements	N/A
Core competencies	N/A
Continuing education	N/A
Authorities and protocol	N/A

Province	Quebec
Location	Sites 1 & 2.
Position title	No nurses in extended/expanded class.
Client populations	N/A
Common practice settings	N/A
Physician services	N/A
Expectations regarding level of autonomous and collaborative practice	N/A
Access to resources	N/A
Lines of authority for supervising/ monitoring nurses in expanded roles	N/A
Job requirements	N/A
Core competencies	N/A
Continuing education	N/A
Authorities and protocol	N/A

Province	Ontario
Location	Site 1 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	General population with special emphasis placed on the homeless & transient, high risk families and preschool children, and low income families.
Common practice settings	Community health centre clinics; works with vulnerable adults in their environment; drop-in centre; and a satellite clinic.
Physician services	Community Health Centre - salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Shares caseload with physicians; and provides on-call services in conjunction with physicians. Collaborative practice with physicians and other health care providers.
Access to resources	Initiates referrals, however physician must co-sign. Has access to most community resources but no hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nurses and physicians work together to form a clinical team and report to the Executive Director.
Job requirements	RN - EC certification required, as well as 3 to 5 years of progressive clinical experience in the health care sector.
Core competencies	As specified by RN -EC Regulations. Able to work independently and deal with a broad range of issues.
Continuing education	Available and expected for all employees.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 2 (rural)
Position title	Registered Nurse - Extended Class.
Client populations	General population with a mix of aboriginal and Caucasian.
Common practice settings	Community health centre clinics.
Physician services	Salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload. Collaborative practice with physicians and other health care providers.
Access to resources	New to role - full scope of responsibilities not yet realized. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Responsible to physician and administrator of centre.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	None specified.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 3 (remote)
Position title	Registered Nurse - Extended Class.
Client populations	General population.
Common practice settings	Community health centre.
Physician services	Two salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload and works collaboratively with physicians and other health care providers.
Access to resources	Initiates referrals with specialists, and does on-call in the emergency department similar to physicians.
Lines of authority for supervising/ monitoring nurses in expanded roles	Physicians supervise NP. Executive Director supervises all staff.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	Available through RN - EC Network. Additional training provided as dictated by recognized needs.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 4 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	Mixed aged and ethnic group affiliations. Population groups with high needs - low SES families, the homeless, young teens, and young moms.
Common practice settings	Community health centre.
Physician services	Four physicians affiliated with centre - 3 PT and 1FT.
Expectations regarding level of autonomous and collaborative practice	Independent caseload, and runs own clinics. Shared practice arrangement with 1 physician. Contacts physician on-call or on-site if needed.
Access to resources	Initiates referrals directly to a variety of providers (e.g., gyneologists, emergency physicians, physiotherapist, & optomologists). No hospital admitting privileges or access to diagnostic facilities.
Lines of authority for supervising/ monitoring nurses in expanded roles	Accountable to Executive Director.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	The centre pays for 5 continuing education days for NP to attend conferences. Monthly inservice is also provided.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 5 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	Inner city clientele - mostly women and the elderly.
Common practice settings	Satellite clinics - mostly in women's shelters.
Physician services	Salaried physicians at centre.
Expectations regarding level of autonomous and collaborative practice	Independent caseload. Collaborative practice with physicians and other health care providers.
Access to resources	Initiates referrals, however physician must co-sign. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Executive Director oversees the clinical practice of all staff.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	None specified.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 6 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	High risk groups.
Common practice settings	Community health centre.
Physician services	Two salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload within scope of practice. Provides on-call services with physician backup. Collaborative practice with physicians and other health care providers.
Access to resources	Initiates referrals to specialists and other health care providers. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Self-monitoring by clinical team.
Job requirements	RN - EC certification required, and must have extensive clinical practice.
Core competencies	As specified by RN -EC Regulations.
Continuing education	Monthly inservice education activities. Encourages & supports participation in outside seminars.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 7 (remote)
Position title	Registered Nurse - Extended Class.
Client populations	High transient population, and elderly with chronic conditions.
Common practice settings	Clinic associated with Health Authority.
Physician services	No physician on-site; monthly visits.
Expectations regarding level of autonomous and collaborative practice	New role in area - not yet defined.
Access to resources	Initiates referrals to professionals within district.
Lines of authority for supervising/ monitoring nurses in expanded roles	Reports to Director of Acute and Chronic Care who is located off-site.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	No established program but has internet access.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 8 (rural)
Position title	Registered Nurse - Extended Class.
Client populations	General population - mostly women and children.
Common practice settings	Community health centre.
Physician services	Salaried physician on-site.
Expectations regarding level of autonomous and collaborative practice	Acts within legislated scope of practice.
Access to resources	New clinic and role - uncertain about access.
Lines of authority for supervising/ monitoring nurses in expanded roles	Executive Director supervises all staff.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations. Experiential base with aboriginal peoples.
Continuing education	None specified.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 9 (rural)
Position title	Registered Nurses.
Client populations	Special groups - high incidence of chronic illness.
Common practice settings	Community health centre.
Physician services	No salaried physician on-site.
Expectations regarding level of autonomous and collaborative practice	Independently manages caseload. Clients are linked to physician resources within the community. Unable to prescribe medications or order diagnostic tests
Access to resources	Referrals limited to physiotherapy and occupational therapy.
Lines of authority for supervising/ monitoring nurses in expanded roles	Accountable to Nurse Manager.
Job requirements	Preference is for BN degree but RN - EC certification not required due to limited extended/expanded role.
Core competencies	Capable of forging strong collaborative relations with other health care providers and community.
Continuing education	Mostly in-house inservice activities.
Authorities and protocol	Organization's terms of reference.

