LibGuides: Team-Based Care Design: RESOURCE: Team Role Profiles

Team Role Profiles

The following information is meant to provide a general overview of the scope of practice/employment of 'typical' care providers who can comprise an interprofessional (IP) team within various practice settings. Additional roles will be added in time.

Considerations for optimized practice have also been highlighted, as applicable. Once patient care needs are known, this information can be used by leaders to:

explore provider competencies.
validate that optimized practices are being maintained or explored within the care team model.
identify optimized functions required to support optimal care delivery.

Team Role Profiles: Regulated

Registered Nurse

The RN provides leadership in nursing assessment, planning, implementation and evaluation to promote, maintain or restore health, prevent illness, injury and disability, or support a peaceful death. The RN develops professional relationships for the purpose of providing care in collaboration with the patient and family, other nurses and health team members throughout all stages of health and complexities of illness. The RN independently provides safe, competent, compassionate ethical nursing care to stable, predictable and unpredictable populations, and ensures the goals and needs of patients and families are prioritized and individualized. Using nursing knowledge, critical thinking and clinical judgement, the RN engages in independent, interdependent (i.e., collaboration and information sharing with other IP team members) and dependent functions (i.e., in collaboration with a physician, NP, other RN colleagues and/or as governed by delegated functions, care directives, etc.) to provide health care focusing on comprehensive assessment, patient/family education and coordination of care (inclusive of discharge/transition plans). (Nova Scotia Department of Health and Wellness, 2009)

Reference

Nova Scotia Department of Health and Wellness. (2009). Registered Nurse (RN): Acute Care Medical Surgical Environment. Model of Care Initiative in Nova Scotia (MOCINS). https://novascotia.ca/dhw/MOCINS/docs/RN%20Role%20Description.pdf

Optimized Practice

Coordinates care (determine IP members that require consultation, facilitate bullet rounds, care plan development, evaluation of outcomes, complex assessments and patient/family teaching plans).
Leads team (i.e., RN oversees/directs care within LPN/CTA team, takes key role in assessing/determining plan for unstable/decompensating patients).
Facilitates/preceptor nursing student learner placements/new hire orientation.
Facilitates complex discharge/transition plans with patient/family.
Performs clinical interventions using critical thinking and assessment skills.

Resources

NSCN Standards of Practice for Registered Nurses

Entry-Level Competencies for the Practice of Registered Nurses

RN Prescriber

An RN Prescriber continues to function with an RN scope of practice as outlined in the RN role and optimized practice summation. An RN Prescriber must also successfully complete additional registration and educational requirements to perform the prescriber role function. The authorization to prescribe applies only to the specific client health conditions identified by the employer under employer authorizing mechanisms, policies and procedures and the RN prescriber must have clinical expertise with the identified conditions, patient population and clinical context. The role is not meant to replace the role of an authorized prescriber.

Reference

Nova Scotia College of Nursing. (2022). Standards of Practice for RN Prescribers. https://www.nscn.ca/professional-practice/practice-support/practice-support-tools/rn-prescribing/standards-practice-rn-prescribers-0

Optimized Practice

Performs RN Prescriber functions in the care of skin conditions and wound care management.
Performs RN Prescriber functions based on developed protocols for specific patient populations within acute care (for example, peritoneal dialysis therapy, bowel management).

Resources

RN Prescriber Competencies

Standards of Practice for RN Prescribers (Nova Scotia College of Nursing)

Nurse Practitioner (NP)

The NP cares for a variety of patient populations within a variety of care settings. The Nursing Act and associated regulations authorize NP standards of practice to independently manage clients’ health care needs, including diagnosing, ordering diagnostic tests, performing procedures, prescribing medication and consulting/referring to other health care providers. Within acute care med-surg context, the NP may also have a role/lead research, education and policy development activities.

Reference

Nova Scotia College of Nursing. (2018). Nurse Practitioner Standards of Practice. https://cdn3.nscn.ca/sites/default/files/documents/resources/NP_Standards_of_Practice.pdf

Optimized Practice

Contributes to development of practice guidelines related to patient care.
Engages in research and/or quality improvement, shares information and provides education to peers and other health professionals.
Acts as role model and mentor to RNs and students.

