The evolution of the Canadian healthcare system requires a continuous focus on the optimal use and allocation of resources to focus equitably on the health outcomes of Canadians, and to ensure sustainability of the system. Over the medium and longer term, the inevitable slowing of growth in the Canadian economy to match the downturn in workforce growth means that there will be increasing pressures on government revenue and on manpower resources. This means that there must be an increased emphasis on maximizing the value from government programs such as healthcare. Trying to get more health gain for the same or fewer resources, both human and material, is necessarily an important goal. This can involve adapting healthcare processes and skill mixes to improve results. One potential route is to optimize the use of nursing human resources, which many experts consider to be under-utilized in Canada, to enhance the coordination of care and health outcomes.
This report reviews selected published literature and available grey material that focus on the contribution of nurse-led and interprofessional teams in areas such as chronic disease, health promotion, prevention, improved health outcomes and health access. The emphasis is on effectiveness with respect to health outcomes and other measures of health system performance. The overarching theme to the paper is the contribution of registered nurses (RNs) and nurse practitioners (NPs) as essential components of interprofessional teams in the management of complex chronic diseases. This report specifically focuses on primary care.
The key messages in this report devolve from a general focus on the effective use of collaborative teams involving nursing resources in the Canadian healthcare system.
- The role for nursing human resources is particularly clear in chronic disease management in primary care, because of the greater requirement for patient involvement and activation that is facilitated by team care, as highlighted in the chronic disease management literature.
- Chronic disease management requires more than just physicians to take a key role in helping patients manage their disease. Interprofessional team care should be the modality of choice, with a strong emphasis on the increased use of nursing resources in more responsible roles.
- Nurses and other healthcare providers share common ground in their respective practices. For example, nurses are able to provide equivalent care within their scope of practice compared to that provided by physicians, which has been shown to lead to better-quality care and improved patient satisfaction.
- This increased capacity of nursing makes a vital contribution to the success of interprofessional teams. However, institutional settings may constrain nurses’ scope of practice to less than might be possible given their education and training. The economic rationale for interprofessional teams is the optimal utilization of healthcare providers in terms of their comparative advantage in skill sets, cost and availability.
- Patient-oriented payment modalities such as capitation and blended payment models are shown to be more appropriate to the optimal utilization of nursing resources in interprofessional teams.
- A shift in emphasis to nurse-led interprofessional teams can increase capacity at relatively lower cost than other alternatives if appropriate payment levels and modalities, as well as institutional settings, are available.
- Interprofessional models, including nurse-led teams, are shown to improve quality, patient satisfaction, access and equity. Such gains, appropriately valued, should offset the additional resource costs associated with such service expansion.
- Access to care in remote and rural areas and to other underserviced populations can be facilitated particularly well with nurse-led teams.
- Increasing nursing resources may not result in direct cost-savings. However, there may be significant cost gains if resources are targeted at patients with specific chronic diseases or other high-needs populations.