Province	Ontario
Location	Site 10 (rural & remote)
Position title	Registered Nurse - Extended Class.
Client populations	Large group of ethnic elderly, transient native population, and single moms and infants. Mostly chronic illness.
Common practice settings	Community health centre and a satellite station.
Physician services	Two salaried physicians at centre, but none at satellite site.
Expectations regarding level of autonomous and collaborative practice	Community health centre - independent caseload but also works collaboratively with physicians. The satellite clinic does not have a RN - EC. The nurses there have independent caseloads, provide on-call coverage, and do medical evacuations to acute care facility.
Access to resources	Broad referral base but limited with regard to specialists. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Clinical Co-ordinator.
Job requirements	RN - EC certification required and a minimum of 3 years clinical experience but not always followed.
Core competencies	As specified by RN -EC Regulations.
Continuing education	Budget for continuing education activities. NPs also do course work regularly.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines. As well as the Hospital Act and medical directives for nurses without EC preparation.

Province	Ontario
Location	Site 11 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	Low income families with a high percent of seniors and immigrants.
Common practice settings	Clinics mostly operated by nurses.
Physician services	Physician on-site for clinics.
Expectations regarding level of autonomous and collaborative practice	Independent activities as per legislation. Nurse consults with physician for 5% of cases.
Access to resources	No information.
Lines of authority for supervising/ monitoring nurses in expanded roles	Works within a multi-disciplinary team.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	As required by licensing body.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 12 (rural)
Position title	Registered Nurse - Extended Class.
Client populations	General population.
Common practice settings	Community health centre.
Physician services	Three salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	No independent caseload. Multi-disciplinary team approach at Centre. Collaborative practice with physicians and other health care providers.
Access to resources	Initiates referrals to obstetricians and other health care providers. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Accountable to Executive Director.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	Expected to participate in external and internal continuing education activities on a regular basis.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 13 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	Inner city population - mixed age and ethnic group affiliation, the homeless, and low SES.
Common practice settings	Community health centre.
Physician services	One to two physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload as per scope of practice guidelines. Collaborative practice arrangement with physicians.
Access to resources	Initiates referrals to a variety of providers (e.g., specialists, occupational therapists, etc.). No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Physicians do most of the supervision.
Job requirements	RN - EC certification required.
Core competencies	As specified by RN -EC Regulations.
Continuing education	Wide-range of education opportunities available in area. No organization requirements - actual participation is individual-driven.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Ontario
Location	Site 14 (urban)
Position title	Registered Nurse - Extended Class.
Client populations	General population. Priority groups include seniors who pose an isolation risk, the homeless, and persons with HIV and AIDS.
Common practice settings	Community health centre. Community health centre, as well as an off-site clinic for the homeless.
Physician services	Three physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Shares caseload with physicians. Collaborative practice arrangement with physicians and other health care providers.
Access to resources	Not able to refer to specialists. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Accountable to Executive Co-ordinator.
Job requirements	RN - EC certification required, and must have a minimal of 3 years prior experience, preferably in a community health centre.
Core competencies	As specified by RN -EC Regulations.
Continuing education	None specified, individually determined. A small budget to support continuing education activities.
Authorities and protocol	RN - EC Regulations and the College of Nursing Scope of Practice Guidelines.