Resources

Nurse Practitioner Standards of Practice, 2018

Entry-level competencies for Nurse Practitioners in Canada

Licensed Practical Nurse (LPN)

"The LPN applies practical nursing theory in the assessment of patients, collaboration in the development of the nursing care plan, implementation of the care plan and ongoing evaluation of the patient. The LPN provides nursing services independently for patients considered stable with predictable outcomes and under direction or guidance of a registered nurse, medical practitioner, or other health care professional authorized (i.e., NP) to provide such consultation, guidance or direction for patients considered unstable with unpredictable outcomes."

Reference

Nova Scotia Department of Health and Wellness. (2009). Licensed Practical Nurse Acute Care Medical Surgical Environment. Model of Care Initiative in Nova Scotia (MOCINS). https://novascotia.ca/dhw/mocins/docs/LPN%20Role%20Description.pdf

Optimized Practice

Performs many/most psychomotor clinical intervention skills following Nova Scotia College of Nurses (NSCN) Three-factor Framework (for example, physical assessment, IV medication administration, central vascular access devices, routine blood administration, negative therapy, etc.).
Evolves care plan as patients meet expected outcomes, collaborates with RN when care needs are new/fall outside expected norms and/or expected outcomes not met.
Provides direction to support roles to ensure key aspects of patients ADLs/IADLs IADL (instrumental activities of daily living) are being addressed/supported.

Resources

2020 Standards of Practice for Licensed Practical Nurses in Canada

Entry-level competencies for Licensed Practical Nurses

Physician

College of Physicians & Surgeons of Nova Scotia

Clinical Assistant (CA)

Clinical Assistants assist in the provision of primary medical care under the supervision of a fully licensed physician who is directly responsible for the care provided by the clinical assistants. A clinical assistant is not an independent practitioner but acts in the role of physician extender in the hospital environment. Depending on the specialty, the CA performs procedures within the scope of his/her demonstrated competence. In Nova Scotia, CA are generally internationally trained health care professionals not licensed to practice in Canada.

Reference

Nova Scotia Health internal document 2021

Paramedic

See the Paramedics Clinical Practice Support Guide for paramedic scope of practice.

Registered Respiratory Therapist (RRT)

The RRT applies specialized knowledge and clinical expertise for patients with cardiopulmonary disorders across the lifespan. This entails evaluation and treatment of conditions using advanced medical technology (for example, ventilators, lung function tests, hyperbaric oxygen therapies) and/or treatment modalities (inhaled drugs/medical gases). The RRT can provide advanced life support and/or stabilization for extremely ill patients, as well as evaluate and provide treatment, education, and support to people living with chronic illness. Through specialized training/certification, they can perform various roles with other patient subsets/care contexts (for example, Anesthesia Assist role) (Nova Scotia College of Respiratory Therapists, 2015).

Reference

Nova Scotia College of Respiratory Therapists. (2015).About respiratory therapists. https://www.nscrt.com/about-respiratory-therapists

Optimized Practice

Performs assessments, diagnostic testing and clinical interventions that entail cardiopulmonary management (basic respiratory modalities, airway management, blood samples, medical gas therapy, administer medications, etc.).
Consults on complex cardiopulmonary care needs and/or when patient(s) not meeting expected outcomes related to cardiopulmonary care needs/goals.
Part of care team for Quick Response Team (QRT), Code Blue.
Leads/assists with cardiopulmonary patient teaching needs.

Resources

About Respiratory Therapists - Nova Scotia College of Respiratory Therapists

Standards of Practice - Nova Scotia College of Respiratory Therapists

Scope of Practice - Nova Scotia College of Respiratory Therapists

National Competency Framework for the Profession of Respiratory Therapy (2016-2021)

Social Worker (BSW/MSW)

"The healthcare social worker is a member of the inter-professional healthcare team providing collaborative, holistic care. Social workers' values and principles are aligned with patient-centred care which views patients/clients in a collaborative partnership with the healthcare team, respecting their right to autonomy and self-determination including making informed choices" (Nova Scotia Department of Health and Wellness, 2012).

