Registed Nurses' Association of Ontario


RNs' scope of practice

The role of the nurse practitioner (NP) in Ontario has developed and grown exponentially over the past three decades. This is thanks, in part, to the work of RNAO, in collaboration with its interest group, the Nurse Practitioners' Association of Ontario (NPAO).

NPs are registered nurses (RN) with additional education and legislated authority to do more for patients. RNAO and NPAO's advocacy efforts mean NPs can now diagnose and treat illnesses, set and cast bone fractures, admit and discharge hospital patients, and prescribe medications.

The establishment of NP-led clinics and the removal of restrictions to the role have helped to pave the way for faster access to care.

Now that NPs are better recognized and accepted for the part they play in improving the health system, RNAO continues to focus its attention on how the role of the RN can be expanded to include responsibilities that reflect their knowledge base. This will help to ensure the system runs more smoothly.

Just imagine this scenario: You notice you are almost out of your medication. You call your primary care provider, who puts you in contact with an RN at the clinic. The RN is able to see you that evening. After performing an assessment, the RN writes you a prescription refill and sends you on your way. It’s an example of seamless, efficient care resulting from RNs’ expanded scope.

Across Canada, it's estimated only 61 per cent of RNs practise to their full scope in primary care, which includes leading patients' physical exams, interpreting the outcomes, deciding whether referral to an NP or physician is necessary, and determining if it’s appropriate for the RN to deliver next steps, such as developing a treatment plan. In Ontario, there are roughly 4,000 RNs and about 2,500 registered practical nurses in primary care.

In 2012, RNAO launched a task force alongside the Ontario Family Practice Nurses, an interest group of RNAO. This collaboration led to the release of Primary Solutions for Primary Care: Maximizing and Expanding the Role of the Primary Care Nurse in Ontario. The groundbreaking report contains 20 recommendations aimed at improving timely access to quality primary care, system integration and effectiveness, and cost savings for the government and taxpayers.

At RNAO’s 88th annual general meeting in the spring of 2013, Premier Kathleen Wynne pledged to work with RNAO and the College of Nurses of Ontario to expand the role of nurses. Proposed changes could include dispensing medication in specific circumstances, such as instances where patients find themselves without timely access to a pharmacy. She also said she would try to identify other opportunities to expand nurses’ scope, including allowing RNs to prescribe medications and paving the way for NPs to prescribe narcotics, the only type of drug they are not yet able to prescribe.

RNAO knows maximizing and enhancing the role of the RN will lead to improved patient outcomes, faster access to care, and a health-care system that is more responsive, effective and cost-efficient. That's why the association will continue its advocacy to ensure as many nurses as possible are working to their full scope, and patients benefit from their care.