10 Steps to Maximizing Nurses Full Scope of Practice Utilization in Primary Care Settings

Transcription

1 10 Steps to Maximizing Nurses Full Scope of Practice Utilization in Primary Care Settings 1. Remember this will require understanding of the change process 2. Make a decision to become a nursing full scope organization Make a decision with your team to maximize registered nurses and registered practical nurses full scope of practice utilization in your setting. Start by Identifying key factors that can facilitate of hinder the achievement of this goal. Please check off which factors you and your team perceive as barriers and which are perceived as enablers to maximizing nurses full scope of practice at your clinic. Barrier Enabler Staff readiness Staff readiness Time available Time available Resources for education Resources for education Organizational culture Organizational culture Understanding rationale Understanding rationale Funding models Funding models Team trust Team trust Role clarity Role clarity Change management Change management Team communication Team communication Liability considerations Liability considerations Patient population Patient population Other Other 3. Gain an understanding of the roles and responsibilities of RNs and of RPNs Discuss the roles and responsibilities of RNs using the RN position description and of RPNs using the RPN position description, both of which are found in the Primary Solutions for Primary Care report. 4. Conduct an RN gap analysis and conduct an RPN gap analysis to determine how the current roles relate to roles consistent with full scope of practice The gap analysis will help you determine whether your organization is currently maximizing RNs and RPNs full scope of practice utilization.

2 5. Discuss gap analysis results with the team Acknowledge the areas in which RNs are consistent with the roles and responsibilities descriptions as found in the primary solutions report. Acknowledge the areas in which RPNs are consistent with the roles and responsibilities descriptions as found in the primary solutions report. Discuss the areas in which improvements can be made such as areas that were noted as being not consistently met or not at all part the RN s role or of the RPN s role. Discuss what changes will be made to other staff roles when RNs and RPNs move to full scope. 6. Create and implement an action plan to enable RNs and RPNs work to full scope of practice, and to address any other role changes See RN and RPN project plans 7. Communicate to the entire team, partners, and clients. Use the key messages that summarize the goals for maximizing full scope of practice utilization. 1. Interprofessional is part of the vision of better health and health care for Ontarians. 2. Primary care RNs and RPNs have historically been underutilised, and not expected to work to full scope of practice, which if addressed could greatly improve timely access to, client outcomes and health system cost-effectiveness. 3. Full scope of practice in refers to nurses practising to the full extent of their competencies, knowledge and skills that they are educated, competent and authorized to perform; as outlined in phase one of Primary Solutions for Primary Care: Maximizing the Role of the Primary Care Nurse. 4. Professional development opportunities are available in face-to-face and web based formats to assist nurses expand and extend their knowledge, skills and competencies to enable full scope of practice. 5. Achieving full scope of practice for nurses and others in a setting requires leadership, communication and an action plan involving patients and all members of the interprofessional team. 6. Monitoring and evaluation, and ongoing changes as necessary are important aspects of the work plan developed to maximize full scope of practice utilization for nurses and others. Inform nursing staff of resources available to them should they require/ like to pursue further training e.g. educational resources for RNs and RPNs. Invite community partners to share about what it means to maximize RNs and RPNs full scope.

3 8. Collect baseline structure, process, provider and client outcome data RN indicator examples Indicators Structure indicators Turnover rate/retention Process indicators Continuity of care Holistic care Team effectiveness Provider indicators Role satisfaction among registered nurses Knowledge of other team members about the roles and responsibilities of RNs Registered nurses skills Attitude towards maximizing registered nurses full scope of practice Client indicators Client access to Percentage of clients able to access sameday Client capacity and volume Client satisfaction Client health outcomes Emergency department utilization Hospitalization Client safety Therapeutic self-care System indicators Emergency visits Hospitalization rate Anticipated outcomes when maximize full scope of practice utilization Improved retention Improved continuity of care Improved client reports of receiving holistic care Improved integration, collaboration, communication, consultation and overall team effectiveness Improved role satisfaction Improved provider knowledge about registered nurses roles and responsibilities Increased confidence and enhanced use of skills among RNs Increased openness towards maximizing registered nurses full scope of practice amongst registered nurses and other team members Increased access to and attachment to providers for Ontarians Increased percentage of clients able to access same-day Increased capacity of organizations and subsequently increased client volume Increased client satisfaction Improved client health outcomes e.g. early detection, reduction in number of adverse events Decreased emergency department utilization to access services Decreased unnecessary hospitalization Improved client safety Empowered clients and increased self-efficacy Reduced emergency room visits Decreased hospitalization rate

4 RPN indicator examples Indicators Structure indicators Turnover rate/retention Process indicators Continuity of care Holistic care Team effectiveness Provider indicators Role satisfaction among registered practical nurses Knowledge of other team members about the roles and responsibilities of RPNs Registered practical nurses skills Attitude towards maximizing registered practical nurses full scope of practice Client indicators Client access to Percentage of clients able to access sameday Client capacity and volume Client satisfaction Client health outcomes Emergency department utilization Hospitalization Client safety Therapeutic self-care System indicators Emergency visits Hospitalization rate Anticipated outcomes Improved retention Improved continuity of care Improved client reports of receiving holistic care Improved integration, collaboration, communication, consultation and overall team effectiveness Improved role satisfaction Improved provider knowledge about registered practical nurses roles and responsibilities Increased confidence and enhanced use of skills Increased openness towards maximizing registered practical nurses full scope of practice amongst registered practical nurses and other team members Increased access to and attachment to providers for Ontarians Increased percentage of clients able to access same-day Increased capacity of organizations and subsequently increased client volume Increased client satisfaction Improved client health outcomes e.g. early detection, reduction in number of adverse events Decreased emergency department utilization to access services Decreased unnecessary hospitalization Improved client safety Empowered clients and increased self-efficacy Reduced emergency room visits Decreased hospitalization rate

5 9. Evaluate client, provider, and organizational outcome data 10. Share outcome data with the team regularly and review what is working and what needs to change, to achieve and sustain full scope of practice utilization Share outcome data with the team regularly Share successes with team, modify areas that are not going as well as expected, embed changes in policy and other organisational practice, position descriptions, orientation, vision, mission, performance appraisal