3 | Optimizing scope of practice

The tools linked below can help your organization identify and address gaps between the current and full scope of practice for registered nurses and registered practical nurses (RNs and RPNs) in your primary health care setting. 

# Gap Analysis 

Gap analysis is a process of finding gaps between the full scope of practice for a profession and the current functions being fulfilled by that profession in your organization. If your RNs and RPNs are not practicing to full scope, a gap analysis can help you figure out what's missing from their role and find opportunities to make the most of their expertise. 

These two tools from the Registered Practical Nurses Association of Ontario (RPNAO) can guide you in doing a gap analysis.

• Primary Solutions for Primary Care outlines the full RN and RPN scope of practice.
• The Gap Analysis Tool will lead you through a process of comparing the current roles of RNs and RPNs in your organization to the full scope of practice. For each of the 30+ role description recommendations in the Primary Solutions document, you can flag whether your RNs and RPNs are performing the task consistently, inconsistently, or not at all, and then record change strategies for incorporating those tasks into their roles. 

# Barriers and Enablers of Full-Scope Practice

To expand the scope of practice for nurses, it is crucial to address both the enablers and barriers to implementation. This article, How Do We Achieve Full scope?  is part of a Primary Care Nurse Toolkit produced by the Registered Practical Nurses Association of Ontario (RPNAO). It identifies some of the key enablers for your organization to enhance and barriers to address in order to reach the improvement goals identified in your gap analysis. 

• Key enablers include effective team communication, trust, role clarity, access to education, and a supportive organizational culture.
• Barriers identified include staff readiness, time constraints, lack of resources, and heavy workloads.

A pressing need in primary health care is mental health. Social workers have an essential role to play in addressing this need. 

Social Work and Primary Care: A Vision for the Path Forward is a report as well as a vision document that emphasizes the importance of integrating social workers more fully into primary care as a way to meet rising demand for mental health and chronic disease management. Social workers in primary care provide a range of services, including assessments, crisis management, counseling, and support for patients with complex health needs. 

The report also discusses several barriers to fully utilizing social workers, including underrepresentation in primary care teams as well as pay disparities. It calls for increased access to social workers in primary care across Canada, ensuring they can practice to their full scope and are better represented in leadership roles. 

# Social Work in Primary Care e-Learning Modules

Team Primary Care is a federally-funded initiative that is building capacity for effective interprofessional collaboration in primary care settings. The program funded researchers and leaders from 25 professions to develop learning resources in support of this. In addition to the Social Work and Primary Care report linked above, Team Primary Care funded the development of a free, public curriculum about the role of Social Work in Primary Care. It consists of six e-learning modules that take about 30 minutes each to complete. Each also contains additional, optional resources to explore. They are intended for new or practiced social workers who wish to work in primary care settings, as well as for other health professionals who want to learn more about social workers' roles in primary care. 

Physiotherapists (PTs) and occupational therapists (OTs) working to their full scope of practice within interprofessional primary healthcare teams can be an  effective way to increase capacity for patient attachment and ease the workload for primary care providers. 

In a primary care setting, patients can directly access PTs and OTs, without first seeing a physician or nurse practitioner. Within their scopes of practice, these rehab professionals can address a wide range of conditions including, but not limited to, neuromusculoskeletal injuries and diseases, heart and lung disease, stroke, brain injury, spinal cord injury, cancer related sequelae, incontinence and pelvic dysfunction, chronic pain/conditions and pre- and post-surgical recovery.

This letter from the Ontario Physiotherapy Association (OPA) outlines the benefits of including PTs working to full scope in primary health care teams. 

To support the development of Interprofessional Primary Care Teams and local health networks that are inclusive of these occupations, these organizations are also available to support proposals and help make the case for having their members join the team. This support will continue through future cycles of expansion funding.

# Learning Modules for Physiotherapy and Occupational Therapy in Primary Care

Team Primary Care is a federally-funded initiative that is building capacity for effective interprofessional collaboration in primary care settings. The program funded researchers and leaders from 25 professions to develop learning resources in support of this. 

• Preparing Physiotherapists for Team-Based Primary Care is a series of eight e-learning modules which aim to help physiotherapists develop competencies for physiotherapy practice in team-based primary care settings.
• Occupational Therapy and Primary Care is a free, two-part course designed to enhance the capacity of OTs to participate in collaborative primary care teams. It is available to members of the Canadian Association of Occupational Therapists.

# Additional Physiotherapy and Occupational Therapy Resources

More information about physiotherapy in primary care is available from the OPA's website. Other relevant resources available there include:

• A slide deck about physiotherapy scope of practice
• A mock job description for a physiotherapist in primary care

The Canadian Association of Occupational Therapists also has a variety of resources on their website to support integration of OTs into primary health care teams: 

• OT Practice Document: Primary Care
• Occupational Therapy and Primary Health Care (info sheet)

For decades, Alliance members have embraced the roles of Community Health Workers and Community Ambassadors.  are something that Alliance members have embraced for years. This report, published in Healthcare Policy, describes the vital ways community health workers contribute to advancing health equity in Canada. They assist patients in accessing necessary care, deliver health education, and offer guidance and counseling to those in need. 

The report argues that formally recognizing and supporting these roles, alongside integrating community health workers and Multicultural Health Brokers into health systems, can significantly enhance care delivery and address barriers faced by marginalized communities. 

For more about the potential of Community Health Ambassadors to make primary health care more accessible to people in your community, especially those who experience systemic barriers to care, check out the case example of the Thorncliffe Community Hub in Chapter 8 of this toolkit. 

Team Primary Care is a federally-funded initiative that aims to build a strong interprofessional primary care workforce across the country, as a key step in addressing the crisis in access to care. They are building capacity for effective interprofessional collaboration in primary care settings by sharing innovations that are ready for spread, developing learning and QI tools for better collaboration, helping organizations integrate new staff, and supporting people to work to the full scope of their professional practice. 

To support this last goal, Team Primary Care convened an Interprofessional Collaborative Table with representatives from 30 professions within primary care. Researchers and leaders from 25 of these professions were funded to develop learning resources that would empower richer integration of their professions into interprofessional primary care. Resources include pre- and post-licensure training, tools to support workflow and role integration, and detailed role descriptions to support decision-makers.  This page contains links to all of these resources.