Province	Manitoba
Location	Site 1 (urban)
Position title	Nurse Practitioner.
Client populations	Inner city - mix of low and middle income clientele.
Common practice settings	Physician operated clinic.
Physician services	Salaried physicians at site.
Expectations regarding level of autonomous and collaborative practice	No independent caseload. Unable to prescribe, order diagnostic tests or perform certain procedures. Shares responsibility with physician - reports assessment findings and confers on treatment plans.
Access to resources	Most referrals are co-signed by the physician. No hospital admitting privileges or authority to order diagnostic tests.
Lines of authority for supervising/ monitoring nurses in expanded roles	Clinical supervision by Medical Director.
Job requirements	None specified. However, nurse working at the clinic does have Nurse Practitioner Certification.
Core competencies	None specified.
Continuing education	Self-directed but must engage in continuing education to maintain NP certification.
Authorities and protocol	Transfer of function or delegation agreement.

Province	Manitoba
Location	Site 2 (urban)
Position title	Nurse Practitioner.
Client populations	Inner city/ethnic mix, including aboriginals and working poor.
Common practice settings	Clinics.
Physician services	Four salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Manages an independent caseload, but is unable to prescribe or do testing without physicians co-signing. Collaborative practice arrangement with physicians.
Access to resources	Initiates referrals but must be co-signed by physician. No hospital admitting privileges or authority to order diagnostic tests.
Lines of authority for supervising/ monitoring nurses in expanded roles	Reports to physician on clinical matters, and to Director of Operations on administrative matters.
Job requirements	Nurse Practitioner Certification. Prior clinical experience is preferred.
Core competencies	None specified.
Continuing education	Self-directed but must engage in continuing education to maintain NP certification.
Authorities and protocol	Delegated medical functions.

Province	Manitoba
Location	Site 3 (urban)
Position title	Registered Nurse.
Client populations	Inner city clientele.
Common practice settings	Physician operated clinic.
Physician services	Salaried physicians at site.
Expectations regarding level of autonomous and collaborative practice	Nurses in the clinics do not perform primary care functions (i.e., assess, diagnose or prescribe). The focus is restricted to prevention and promotion activities, and community development.
Access to resources	N/A
Lines of authority for supervising/ monitoring nurses in expanded roles	N/A
Job requirements	N/A
Core competencies	N/A
Continuing education	N/A
Authorities and protocol	N/A

Province	Manitoba
Location	Site 4 (urban)
Position title	Nurse Practitioner.
Client populations	Inner city clientele.
Common practice settings	Resource centre and primary care clinic.
Physician services	Salaried physicians at site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload and performs advanced practice roles. Unable to prescribe, but may order diagnostic tests with a physician co-signature. Collaborative practice arrangement with physician and other professionals.
Access to resources	Initiates referrals to physiotherapist, chiropractor, and nutritionist. Physician must co-sign when referring to medical specialists. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Immediate clinical supervisor and program manager.
Job requirements	BN with several years experience working in under-serviced areas - recruitment/retention difficulties.
Core competencies	Well-developed set of skills and abilities in performing primary care functions.
Continuing education	Regular participation in inservice activities, relevant continuing medical education, and distance education courses.
Authorities and protocol	Delegated functions under the Collaborative Practice Guidelines developed between the physicians, nurse practitioners, and employer.

