Healthy Relationships, Healthy Teams




Full scope RNs in family practice improve access, continuity and reduce ER visits

Without a doubt, team members provide better care when resources are properly distributed. By introducing a full scope role for its registered nurses (RNs), Greater Peterborough FHO, part of the Peterborough FHT, was better able to serve its patient population, which includes a higher than average number of the elderly, patients living in poverty, and with mental health conditions. Recognizing that this more marginalized population has been shown to have more barriers to access, this inter professional team was able to provide an increased range of low threshold services using existing human resources within the team. Within a 12-month period, the team improved access to care and reduced the number of this elderly population’s non urgent emergency department visits by 20 per cent. They did this by increasing full scope nursing to five days per week from two and saw terrific improvements during the first 12 months that this approach was in place. For example, continuity with the patient’s own physicians has increased to 84 per cent from 80 per cent and hospital readmission within 30 days is 2.5 per cent for this practice compared to five per cent for the LHIN as a whole.

This success led to greater satisfaction by all team members, reduced staff burnout and ensured patients had better access to holistic care.

Before implementing this change, the team researched barriers to caring for marginalized populations and studied the baseline data on access to their practice for their patients. This helped them come to the realization that maximizing team roles would allow them to address gaps in access and care. The team then educated patients on the role of full scope nursing in primary care, individually and collectively as a team from the front-line staff to the physician. Eventually, patients began asking for appointments with the nurse, rather than being prompted to do so.

Nurses received education to supplement their existing base of knowledge and skills. The team embraced nursing mentorship and a shared leadership model to support a healthy team dynamic. Full scope nursing was provided in multiple areas of practice: preventive care (well baby, prenatal, well woman), chronic disease prevention and management (lifestyle, smoking cessation, asthma, COPD, diabetes), care of the elderly (cognitive screening, advanced

directive, palliative care), acute care (UTI, respiratory, wound care), care co-ordination for complex cases, procedures, and specialized care (trans care, ADHD assessments).

To help other teams achieve similar success, Peterborough FHT has created a template on the process of developing full scope nursing roles, and the practicalities of scheduling and communication practices in inter professional teams. The team has also created resources in the form of medical directives that can be shared, both for the common situations where the directives would be utilized, to the less typical that address a more marginalized population, such as the nursing role in managing the primary care of trans patients.

The team has offered mentorship opportunities for nurses and other providers locally within their FHO and Peterborough Family Health Team to observe and understand the practice in action. This project is worthy of commendation for providing all patients access to barrier-free, low-threshold in-house care and better access to nursing and physician care.

Key Facts: • High number of at-risk patients: elderly, living in poverty or have mental health issues • Full scope nursing increased patient range of access to nursing and physician care • 20 per cent reduction in non-urgent ER visits during 12-month period thanks to same-day access to nursing care • Education for nurses supplemented existing knowledge bases • Increased full scope of practice to five days a week from two • Hospital readmission within 30 days is 2.5 per cent for this practice compared to five per cent for the LHIN as a whole