Statement of Current Position on the Expanding Role of the Nurse

Abstract

An explicit statement regarding the "expanded role of the nurse" is difficult to formulate as this pattern of nursing practice develops in Canada. However, we are in agreement with those who state that "the expanded role" represents broadening of the present role to include changed attitudes as well as additional knowledge and skills. Such broadening would provide a firmer basis for independent decision-making and for application of the concepts of responsibility and accountability in nursing care. In contemplating the expanded role for nurses we are acutely aware that the practice will require an orientation by the health team that is not currently visible in today's health care. Nursing education programmes cannot prepare this practitioner without fundamental changes in role concept. The expanded role gives priority to nursing the client rather than providing service to an institution or to the medical practitioner. Present patterns in nursing education involve faculty members who, for the most part, were conditioned by situations wherein nursing practice was influenced significantly by the needs of the institutions and of the medical personnel. In spite of changing attitudes in faculty members and their efforts to create a changed environment, students still obtain their clinical experience in settings which are basically bureaucratic and hierarchical in structure, and procedure-oriented in nursing practice. It is difficult in such a setting for the student to apply the necessary independent nursing decisions based on her own observations and judgment, or to develop a deep sense of commitment founded on attitudes of responsibility and accountability. Furthermore, it is virtually impossible to expect the student to obtain experience in working independently or intra-dependently with colleagues or to learn the advocate role when the present system of education, especially the clinical setting, virtually precludes such a possibility. Priority must be given to initiating and maintaining a change in nursing education and practice so that the self-concept developed by the nurse is one of a provider of direct care to patients and families, one which is practiced in a way that is significantly different from the current pattern in this geographic area.