RN(EC) is the protected credential in Ontario; Nurse Practitioner ( NP) is the commonly used term
Primary Health Care.
We work in community settings and manage most common illnesses, and provide preventative care and education for healthy living.
2. & 3. Adult and Paediatric
We work as part of a health care team in hospitals and home health care agencies, where we manage complex patient conditions.
This role will be introduced into Ontario’s health care system in the future.
1965 - first NP program established at the University of Colorado
1967 - first education program for NPs working in northern nursing stations began at Dalhousie University, Halifax, Nova Scotia
1971 - first university program in Ontario to prepare expanded role RNs
1973 - NPAO established as an affiliated Interest Group of the Registered Nurses Association of Ontario with the mandate to lobby for the PHCNP role
1973 - CNA/CMA Joint Committee releases joint policy statement on the role of the NP
1975 - Ontario Council of Health releases The Nurse Practitioner in Primary Care with recommendations about necessary legislative changes and remuneration issues
Early 1980s - first NP initiative ends because of:
perceived physician oversupply,
lack of remuneration mechanisms,
lack of legislation,
lack of public awareness regarding the role
lack of support from both medicine and nursing
1983 - last NP education program closes at McMaster University, Hamilton, Ontario
1988 - CNS-NP role implemented in Level 3 NICUs following reduction in number of Pediatric Residents
In spite of failure of the first initiative, NP role consistently cited in the recommendations of many provincial health care commissions and task forces
NPAO continues to actively lobby to re-establish educational programs in Ontario and for the recognition of the NP role as a viable member of the Ontario health care system.
1993 - Minister of Health and NDP government announce a new Nurse Practitioner Initiative as part of improving access to primary health care.
December 1994 - "Nurse Practitioners in Ontario: A Plan for their Education and Employment of NPs" is released with specific steps for implementation.
1994 - Council of Ontario University Programs in Nursing (COUPN) involving a consortium of 10 nursing faculties develops the new PHCNP Program
1995 (September) - the PHCNP education program begins
1996 - first graduates of the PHCNP program.
1997 (September) - University of Toronto, Masters of Nursing offers two program streams: Acute Care NP Adult Health and Acute Care NP Child Health
1998 Bill 127, the Expanded Nursing Services for Patients Act proclaimed
1998 – CNO accepts first registrants
1999 Minister of Health announces investment of $375 million in nursing, including 106 PHCNP positions:
80 in Underserviced Areas
20 positions in long term care homes
Experienced registered nurses with advanced university education who provide personalized, quality health care to patients.
provide a full range of health care services to individuals, families and communities.
provide comprehensive primary health care with a focus on health promotion and disease prevention .
practice in urban, rural and remote communities and in a wide variety of settings
Nurse Practitioners are not physician assistants or mini doctors, but are expert nurses functioning at an advanced practice level.
Are governed by the College of Nurses of Ontario
Are regulated by many different Acts
Have registration requirements including:
graduation from an accredited program
passing the provincial exam
review at 1800 hours or 1 year full time practice
provide comprehensive primary health care to a diverse population of patients
work in complementary and collaborative role with physicians
are authorized to communicate a diagnosis of disease or disorder
are able to prescribe a limited range of drugs (open prescribing)
Provide wellness care and health screening (e.g., pap smears, infant growth & development)
Diagnose and treat minor illnesses & injuries (e.g., strep throat, bladder infections, sprains, ear infections)
Screen for presence of chronic illness and monitor stable chronic illnesses (e.g., diabetes, asthma)
Collaboration is a cornerstone of NP practice
Interdisciplinary teams benefit patient care
each brings unique knowledge and skills
decreases duplication and fragmentation
increases patient access to medical care
NP led clinics – several NPs with fewer doctors – NPs see most patients, Doctor sees complicated cases and is available for consultation when needed
According to recent statistics, there were 800 primary health care NPs registered in the extended class and working in nursing in Ontario in 2007.
Nurse Practitioners work in a variety of settings such as
community health centers
urgent care centers
public health units
long-term care facilities
hospital in-patient and outpatient units
community mental health programs
social service agencies
aboriginal healing and wellness centers
NP’s provide high quality, comprehensive care
Collaborative models enhance delivery of care, increasing caseload by 25-50%
NP’s provide effective patient care coordination
NP’s provide patient choice and are demonstrated to have high patient satisfaction
NP’s are the most researched and evaluated health professional in Canada
NP’s decrease use and relieve burden for hospital emergency rooms
NP’s focus on health promotion and prevention with increased rates of:
-Risk factor screening
Healthy Patients = Less Utilization & Lower Costs
Lack of financial incentives for remote & rural placement
Salary inequities across different funding programs
Inconsistent funding for capital and operating costs across different funding programs
MD fee for service remuneration discourages effective role utilization
In order to support full utilization of the resources NP’s provide we need:
Primary health care reform that promotes interdisciplinary collaborative teams & comprehensive care
NP involvement in planning and delivery of primary health care services
Legislative and policy changes to remove barriers
Long term NP funding strategy as part of well thought through health human resource plan
flexible and supportive to a wide variety of settings
comprehensive and equitable
separate from MD funding
Changes in MD funding
alternate payment plans
compensation for consultation
change in specialist referral funding
Retention and recruitment strategies for remote and rural areas, under serviced populations
Introduce interdisciplinary collaborative education programs & education on collaborative practice for health professions
Broad based public education program to increase understanding and acceptance of the role
Full integration into primary health care delivery
Practice in interdisciplinary teams wherever primary health care is provided
Assist Canadians as individuals, families, groups and communities to attain and maintain optimal health
FHT’s provide a comprehensive range of primary care services
Care is provided by an interdisciplinary team of family doctors, NP’s, nurses, pharmacists, social workers, physiotherapists, psychologists, and dieticians
To help increase access to primary care and to be instrumental in providing preventative care which helps the community to be as healthy as possible. Through better access to care the NP aids in the prevention of illness and early detection and treatment of disease
Provides well baby/child assessments
Monitor clients with stable chronic illness (HTN, DM, asthma)
Does prenatal check ups (low risk pregnancies)
Just by performing annual physicals the NP can include health promotion, promote wellness and do appropriate screening for disease
New diagnosis diabetic – consult physician re med starts, referral to diabetes educators