"Social workers are primarily concerned with the relationships between people, social determinants of health, and their environments including the healthcare system. Social worker practice focuses on the interactive processes of assessment (bio-psycho-social), intervention and evaluation that helps empower patients/clients to achieve optimal health outcomes and well-being (adapted from CSWE, Advanced Social Work Practice in Clinical Social Work, 2008). Social workers build upon the strengths of patients/clients by focusing on coping strategies, problem solving skills, past successes, and personal resources" (Nova Scotia Department of Health and Wellness, 2012).

The MSW role holds a master level education in the discipline of social work and the expectation of this role is that they hold specialized knowledge about, and acquire specialized clinical training for, specific patient populations they provide service(s) to within specific care contexts (i.e., therapeutic interventions/modalities).

Reference

Nova Scotia Department of Health and Wellness. (2012). Provincial Practice Profiles: BSW & MSW Social Workers in Healthcare. Model of Care Initiative in Nova Scotia (MOCINS). https://novascotia.ca/dhw/mocins/docs/Provincial_Practice_Profiles_BSW_MSW_Social_Workers_in_Healthcare.pdf

Optimized Practice

Consults and performs assessments (coping strategies, personal/financial/social resources, existing problem-solving skills, etc.) to help inform the delivery of care/care plan development to optimize patient/family participation in their care (inclusive of patient teaching, discharge, or transition planning).
Leads identification (based on social determinants of health perspective and assessment findings) and execution of interventions (therapeutic modalities such as motivational coaching, etc.) to help address or mitigate complex issues that lessen, or have the potential to lessen, the ability of patients/families to actively participate in care, or delay/hamper discharge/transition plans.

Resources

CASW Scope of Practice Statement

CASW Code of Ethics and Scope of Practice

Occupational Therapist (OT)

"Occupational Therapy helps people achieve satisfying, independent lives by identifying and addressing key factors that may be causing personal barriers. Functional abilities are assessed in consideration of physical, cognitive, emotional, social and environmental circumstances and then plans are developed. Occupational Therapists work directly or indirectly with clients in healthcare, community-based, and private sector environments." (College of Occupational Therapists of Nova Scotia, 2023)

Reference

College of Occupational Therapists of Nova Scotia. (2023). What is Occupational Therapy? https://cotns.ca/

Resources

College of Occupational Therapists of Nova Scotia

College of Occupational Therapists of Nova Scotia: Standards of Practice

Physiotherapist (PT)

"Physiotherapy is an essential healthcare profession that deals primarily with the prevention or alleviation of movement dysfunction. Physiotherapists are skilled in the assessment and management of a broad range of conditions that affect the musculoskeletal, circulatory, respiratory, and nervous systems" (Nova Scotia Physiotherapy Association, 2023).

"The Physiotherapist (PT) participates in a collaborative care model providing holistic, comprehensive care to meet the needs of patient(s).

As a member of the team, the PT participates in the overall plan of care for the patient(s) by providing physiotherapy services when indicated.
The PT provides care in collaboration with the patient and family, other health team members throughout all stages of health and complexities of illness. The PT participates in the provision of safe, evidence based, competent, patient-centred, ethical care, ensuring the goals and needs of the patient are prioritized and individualized.
Using professional knowledge, critical thinking and clinical judgment, the PT engages in independent, interdependent and dependent functions to provide health care. The PT focuses on comprehensive assessment and treatment, integrated plans of care, patient/family education, coordination of care, facility/student education and research." (Nova Scotia Department of Health and Wellness, 2012)

References

Nova Scotia Department of Health and Wellness. (2012). Position description: Physiotherapist. https://novascotia.ca/dhw/mocins/docs/Physiotherapist_Standardized_Position_Description.pdf

Nova Scotia Physiotherapy Association. (2023). What Physiotherapists Do.https://www.physiotherapyns.ca/physio-for-you/category/what_physiotherapists_do

