Exploring the Role of RNs in Family Practice Residency Training Programs

March 2010   Comments
(Photo: Michelle Allard)

The authors developed a survey as part of a study to explore the role of nurses employed in Canadian family practice residency training programs, which provide physicians with two years of additional training after they have completed undergraduate medical education. Licensed practical nurses, registered nurses and nurse practitioners employed at residency training program sites have a unique opportunity to educate new physicians about nursing scopes of practice and about how to work effectively with nurses. A total of 127 nurses, including 94 RNs, from 41 program sites across Canada completed the survey. In this article, the authors present the findings specific to this RN group. RN respondents reported performing a wide range of nursing and non-nursing activities, and only 61 per cent indicated that they felt they worked to full scope. That so many RN respondents were performing below their scope of practice may be the result of employer and organizational policies or a lack of understanding and awareness of scope of practice. The authors propose that family practice residency training programs adopt a standardized approach to the role of RNs.

Until recently, there has been little interest in understanding or developing the role of the registered nurse (RN) employed in family practice/primary care (FP/PC) settings in Canada. According to the Canadian Institute for Health Information (2009), RNs who are employed in physician offices and family practice settings make up less than 13 per cent of the nursing workforce. This group provide important primary care services to patients and are considered integral members of the primary care team (Nasmith, 2006). In fact, they have been described as “unsung heroes,” who not only carry out key clinical functions but are a steady presence in family practice settings, providing stability for patients when their physician is unavailable (Nasmith, 2006).

In 2007, the College of Family Physicians of Canada (CFPC) and the Canadian Nurses Association (CNA) released a joint vision statement on interprofessional care, which stated, “All people in Canada will have access to a family practice/primary care setting that offers each person the opportunity to have his/her care provided by each of the following: a personal family doctor and a registered nurse and/or nurse practitioner.” The vision statement focuses on complementary roles rather than role substitution and on the need for health-care professionals to have a clear understanding of the skills and knowledge of those in other disciplines.

Physicians who are accepted into family practice residency training programs receive two years of additional training after they have completed undergraduate medical education. These programs provide an ideal environment for new physicians to learn and understand the roles and responsibilities of nurses and other health professionals as well as the benefits of collaboration. It is therefore vital that all health-care professionals working in these settings are working to their full scope of practice.

In an extensive literature search, utilizing CINAHL, PubMed and Google Scholar, we found fewer than a dozen articles with reference to the roles of nurses in family practice residency training programs. Although nurses’ contributions to medical education were consistently described as being valuable (Bradley, Bond, & Bradley, 2006; Howe, Crofts, & Billingham, 2000; Solberg, Nesvacil, & Stroller, 1989), these articles focused almost exclusively on the nurse practitioner (NP) role. A recent Canadian study suggests that the RN role in family practice is ill-defined in general and even more so in the interprofessional academic family practice setting, where the role was found to be largely defined by tasks and often ambiguous (Akeroyd, Oandasan, Alsaffar, Whitehead, & Lingard, 2009).

Building on the research of Todd, Howlett, MacKay and Lawson (2007), we sought to investigate the role of nurses employed in family practice residency training programs and determine the amount of time they spent engaged in nursing and non-nursing activities, their scopes of practice and their level of job satisfaction.

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Michelle Allard, RN, BN

Michelle Allard, RN, BN, is a primary care nurse at The Family Medical Centre in Winnipeg, Manitoba. She holds a nil-appointment with the Department of Family Medicine, University of Manitoba, a nil-appointment with the Faculty of Nursing, University of Manitoba, an executive position as Membership Secretary for the Canadian Family Practice Nurses Association and is co-chair of the Manitoba Primary Care Nursing Association.

April Frego, RN, CDE

April Frego, RN, CDE, is a clinical resource nurse at the Kildonan Medical Centre in Winnipeg, Manitoba. She holds a nil-appointment with the Department of Family Medicine, University of Manitoba, a nil-appointment with the Faculty of Nursing, University of Manitoba, an executive position as education chair for the Canadian Family Practice Nurses Association and is co-chair of the Manitoba Primary Care Nursing Association.

Alan Katz, MBCHB, MSC, CCFP

Alan Katz, MBCHB, MSC, CCFP, is the Research Director, Department of Family Medicine, University of Manitoba, Associate Director for Research, Manitoba Centre for Health Policy, and Associate Professor, Departments of Family Medicine and Community Health Sciences, University of Manitoba.

Gayle Halas, RDH, MA

Gayle Halas, RDH, MA, is a research associate, Department of Family Medicine, University of Manitoba.

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