Thank You Nurses…Now, Can You Do More?

National Nursing Week is in full swing in Canada, and it’s crucial to recognize the tremendous contribution nurses make in all areas of health care.   I’m happy to see so many people singing their praises…and rightly so!  But, despite their great commitment and healing impact, I think nurses can play a stronger role in health care.   

I have never met a health care professional who thinks that the system can’t be improved, and nurses know that the system would be better if they could do more for patients, alongside their clinical colleagues.  In fact, if we want to provide quality health care to our children and their children, we will need nurses to play a stronger role, particularly in primary care settings like the family doctor’s office. 

A new study from the Canadian Academy of Health Sciences explores the clinical division of labour that will support a health care system that serves all Canadians.  The report is called “Optimizing Scopes of Practice:  New Models of Care for a New Health Care System.”  The upshot of their analysis is that the current, limited range of activities for nurses and other regulated health care professionals is more a result of past practices and politics than evidence or even legal rulings of clinical responsibility.   

The limits exist despite the broad training that we offer nurses.  As one of the report authors, Ivy Lynn Bourgeault says, when it comes to nurses and other professionals, “we train and then constrain.”   This means that nurses are capable of taking on a wide range of roles, but are then limited when they enter the workforce –by the expectations that have developed through decades of habit and politics. 

The report calls for us to approach the issue of “scope of practice” from the dual perspective of flexibility and accountability.   Its authors argue that we need to develop roles that are based on patient and community need, rather than habit and historical pattern.  They also suggest we see the issue through the lens of “optimal scope of practice,” so that team-based clinics can evolve the best division of labour based on clinicians’ relative competencies, and aimed at meeting the health needs of their panel and the community.

I witnessed this dynamic several years ago when BC was developing its initiative to increase the availability of Nurse Practitioners.  A group of physicians and nurse practitioners spent over an hour demystifying their clinical roles, revenue sources and range of activities to each other so that we could lose our assumptions and approach the integration of nurse practitioners from a new perspective.  My fear is that as the cost of health care systems rise, we may not have the luxury of limiting this dialogue to small group discussions.  We need a critical mass of innovation to introduce interdisciplinary team-based care if we want to bend the cost curve in a meaningful way. 

In my recent blogs, I describe how doctors doing less of what we have come to expect, can result in better and more convenient access to quality primary care treatment and prevention.  This is only possible if we reimagine clinical culture and workflow from a fresh perspective that defines “scope of practice” through the lens of patient health and safety, provider wellness and system sustainability.   I think that enabling the full range of activities that nurses can do to keep us healthy should be a priority for all of us who appreciate what nurses already do! 

In my next blog, I’ll describe governance and collaboration models that will help move these changes forward.  In the meantime and if you’re interested, you can find the Executive Summary of Optimizing Scopes of Practice here:   http://www.cahs-acss.ca/wp-content/uploads/2014/05/Optimizing-Scopes-of-Practice_-Executive-Summary_E.pdf