Province	Saskatchewan
Location	Site 1 (Northern - rural & remote)
Position title	Primary Care Nurse.
Client populations	General population, excluding First Nations.
Common practice settings	Community health centres or nursing stations.
Physician services	Physicians not on-site; usually visits once per week.
Expectations regarding level of autonomous and collaborative practice	Nurses are often the only health care provider. Manages independent caseloads, and prescribes and dispenses medication through central pharmacy. Expected to consult with physician by telephone.
Access to resources	Initiates referrals to available services (e.g., physicians, mental health workers, etc.).
Lines of authority for supervising/ monitoring nurses in expanded roles	Immediate nursing supervisor.
Job requirements	RN diploma or BN with hospital experience. Retention/recruitment difficulties.
Core competencies	Minimal requirement of basic life support training.
Continuing education	Regular inservice with visiting physician. Other continuing education opportunities are via telehealth, specialist inservice activities, and attending one conference annually.
Authorities and protocol	Delegated medical functions based on protocols negotiated between Medical Society, Nursing Association, Ministry of Health, & employers.

Province	Saskatchewan
Location	Site 2 (rural)
Position title	Primary Care Nurse.
Client populations	General population.
Common practice settings	Community health centre and off-site clinics in other communities.
Physician services	Physicians present at health centre but not off-site clinics.
Expectations regarding level of autonomous and collaborative practice	Community health centre site: Balance between independent and collaborative functions. Consults with physicians directly or by telephone regarding clients. Manages an independent caseload, and prescribes and dispenses medication through central pharmacy.
Access to resources	Initiates referrals to available services (e.g., physicians, mental health workers, occupational therapy, etc.) within particular project area.
Lines of authority for supervising/ monitoring nurses in expanded roles	Physician supervises clinical functions.
Job requirements	Completion of advanced clinical program at the Saskatchewan Institute of Applied Technology.
Core competencies	Meet physician competency expectations with regard to the performance of each delegated function.
Continuing education	Encouraged to participate in medical and nursing continuing education activities.
Authorities and protocol	Delegated medical functions based on protocols negotiated between Medical Society, Nursing Association, Ministry of Health, & employers.

Province	Saskatchewan
Location	Site 3 (rural)
Position title	Primary Care Nurse.
Client populations	General population.
Common practice settings	Community health centre.
Physician services	Physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Collaborative practice re multi-disciplinary teams. Shared caseload among team members. PCN may assess, diagnose, and treat, as well as prescribe and dispense medications.
Access to resources	Initiates referrals to other professionals (e.g., physiotherapy, etc.), however, medical referrals are done by physician. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Physician supervises clinical functions. The primary care nurse must also report to site manager.
Job requirements	Completion of advanced clinical program at the Saskatchewan Institute of Applied Technology (SIAT). Minimum of 2 years experience in primary health preferred.
Core competencies	As per expected competencies following graduation from the SIAT program.
Continuing education	Self-directed ongoing education to maintain acceptable level of competency in performing delegated functions.
Authorities and protocol	Transfer of functions - umbrella document negotiated between medicine, nursing, and pharmacy regulatory bodies.

Province	Saskatchewan
Location	Site 4 (rural & remote)
Position title	Primary Care Nurse.
Client populations	General population, including Aboriginal people on and off reserves.
Common practice settings	Community health centre and off-site clinics in other communities.
Physician services	Salaried physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Collaborative practice with physicians and other health care providers. Degree of autonomous practice as per protocols. Some authority to prescribe and dispense medications.
Access to resources	Initiates referrals to other professionals (e.g., physiotherapy, etc.), however, medical referrals are done by physician. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Physician supervises clinical functions.
Job requirements	Completion of advanced clinical program at the Saskatchewan Institute of Applied Technology.
Core competencies	Expected competencies in-line with those of the SIAT program graduates.
Continuing education	Self-directed but opportunities are provided to upgrade basic life-saving and trauma skills.
Authorities and protocol	Delegated medical functions based on protocols negotiated between Medical Society, Nursing Association, Ministry of Health, & employers.

