Strengthening Team-Based Care: Optimizing the Scope of Practice of Primary Care Nurses (SCOPE-PCN)
Goal: To strengthen team-based primary care and primary care nurses' (PC-Ns: Nurse Practitioners [NPs],
Registered Nurses [RNs], Licensed/Registered Practical Nurses [LPN/RPNs]) intra-professional collaboration
by delineating professional scopes of practice of each PC-N provider.
Background and Rationale: In Canada, three regulated nursing designations work in primary care (NPs,
RNs, LPNs/RPNs). PC-Ns are the second largest workforce in primary care and play critical roles in
optimizing outcomes, while reducing health disparities. There is renewed interest in team-based primary
care that includes nurses as a solution for health workforce challenges. Some team models enable PC-Ns to
leverage one another’s expertise to work to optimal scope, while other models do not. A recent Canadian
Institute for Health Information report compared PC-Ns’ legislated scopes of practice but did not offer
insights into PC-Ns’ professional scopes to meet patient and population health needs. We will examine PCNs’
professional scopes of practice and how the presence of other PC-Ns and providers impacts scope
enactment.
Research Questions and Objectives: How do PC-N professional scopes of practice overlap/differ? How
does the presence/absence of other PC-Ns impact (narrow, expand, and/or shift) activities of each PC-N
provider? How does the presence/absence of other non-PC-N providers impact activities of each PC-N
provider? How do characteristics of the clinical setting influence PC-Ns’ professional scope of practice
enactment? This project consists of two linked studies: 1) umbrella review and 2) multiple case study. The
objectives are:
1. To synthesize and compare international knowledge syntheses focused on scope of practice
enactment (i.e., roles/activities) of PC-Ns in primary care.
2. To examine how nursing care organization (i.e., staffing, practice attributes) impacts professional
scope of practice enactment of PC-N providers in a primary care team.
Methods: The Umbrella Review will consolidate international scoping and systematic review evidence on
PC-N roles into a single report. The Multiple Case Study consists of two components: (1) qualitative
interviews and (2) a measure of PC-N scope enactment (Actual Scope of Practice-Primary Care tool) in four
provinces (Alberta, Ontario, Quebec, Newfoundland & Labrador). PC-Ns will describe their scope of
practice, challenges/facilitators, and opportunities for role optimization. Overlap in care will be examined
by presenting PC-Ns with clinical scenarios and prompting discussion about care activities. Thematic
analysis will be used. Data will be compared across cases.
Outcomes and Significance: This project will generate evidence about the extent to which PC-N scopes
are optimized/enacted in teams and guide funding and staffing policies to ensure that the best qualified
nurse, or team of nurses, is in place to realize the benefits of team-based care. Findings will enhance
understanding of PC-Ns’ shared/unique contributions to patient care, strengthen collaboration, and
enhance the capacity of primary care to optimize team configurations.
Principal Investigators: Drs. Julia Lukewich (Memorial University) and Maria Mathews (Western University)
Co-Investigators: Joan Almost, Shabnam Asghari, Kris Aubrey-Bassler, Suzanne Braithwaite, Jill Bruneau, Patrick Chiu, Deanne Curnew, Emilie Dufour, Annette Elliott Rose, Christelle Guedon-Fourneau, Elizabeth Halcomb, Lindsay Hedden, Toni Leamon, Carole Lunny, Danielle Macdonald, Ruth Martin Misener, Monica McGraw, Anaelle Morin, Alison Norful, Marie-Dominique Poirer, Marie-Eve Poitras, Annie Rioux-Dubois, Michelle Swab, Joan Tranmer, Erin Wilson
Collaborators: Ministere de la Sante et des Services sociaux (Quebec); Canadian Health Workforce Network (CHWN); Primary Care Nurses of Ontario; Government of Newfoundland and Labrador, Department of Health and Community Services (DHCS); RPN Association of Ontario (WeRPN); College of Licensed Practical Nurses of Alberta; Canadian Family Practice Nurses Association (CFPNA); Cheryl Etchegard, Memorial Uuniversity, Quality of Care NL; Nurse Practitioner Association of Canada (NPAC); Nurse Practitioner Association of Alberta (NPAA); Canadian Nurses Association/Association des infirmieres et infirmiers du Canada; Nurse and Nurse Practitioners of British Coumbia; College of Registered Nurses of Alberta (CRNA); Family Practice Nurses Association of Nova Scotia; College of Registered Nurses of NL (CRNNL); Ordre des infirmieres et infirmiers due Quebec; Alberta Assocaition on Nurses (AAN); NL Nurse Practitioner Association (NLNPA); The College of Family Physicians of Canada/Le College des medecins de famille du Canada; Alberta Primary Care Nureses Association (APCNA); College of Licensed Practical Nurses of NL
