As a registered nurse in an Ottawa-based hospital, Anne-Marie Lemieux has a long list of daily to-dos: she assists patients in the restroom and the shower and helps them eat their meals; she administers medicine; inserts and removes catheters; changes dressings; starts IVs; preps patients for diagnostic tests and surgeries; supports families; updates charts; and works the admissions and discharge desk.
Like Lemieux, most registered nurses have plenty on their plates to keep them busy, yet 40 per cent of Canadian nurses say they aren’t being used to full capacity. If given the green light from the Ministry of Health, these nurses would happily take on more responsibilities, like those currently held by the more senior nurse practitioners.
“The bottom line is that we’re wasting valuable resources with our RNs,” says Doris Grinspun, the Registered Nurses’ Association of Ontario’s chief executive officer. “European countries like the U.K. have been using RNs to their full capacity for years. It will be a missed opportunity for the public, taxpayers and patients if we don’t move to full utilization of our nurses.”
According to the Ontario Medical Association, Ontario is short 1,000 physicians, and almost one million Ontarians don’t have a family doctor. The provincial shortage of doctors and the increasing waiting times for patients have lit the fire under Grinspun and her colleagues to establish a task force calling for the expansion of the role of registered nurses. “Every group that has anything to do with health care in Ontario is involved in this task force,” she says, from the Ontario College of Family Physicians to the Nurse Practitioners’ Association of Ontario. She wants the province to recognize the education and expertise of registered nurses, and to agree that they could be doing more within the scope of their practice, like diagnosing patients, ordering diagnostic and lab tests, conducting pelvic exams and prescribing medications.
Though the mandate of Ontario’s action plan for health care is to find ways to maximize the system, full utilization of care providers isn't possible until the government revamps policies about who can bill for certain medical procedures. “We should be using nurses and all health-care providers to open access, increase the timeliness and quality of care and to contain cost,” she says. “But if a nurse does a pap smear, the doctor doesn’t get paid. If a nurse diagnoses a child’s ear infection and prescribes antibiotics, the physician doesn’t get paid. I go berserk when I see doctors taking blood pressure,” she says. “Nurses have the training to free up a doctor’s time in primary-care settings so she can focus on more complex situations.” Plus, the move to grant registered nurses more autonomy on the job would lower the waiting times for patients to be seen, meaning there will be fewer patients showing up at walk-in clinics and emergency rooms.
And there are other issues that surface when nurses aren’t exercising their full knowledge and expertise: Lower job satisfaction and instability in the nursing workforce, as well as fewer students interested in enrolling in nursing programs.
Dr. Laurie Mazurik works in Toronto’s Sunnybrook Hospital’s emergency room and says that nurse practitioners and registered nurses are a great source of help to physicians. “Nurses and physicians’ assistants are an acknowledgement that MDs are not needed for all aspects of health care. They work well with doctors and can certainly help reduce the time it takes to manage a large volume of patients who don't need hospitalization or advanced procedures and diagnostics.” Mazurik says giving nurses the ability to run tests, draw blood work, do ECGs and give certain medications prior to physician contact would help to shorten the time to make a diagnosis or treatment decisions. “They could also work in low-acuity clinics, or independently with online physician backup by phone or web-cam, such as is done in nursing stations in remote areas.”
Dr. Mona Loufty, a physician in a primary-care clinic in Toronto, says she too is in full support of nurses taking on more responsibility. “In many areas like cardiology, maternal health, diabetes and osteoporosis, for example, the medicine is very specialized, evidence-based and repetitive. A nurse can often offer more time with patients than doctors, more compassion and provide excellent medical care,” she says. “With our increasing lack of capacity of doctors in Ontario to cover the health workload, I do not feel threatened by nurses taking on more responsibility. In fact, I would look forward to working with a care provider from a different discipline to provide better care for my patients.”
If Grinspun and her task force’s recommendations are successful and granted by the Ministry of Health, she believes there will be an inherent change to the province’s health-care system: Primary care will start focusing on health, not on illness.
Lemieux, who’s been a registered nurse since 2010, says she’d welcome the transition and expansion to her role in the hospital. “The nurses I work with are highly educated and committed to their profession, and many of them are enrolled in continuing education,” she says. “Nurses are lifelong learners, and we can do more.”