I can't speak to all of the groups, but certainly when we ask a number of different health professionals if they believe they have knowledge and skill that they can bring to the improvement of health outcomes but that are not being tapped into, a majority of them will say yes.
I think it's probably worse in some areas than in others. We've primarily studied nursing up to this point in time. We have done interviews with a number of different professionals; what we've identified across the board is a focus on tasks, and there's a lot of overlap in tasks across many of the health professionals. Giving medications, for example, is not the domain only of pharmacists or physicians or nurses. Patients also give them, and so on, so this focus on tasks blurs a lot of the distinctiveness in terms of the knowledge of various professionals, and role ambiguity is something that has come out in all the work we've done.
When we begin to look at under-utilization, I can only speak to nursing, because I've only studied extensively in nursing. We have baccalaureate-prepared registered nurses now in Canada. When we moved to that, it was different in different provinces, so we can't refer to a particular time, but the expectation when we moved to baccalaureate preparation was that registered nurses would contribute more to the population-focused approaches, disease prevention, and so on. However, when we actually study their practice, they are very biomedicalized, as we call it. They're very much involved in medical management--not that they shouldn't be, but that's primarily what they're doing.
In some of the work we've done, we've found it very difficult to differentiate the practice of registered nurses from that of licensed practical nurses, because of this focus on tasks. In some of the work we've done, we've begun to identify that part of the reason registered nurses are not doing what they can do is that we don't have enough licensed practical nurses and health care aides in the staff mix.
Then you begin to wonder what difference it would make if we changed the model of service delivery and had collaborative practice models that incorporated all three. We're only beginning to explore that area of research, but I can give you one tiny example of one medical unit in which we've moved to a collaborative practice model. On a day shift, for example, we went from having 9.5 equivalents of registered nurses and two health care aides to six health care aides, five registered nurses, and four licensed practical nurses. You begin to change, and we're having improved outcomes, more job satisfaction, and a whole lot of stuff. Just that one unit begins to give you a sense of the potential that exists for beginning to work differently, but it also highlights a problem in the mix of people available to us: we can't implement that model in as many places as we'd like because we don't have enough licensed practical nurses in Alberta, and so on and so forth.
That is just an early example of experimenting with new models of service delivery through collaborative practice. What does that mean? We have occupational therapists telling us they are asked to come and be part of the care team when one provider has a particular idea about what that OT can do. As one occupational therapist said, “I'm treated as if I am a technician. I'm called in when somebody wants me to perform a particular test, but if I had been brought in a little earlier, I might have prevented the decision to send that patient to long-term care rather than back home”.
Those are just examples.