Province	Alberta
Location	Site 1 (rural & remote)
Position title	Public Health Nurse.
Client populations	General population - predominance of Mennonites.
Common practice settings	Nurse-managed clinics.
Physician services	No physician on-site.
Expectations regarding level of autonomous and collaborative practice	Independent caseload. Initial assessment, diagnosis, and treatment - stabilizes patients for transfer to hospital via ambulance.
Access to resources	Initiates referrals to physicians but not specialists. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Immediate nursing supervisor.
Job requirements	BN with an advance practice certificate. Minimum of 3 to 5 years clinical experiences as a registered nurse. May obtain a special certificate for prescriptive authority.
Core competencies	The advance practice certificate prepares nurses with the necessary skills and abilities to provide extended health services. Must demonstrate competency in delegated functions prior to independent work.
Continuing education	None specified.
Authorities and protocol	Amended Public Health Act (1995) and accompanying regulations to cover extended practice.

Province	Alberta
Location	Site 2 (urban)
Position title	Registered Nurse - Expanded Practice (RN -EP).
Client populations	Under-served populations - homeless and clients with complex needs (e.g., mental health & addiction issues, etc.).
Common practice settings	Family Resource Centre and clinics on-site, as well as off-site at a shelter.
Physician services	Physician on-site.
Expectations regarding level of autonomous and collaborative practice	Works independently as per RN -EP scope of practice guidelines. Collaborative relations with other health care providers and consults with physicians as required.
Access to resources	Initiates referrals to specialists but physicians must co-sign. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Medical Co-ordinator oversees clinical practice, and the Executive Director administrative matters.
Job requirements	RN-EP certification. Minimum of 3 to 5 years clinical experiences as a registered nurse. May obtain a special certificate for prescriptive authority.
Core competencies	As expected of graduates from a certificated outpost/primary health program.
Continuing education	Self directed - invited to attend relevant continuing medical education activities.
Authorities and protocol	Amended Public Health Act (1995) and accompanying regulations to cover extended practice.

Province	Alberta
Location	Site 3 (rural & remote)
Position title	Community Health Nurse.
Client populations	Non-reserve Aboriginal population in 3 communities.
Common practice settings	Site clinics.
Physician services	No physician on-site; visits every 1 to 2 weeks and holds clinics.
Expectations regarding level of autonomous and collaborative practice	Independent caseload. Nurse is expected to practice autonomously but site has limited testing capabilities. Regular case-conferencing takes place between physician and nurse. Prescribes and dispenses medications as per Nursing Association Guidelines.
Access to resources	Initiates referrals to physicians and other professionals, but not specialists. No hospital admitting privileges. No access to pharmacies and thus dispenses medication through formulary (i.e., in-house supply of drugs).
Lines of authority for supervising/ monitoring nurses in expanded roles	Medical Co-ordinator oversees clinical practice, and the Executive Director administrative matters.
Job requirements	Clinical experience in North with Medical Service Branch. May obtain a special certificate for prescriptive authority.
Core competencies	Expected competencies following completion of the Medical Services Branch program.
Continuing education	Internet access but no job specifications.
Authorities and protocol	Amended Public Health Act (1995) and accompanying regulations to cover extended practice.

Province	British Columbia
Location	Site 1 (rural & remote)
Position title	Community Health Nurse (expanded role).
Client populations	First Nations on reserves.
Common practice settings	Nursing stations and health centres.
Physician services	No physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Nurses carry an independent caseload, and are expected to practice autonomously (i.e., initial assessment, diagnosis, & treatment within defined scope). Expected to work collaboratively with physicians where possible. Consults with physicians via telephone as required.
Access to resources	Initiates referrals to physicians. Must consult with physician for referrals to other health care providers. No hospital admitting privileges, must go through physician.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nurse-in-charge ® Zone Nursing Officer ® Regional Nursing Consultant.
Job requirements	Bachelor of Nursing and/or completion of the Primary Care Clinical Nursing Program. Minimum of 1 year experience in acute care.
Core competencies	Expected competencies following completion of the Medical Services Branch program.
Continuing education	Re-certification required every 2 years in delegated medical functions.
Authorities and protocol	Medical Services Branch Scope of Practice Guidelines.