Resources

Nova Scotia College of Physiotherapists: Standards, Guidelines and Advisories

Nova Scotia College of Physiotherapists

Clinical Dietitian / Nutritionist

"In Nova Scotia, the titles dietitian and nutritionist are used interchangeably and have the same meaning. In order to use either of these titles in Nova Scotia, registration with Nova Scotia Dietetic Association (NSDA) is mandatory according to provincial law. In Nova Scotia, dietitians and nutritionists are regulated health professionals. They undergo comprehensive and rigorous training. Their role is to educate their clients about nutrition and support people to better understand the health impact of their food choices" (Nova Scotia College of Dietitians and Nutritionists, 2023). "In the public interest, the NSDA regulates dietitians and nutritionists to practice in a safe, ethical and competent manner. NSDA ensures Nova Scotians receive safe, competent and ethical dietetic services. We also uphold the standards of dietetic practice." (Nova Scotia College of Dietitians and Nutritionists, 2023)

Reference

Nova Scotia College of Dietitians and Nutritionists.(2023).About Us. https://nscdn.ca/public/about-nsda

Resources

Nova Scotia College of Dietitians and Nutritionists

Professional Dietitians Act - Nova Scotia

Nova Scotia Dietetic Association Standards of Practice

Clinical Pharmacist

The Clinical Pharmacist is responsible for providing safe and effective drug therapy to patients. They:

oversee drug distribution systems (inpatient and outpatient).
provide direction to pharmacy support staff.
identify drug-related problems and initiate steps to resolve.
work on selected medical services, participate in medical rounds and provide discharge medication calendars and counselling to patients.
make therapeutic recommendations to the medical team.
participate in scheduled pharmaceutical care rounds.
provide in-services within and outside of the department.
are responsible for reporting adverse drug reactions (ADRs) according to policy.
document workload statistics.
provide on-call, call back, weekend and night services.
are active in projects, research or writings for departmental or outside publication.
may provide specialty services (such as aminoglycoside and vancomycin dosing) and participate in warfarin dosing in outpatient anticoagulation clinics.
are expected to assist in training and preceptorship of residents and undergraduate students.

Reference

Nova Scotia Health Job fact sheet, August 2020

Resources

Pharmacy Association of Nova Scotia (PANS)

Nova Scotia College of Pharmacists (choose Pharmacy Practice tab for standards)

Registered Pharmacy Technician (RPT)

The RPT works as a member of the inter-professional team to provide safe, competent, patient- or family-centred, ethical care, ensuring the patient’s goals and needs are prioritized and individualized. Working within their legislated scope of practice and scope of employment, the RPT assumes responsibility for their own actions and is accountable to the public. They contribute to the overall plan of care/functioning of the pharmacy to ensure a safe and healthy environment. RPT functions may be:

Self-determined
Assigned through management, a pharmacist, or another RPT
Requested by other members of the care team

Reference

Nova Scotia Health Job Fact Sheet 2022

Team Role Profiles: Unregulated

Recreation Therapist (RT)

The RT:

provides support to patients/families and interprofessional team members through recreation and leisure therapeutic intervention(s) to support the holistic functioning of patients.
provides assessment, intervention plan development, evidence-informed interventions and evaluation of recreation therapy services.
utilizes recreation theory to inform practice.
provides interventions to groups or individuals in a variety of settings, including inpatient settings, related to patients’ leisure needs.
oversees delivery of the recreation therapy service for a program or team.
works within the standards and competencies of an RT as outlined in the Canadian Therapeutic Recreation Association 2006 documents.

Reference

IPP&L Recreation Therapist Standardized Role Document

Optimized Practice

Completes recreation therapy assessment/intake:
- when recreation/leisure needs are identified as areas of need for patients receiving inpatient acute care.
- to help with d/c/transition planning.
Helps develop components of a patient’s plan of care when leisure/recreation needs are identified and/or recreation interventions have been deemed as potential supports to help manage behavioural care needs.
Evaluates ability of targeted interventions to meet expected outcomes.
Delivers intervention (if required) and/or guides associated recreation associate/support roles to perform interventions.
Develops a comprehensive program plan for recreation services for a particular practice setting as appropriate.

