In the recently released report of the National Expert Commission (NEC), nurses were challenged to use their collective knowledge to be a mighty force in ensuring better health, better care and better value in healthcare delivery for all Canadians. The Commission noted that new models of care delivery “should be centred on what individuals and families need, should treat the individual as a whole person…, and should ensure that all professionals, including nurses, work to their full scope of practice.”[1. National Expert Commission. (2012). A Nursing Call to Action: The health of our nation, the future of our health system. Ottawa, Canada Nurses Association. (p. 7)] But to what extent is the Registered Nurse community prepared to respond to that challenge?
There is no question that Registered Nurses (RNs) should be an entry point to health promotion and disease prevention as well as to illness care, and that nursing education currently equips RNs to address the shift from an illness model to keeping people well. But to what extent do RNs in practice actually champion excellent care, caring, and preventative care? [2. National Expert Commission. (2012)]
Research on nursing scope of practice [3. Besner, J., Doran, D., et al. (2005). A Systematic Approach to Nursing Scopes of Practice. Canadian Institutes for Health Research (www.cihr.gc.ca)] [4. White, D., Jackson, K., et al. (2009). Enhancing Nursing Role Effectiveness through Job Redesign. Health Workforce Research and Evaluation Unit. Alberta Health Services] [5. Besner, J., Drummond, J., et al. (2010). Optimizing the Practice of Registered Nurses in the Context of an Interprofessional Team in Primary Care. (www.cihr.gc.ca)] has revealed that we lack a compelling vision for nursing that differentiates the distinct roles of Nurse Practitioners (NPs), RNs, and Licensed Practical Nurses (LPNs) in care delivery. There is little evidence that differences in education (i.e., in nursing knowledge) account for how nursing providers are utilized, which contributes to significant role overlap and duplication, as well as to tension and mistrust between RNs and LPNs in the workplace. This role ambiguity is sometimes also reflected in staffing decisions made by nurse managers, who may fail to consider the potential impact on patient outcomes of replacing one type of provider with another when dealing with staffing shortages. RN practice in acute as well as in primary care has been demonstrated to over-emphasize the management of disease and illness, with insufficient time spent on assessment of population risk factors and individual health needs. The practice of many RNs has been narrowed to a heavy focus on the performance of tasks and activities related to the bio-medical management of patients, although many of those also fall within the scope of practice of other providers.
Developing a meaningful approach to achieving the vision for nursing and healthcare that is reflected in the NEC report will be impossible in the absence of a long-term, shared vision among decision-makers (i.e., employers), educators, regulators, policy-makers and RNs themselves. RNs recognize they are currently not working to the full extent of their knowledge and skill and are unduly absorbed by the bio-medical needs of patients, at a time when all levels of government are calling for a renewed focus on promoting health and wellness. Shifting our system away from its almost singular focus on illness toward an equal preoccupation with health and wellness will simply not happen if nurses don’t lead the way. The sustainability of our health system depends on the willingness and ability of RNs to refocus their practice toward interprofessional models of service delivery that will allow them to more effectively engage in the promotion of health and well being with individuals sick or well, which is the very essence of professional nursing practice. This will require individual commitment and collaborative effort to move beyond talking to actually making change happen.
Is anyone ready to lead the way?
ABOUT JEANNE BESNER
In April 2010, Jeanne retired from full-time work with Alberta Health Services, where she had been the director of the Health Systems and Workforce Research Unit, leading the development of a research agenda focused on promoting effective and efficient utilization of all members of the health care team through redesign of care delivery models in acute and primary care settings.
She is an adjunct associate professor with the faculty of nursing at the University of Calgary, as well as Adjunct Faculty with the School of Nursing at Mount Royal University. She is a former President of CARNA (2003 to 2005) and past member of the Board of Directors of CNA (1999 to 2005), where she served as the Primary Health Care representative from 1999 to 2003. She was appointed to the Health Council of Canada in 2003. Jeanne was awarded an Alberta Centennial Medal in 2005 for her contributions to health care. In 2008 she received a CNA Centennial Award and in 2010, the Canadian College of Health Service Executives Nursing Leadership Award. She was invested to the Order of Canada in 2011and was presented with the Queen's Diamond Jubilee Medal in May 2012.