Province	British Columbia
Location	Site 2 (rural & remote)
Position title	Registered Nurse.
Client populations	General population. Special focus is on individuals with chronic illness.
Common practice settings	Community health centre.
Physician services	No physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Nurses carry an independent caseload, and are expected to practice autonomously (i.e., initial assessment, diagnosis, & treatment within a restricted scope of practice). No ability to order diagnostic tests or prescribe medications. Clients are linked with community resources, such as physicians. Nurses work in collaboration with clients and physicians.
Access to resources	Initiates referrals to physiotherapy and occupational therapy. No hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nurse Manager.
Job requirements	Bachelor of Nursing is preferred.
Core competencies	Basic nursing skills & abilities plus strong rapport with community.
Continuing education	Participation in inservice opportunities.
Authorities and protocol	Nurses are not considered to be in expanded roles requiring legislation.

Province	British Columbia
Location	Site 3 (rural, remote & urban)
Position title	Registered Nurse - Nurse Practitioner.
Client populations	General population in small communities. Special focus on vulnerable populations (e.g., drug-users, frail elderly, street youth, young families, etc.) in urban areas.
Common practice settings	Health centres with nurse only and multi-disciplinary type clinics.
Physician services	Physicians on-site, except for remote areas.
Expectations regarding level of autonomous and collaborative practice	Nurses carry an independent caseload, and are expected to practice autonomously (i.e., initial assessment, diagnosis, & minor treatment). Also may prescribe medications, monitor chronic illness, and provide short-term in-patient care. Nurses work in collaboration with physicians who usually sign off charts.
Access to resources	Refers patients when appropriate. Also stabilizes for medical evacuation in remote areas.
Lines of authority for supervising/ monitoring nurses in expanded roles	Administrator who is usually a nurse.
Job requirements	Basic nursing education.
Core competencies	No core competencies identified to date.
Continuing education	Self-directed.
Authorities and protocol	Protocols vary from centre to centre. Nurses practice within clinical guidelines.

Province	British Columbia
Location	Site 4 (urban)
Position title	Nurse Practitioner (unofficial).
Client populations	Mostly women; some family health and seniors.
Common practice settings	Multi-disciplinary clinics.
Physician services	Physicians on-site, except for remote areas.
Expectations regarding level of autonomous and collaborative practice	Nurses practice autonomously (i.e., first contact, initial assessment, diagnosis, & independent management). Unable to prescribe medications but can order limited diagnostic tests. Nurses work in collaboration with physicians and other team members (i.e., clinical pharmacist, nutritionist, counsellor, & dentist).
Access to resources	Refers patients when appropriate, but must first consult with a team physician.
Lines of authority for supervising/ monitoring nurses in expanded roles	Head physician for clinical issues, and Executive Director for other matters.
Job requirements	Bachelor of Nursing with 2 years experience in a community setting.
Core competencies	Competent to perform delegated primary care functions.
Continuing education	None specified but encouraged to participate in available continuing medical education.
Authorities and protocol	Clinical guidelines/protocols in place; physicians have ultimate responsibility.

Province	British Columbia
Location	Site 5 (rural & remote)
Position title	Registered Nurse (Outpost Hospital Nurse).
Client populations	General population in small communities. Most sites have a high percentage of First Nations people.
Common practice settings	Outpost hospitals.
Physician services	No physicians on-site, but provide intermittent services.
Expectations regarding level of autonomous and collaborative practice	Nurses have independent caseloads, and are expected to practice autonomously (i.e., initial assessment, dx, minor treatment) and prescribe mads as per MSB guidelines. Also must collaborate with physicians and other providers during site visits.
Access to resources	Consult with and refer to physicians and emergency department of referral hospital. Responsible for stabilization and medical evacuation of patients during emergencies. Unable to order diagnostic tests.
Lines of authority for supervising/ monitoring nurses in expanded roles	Off-site manager.
Job requirements	Basic nursing education with extra skills (e.g., suturing, intravenous initiation, physical assessment, etc.). Minimum of 5 years of general practice in adult medicine/ surgery, pediatrics, and obstetrics.
Core competencies	Competent to perform physical assessments and identify need for referrals/consultations.
Continuing education	CPR update & annual in-house inservices.
Authorities and protocol	Medical Services Branch Scope of Practice Guidelines; and Red Cross Emergency Protocols.

