While many people believe Nurse Practitioners (NPs) are relatively new to the Ontario health care scene, they have been providing exemplary care to patients for over 40 years. As this year marks the fortieth anniversary of the Nurse Practitioners’ Association of Ontario (NPAO), it’s fitting to look back and remember where we came from and where we are now.
The seventies were a time of great need in Ontario in terms of access to healthcare. Many northern and remote areas struggled to find physicians. NPs were already integrated in the American health care system at that time, and were known to be highly effective at improving access for vulnerable patients and improving health outcomes. Using the model of the NP as a physician replacement, the role of the NP in Ontario was enabled to expand the scope of practice of Registered Nurses to provide care in these remote and under-serviced communities, as well as in pediatric intensive care units.
The first educational program for NPs was established in Ontario soon after and continued until 1983, with approximately 250 NPs graduating from the program. As a result of the increased number of seats made available in medical schools in the seventies, the physician shortage which initially spawned the NP role was no longer relevant, and the NP program was closed in 1983. However, those NP graduates continued to work in the role, quietly providing the advanced nursing care patients needed.
In 1993, then Minister of Health Ruth Grier announced a significant strategy for primary health care reform. She herself received primary healthcare from one of the initial group of 250 Nurse Practitioners at a local community health centre, and was aware of the impact NPs could have. In 1995, the NP university program was re-established, followed in 1998 by the Expanded Nursing Service for Patients Act , which gave NPs access to three additional controlled acts – communicating a diagnosis, ordering from a list of drugs, and ordering certain laboratory tests, xrays, and ultrasounds.
As more NPs entered the workforce, they were able to act as preceptors for NP students, thereby enabling socialization into this advanced nursing role. As the impact of NP practice began to spread across the province, changes to legislation and regulation continued to facilitate the full scope of practice. Most recently, legislative changes have enabled NPs to admit, treat, and discharge patients from hospital. Patients have also benefitted from the removal of a list-based approach to the ordering of laboratory tests, and are awaiting final proclamation of the legislation which removes the barrier of ordering diagnostic tests from a specified list. From that initial group of 250 NPs, Ontario now boasts over 2300 NPs, representing two thirds of all NPs in Canada.
In order to prepare experienced Registered Nurses for the NP role, the NP education programs focus on those aspects of advanced NP practice which are in addition to those gained in the baccalaureate nursing programs. Following successful completion of a Primary Health Care, Adult, or Pediatric NP program RNs are required by the College of Nurses of Ontario (CNO) to pass the provincial NP registration exam.
The NP role represents a return to the roots of nursing care, and while not a replacement for the medical model, is ideally suited to break down the barrier of access to healthcare across all sectors. As organized healthcare became more dominated by a model which did not fully support the nursing role, patients lost the benefit of the evolution of nursing knowledge and research.
Fortunately, we are coming full circle with the NP role, by enabling Nurse Practitioners to practice to the full extent of their nursing knowledge, skill, and judgement and supporting professional development with a variety of educational opportunities. As a result, patients in all practice settings are working with NPs to maintain their health, and manage and treat their health conditions. Patients are not only receiving information on medications and diagnostics testing, but are also benefitting from advanced nursing knowledge regarding behavioural and emotional responses to health and illness and ongoing, individualized support in the context of their lives.
For more information on the evolution of the Nurse Practitioner role and education program in Ontario, you can view NPAO’s 40th anniversary video here