Resources

Standards of Practice for Recreation Therapists & Therapeutic Recreation Assistants

Recreation Therapy Associate (RTA)

Under the direction of the RT, the RTA provides support to patients/families and interprofessional team members through recreation and leisure therapeutic intervention(s) to support the holistic functioning of patients. The RTA provides screening and contributes to evidence-informed interventions to groups or individuals, related to patients’ leisure needs and overall plan of care, as assigned by the RT.

Reference

IPP&L. Recreation Therapist Standardized Role Document.

Optimized Role

Completes recreation therapy intake screen via patient interview and review of health record and communicates accordingly.
Participates in or delivers recreation and leisure-based activities/interventions as defined within the patient’s or group of patient’s plan.
Observes patient reaction to/tolerance for leisure/recreation activities and communicates accordingly.

Resources

Standards of Practice for Recreation Therapists & Therapeutic Recreation Assistants

Therapeutic Assistant (TA)

Under the direction of the RT and/or a regulated health professional, the TA provides support to patients/families and interprofessional team members through participation in leisure/recreation activities for groups or individuals. TAs support the patient’s plan of care to maximize the patient’s successful engagement in care activities (such as ADLs and independent leisure), modeled within a recreation therapy framework.

Reference

IPP&L. Recreation Therapist Standardized Role Document.

Optimized Role

Collects patient information/patient interests related to leisure/recreation needs.
Observes patient response to related interventions and/or potential triggers that limit ability to engage in leisure/recreation events/interventions.
Assists team members with ADL care and other care as outlined within care plan.

Care Team Assistant (CTA)

"The CTA has the primary task of assisting regulated healthcare professionals in the delivery of care to patients". The CTA is primarily responsible for supporting patients’ Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). CTAs "contribute to the delivery of patient care by providing direct, hands-on care under the direction and supervision of regulated professionals" (Nova Scotia Department of Health & Wellness, n.d.).

"Assignment of duties to CTA is determined by the care coordinator or other regulated health care professional(s) based on the needs of the patient and/or unit and following an assessment of the required skill/skill set to fulfill those needs. Patient acuity and complexity influence the assignment of duties to CTA. Regulated professionals are responsible and accountable for ensuring that the CTA has the skills and knowledge required to perform the assigned duties and collaboration/communication processes are established to communicate goals of care and outcomes of care delivery. CTAs are responsible and accountable for accepting assigned tasks they are competent to perform and communicating when they do not feel competent to complete the assigned task" (Nova Scotia Department of Health & Wellness, n.d.).

Reference

[Nova Scotia Department of Health and Wellness]. (n.d.).Care Team Assistant: Role profile https://novascotia.ca/dhw/mocins/docs/Care_Team_Assistant_Standardized_Role_Profile.pdf

Optimized Role

Prioritizes and organizes delivery of ADL/IADL care, with a specific focus on ensuring patients mobilize (several times/day, up in a chair for meals) and maintain toileting regimens, fluid/nutrition support and engages in appropriate leisure/behaviour-modifying activities.
Reports key findings from delivery/support of ADL/IADL care to licensed providers if care goals are not being met.

Physiotherapy Assistant (PTA)

"The Physiotherapy Assistant (PTA) participates in the provision of holistic, comprehensive care to meet the needs of patients/clients. As a member of the team, the Physiotherapist Assistant participates in the overall plan of care for the patient/client by gathering information and providing physiotherapy interventions and education under the supervision of and as assigned by the Physiotherapist. The PTA provides care in collaboration with the patient/client, family, care providers and other health team members throughout all stages of health and complexities of illness. The Physiotherapist Assistant participates in the provision of safe, competent, patient/client and family centered, ethical care, ensuring the goals and needs of the patient/client are prioritized and individualized. The Physiotherapist Assistant is responsible for specific, assigned physiotherapy therapy services, matching with their training, skill, knowledge, and ability" (Health Association Nova Scotia, 2013).