Province	British Columbia
Location	Site 6 (rural)
Position title	Registered Nurse (expanded role).
Client populations	Across the lifespan with most clientele under 60 years of age.
Common practice settings	Health centre.
Physician services	Physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Nurses practice autonomously (i.e., assessment, problem identification, & management) within approved protocols. Limited collaboration with physicians except as dictated by protocols.
Access to resources	Refers patients to on-site physician, except on weekends when referrals go to the local hospital.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nurse manager on-site.
Job requirements	Registered nurse with RN - First Call training. Minimum of 2 years emergency room experience.
Core competencies	Assess, diagnose and manage care as outlined in protocols.
Continuing education	Encourage to participate.
Authorities and protocol	Delegation of functions as per 10 protocols and 2 standing orders covering such conditions as otitis media, urinary tract infection, lacerations/abrasions, minor thermal burns, among others.

Health Canada	Medical Services Branch (MSB)
Location	Sites (Northern remote lands - Federal jurisdiction)
Position title	Registered Nurse.
Client populations	General population, primarily First Nations people on reserves.
Common practice settings	Nursing stations.
Physician services	No physicians on-site.
Expectations regarding level of autonomous and collaborative practice	Nurses are often the only health care provider, and work in advanced practice roles. Expected to consult with physician by telephone as required. Prescribes and dispenses medications as per scope of practice guidelines.
Access to resources	No access to pharmacies and is therefore required to dispense medication through formulary (i.e., in-house supply of drugs). Stabilizes patients for medical evacuation.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nursing Supervisor and Practice Consultant.
Job requirements	RN diploma and current registration with a regulatory body. Retention/recruitment difficulties.
Core competencies	General nursing with knowledge of community health. Expected competencies re performance of primary care functions following completion of the Medical Services Branch program.
Continuing education	Expected to participate in "zone" conferences.
Authorities and protocol	MSB Scope of Practice Guidelines.

Territory	Nunavut/North West Territories
Location	Sites (rural & remote)
Position title	Community Health Nurse.
Client populations	General population - mostly Inuit.
Common practice settings	Health centres.
Physician services	No physicians on-site, but are available for referrals and make monthly on-site visits.
Expectations regarding level of autonomous and collaborative practice	Nurses carry an independent caseload, and are expected to practice autonomously (i.e., assess, diagnose, & treat within defined scope). Collaborative practice arrangements between nurses and physicians. Nurse consults with physicians via telephone as required, and prescribes medications as per North West territories Nursing Association (NWTRNA) Guidelines.
Access to resources	Initiates referrals to physicians, as well as some specialists (e.g., psychiatrists, etc.). Possible to order some diagnostic tests. No direct hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nurse Manager ® Director of Patient Services.
Job requirements	Preference is to have nurses with community health, primary care, or outpost experience. Nurses with emergency/intensive care experience are also considered. Difficult to recruit and retain nurses.
Core competencies	None specified at present but currently developing guidelines.
Continuing education	None specified.
Authorities and protocol	MSB Scope of Practice Guidelines and NWTRNA Guidelines.

Territory	Yukon
Location	Sites (rural & remote)
Position title	Community Nurse Practitioner.
Client populations	General population - cultural/ethnic mix.
Common practice settings	Nurse-managed clinics.
Physician services	The norm is not to have physicians on-site, with one or two exceptions. Physicians are available for referrals and visit sites every 2 to 3 weeks to hold a 1-day clinic.
Expectations regarding level of autonomous and collaborative practice	Nurses carry an independent caseload, and are expected to practice autonomously (i.e., assess, diagnose, & treat within defined scope). Must work collaboratively with physicians, when possible, and consult with them via telephone as required. Prescribe medications as per MSB Guidelines.
Access to resources	Initiates referrals to physicians and other providers but not medical specialists. Possible to order some diagnostic tests. No direct hospital admitting privileges.
Lines of authority for supervising/ monitoring nurses in expanded roles	Nursing Supervisors ® Managers ®Director of Community Nursing Programs.
Job requirements	Preference is to have nurses with a BN degree and graduates of recognized outpost or clinical skills programs. Minimum of 2 years experience in an acute care setting.
Core competencies	Expected to be competent in performing recognized outpost or clinical skills.
Continuing education	Required to attend annual 5-day conference for clinical updating.
Authorities and protocol	Medical Services Branch Scope of Practice Guidelines.