The scope of practice of nurses and allied health professionals in primary care in Ontario, Canada: a scoping review

Abstract

Background Primary care is essential for health care systems to promote health, prevent disease, and manage chronic conditions. However, a shortage of primary care physicians challenges the delivery of high-quality primary care services to the population, especially for those living with multimorbidity. To address this challenge, interprofessional primary teams consisting of primary care physicians, nurses, and allied health professionals (AHPs) have been rolled out in many jurisdictions. This approach allows physicians to focus on complex patient care, where less complex care can be delegated to nurses and AHPs. Methods We conducted a scoping review of the literature on the scope of practice of nurses and AHPs in interprofessional primary care teams in Ontario, Canada. Results Nurse practitioners and registered nurses are heavily involved in providing direct patient care, whereas registered practical nurses are less involved. Pharmacists focus on medication management and patient education, dieticians focus on dietary assessments and nutrition education, and social workers focus on counselling and psychosocial assessments. Pharmacists and nurse practitioners often face challenges in defining their independent roles. Some physicians struggle with teamwork, whereas others appreciate multidisciplinary approaches. Conclusions Effective integration of nurses and AHPs in a primary care setting would enable physicians to delegate several tasks and address primary care physician shortages in various jurisdictions. Clarifying the professional roles of AHPs in primary care would enhance interprofessional team functioning, helping to increase both the quality and quantity of primary care.