Understanding the expanded nursing role in indigenous communities: A qualitative study

By studying an extreme context, we aim to provide an in-depth understanding of the expanded nursing role in remote aboriginal communities, its dynamics and the main barriers to its full expansion.

While it is recognized that nurses play a major role in remote or rural areas, little is known about the dynamics of the expanded role and the nurses' daily practice and routines.

We conducted 49 in-depth interviews with nurses and key informants and more than 14 days of observation: two days of pre-departure training and 12 days in dispensaries and a hospital in Hudson Bay, Québec, Canada.

We identified four sub-roles within the nurses' expanded role: administrative, nursing, medical and community sub-roles. This typology allowed us to document the evolving and dynamic nature of the role as well as the individual, organisational and community barriers that limit its expansion.

This typology represents the first attempt to gain an in-depth understanding of the enlarged nursing role in northern Québec and of the complexity of the daily nursing routines and dynamics. We believe it to be relevant for other contexts, such as rural areas, even if nurses there do not always take on all four sub-roles during their nursing experience.

Our paper has significant practical implications for different stakeholders-educators, directors of nursing, recruiters, regulators and policymakers-as it may help with identifying the education and training requirements for developing specific sub-roles, overcoming obstacles to widening the expanded role or better allocating the resources needed based on the predominant sub-role in different contexts. More broadly, this study shows that, when properly regulated, extending professional nursing boundaries does not put the patient at risk and enables professionals to develop their practice. It represents a textbook case for rethinking our contemporary health care systems.