Verberne Nurse Practitioner

RN(EC) is the protected credential in Ontario; Nurse Practitioner ( NP) is the commonly used term

1. 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 PaediatricWe work as part of a health care team in hospitals and home health care agencies, where we manage complex patient conditions.

4. Anaesthesia. 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

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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:

1) graduation from an accredited program

2) passing the provincial exam 3) review at 1800 hours or 1 year full

time practice

NP’s: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

NP’s :are able to prescribe a limited range of drugs (open prescribing)

Provide wellness care and health screening (e.g., pap smears, infant growth & development)

NP's: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 clinics urgent care centers public health units long-term care facilities hospital in-patient and outpatient units family practices FHNs hospital clinics ER’s CCAC’s 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:

-Immunizations-Mammography -Pap Screens

-Risk factor screening

Healthy Patients = Less Utilization & Lower Costs

Funding: 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 Gives immunizations 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

Well baby exam (development, safety, immun) Prescription renewal – check for screening Physical woman >50 90 year old “feeling tired” Elderly woman with “wobbles”, known TIAs Child with ear infection Review lab and test results Arrange U/S, x ray appts Do referral letters to specialists Call pts re test results and follow ups

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Eat a healthy diet Exercise Be nice to your family Wash your hands Get a flu shot

Get Screened

Mammogram PAP Diabetes Heart disease Colon Cancer Check

RNAO.org NPAO website

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