Reference

Health Association Nova Scotia. (2013).Position description: Physiotherapy Assistant. https://novascotia.ca/dhw/mocins/docs/Physiotherapy_Assistant_(PTA)_Position_Description.pdf

Resources

Supervision and Support Personnel - Nova Scotia College of Physiotherapists

NSCC - Occupational Therapy/Physiotherapy Assistant

Occupational Therapy Assistant

"The Occupational Therapy Assistant (OTA) participates in the provision of holistic, comprehensive care to meet the needs of patients/clients. As a member of the team, the Occupational Therapy Assistant participates in the overall plan of care by gathering information and providing Occupational Therapy interventions and education under the supervision of and as assigned by the Occupational Therapist. The Occupational Therapy Assistant provides care in collaboration with the patient/client, family, care providers and other health team members throughout all stages of health and complexities of illness. The Occupational Therapy Assistant participates in the provision of safe, competent, patient/client and family centered, ethical care, ensuring the goals and needs of the patient/client are prioritized and individualized. The Occupational Therapy Assistant is responsible for specific, assigned occupational therapy services, matching with their training, skill, knowledge, and ability" (Health Association Nova Scotia, 2013).

Reference

Health Association Nova Scotia. (2013).Position description: Occupational Therapy Assistant. https://novascotia.ca/dhw/mocins/docs/Occupational_Therapy_Assistant_(OTA)_Position_Description.pdf

Resources

NSCC - Occupational Therapy/Physiotherapy Assistant

Rehabilitation Assistant

"The Rehabilitation Assistant participates in the provision of holistic, comprehensive care to meet the needs of patients/clients. As a member of the team, the Rehabilitation Assistant participates in the overall plan of care by gathering information and providing occupational therapy and physiotherapy interventions and education under the supervision of and as assigned by the Occupational Therapist and Physiotherapist, respectively. The Rehabilitation Assistant provides care in collaboration with the patient/client, family, care providers and other health team members throughout all stages of health and complexities of illness. The Rehabilitation Assistant participates in the provision of safe, competent, patient/client and family centered, ethical care, ensuring the goals and needs of the patient/client are prioritized and individualized. The Rehabilitation Assistant is responsible for specific, assigned occupational therapy and physiotherapy services, matching with their training, skill, knowledge, and ability"(Health Association Nova Scotia, 2013).

Reference

Health Association Nova Scotia. (2013). Position description: Rehab Assistant. https://novascotia.ca/dhw/mocins/docs/Rehab_Assistant_Position_Description.pdf

Dietetic Technician (DT)

Under the direction of the Manager of Nutrition and Food Services, and in collaboration with the Clinical Dietitian, the DT:

conducts nutrition risk screening based on a pre-defined program.
identifies patients at risk using established criteria and refers these patients to the Dietitian.
interviews patients, documents pertinent information and calculates Body Mass Index (BMI) and percentage of unintentional weight loss, as appropriate.
takes meal orders for high-risk patients on therapeutic diets to support Room Service dining.
completes various menu management activities, including inputting meal and/or nourishment information into the computerized menu management system to meet patients' diet/food requirements and to optimize and encourage oral intake.
provides some nutrition education.

Reference

Nova Scotia Health Job Fact Sheet, August 2020

Pharmacy Practice Assistant (PPA)

The PPA participates in providing safe, competent, patient or family-centered, ethical care, ensuring the patient’s goals and needs are prioritized and individualized. Using their knowledge, critical thinking and judgment, the PPA engages with their team to work in roles that are independent, interdependent and dependent to provide health care focusing on appropriate data collection, inventory management, medication preparation, patient/family education and research. PPA functions may be:

Self-determined
Assigned through management, a pharmacist or another PPA/RPT
Requested by other members of the care team

Reference

Nova Scotia Health Job Fact Sheet, August 2020

Physician Assistant (PA)

PAs are advanced practice clinicians trained in the medical model. PAs practice medicine with a degree of autonomy negotiated with supervising physicians to provide primary, acute and specialty care in all types of settings. They diagnose illness, develop and manage treatment plans, prescribe medication, perform procedures, act as a first assist in surgery and more.

Reference

Nova Scotia Health internal document, 2021