Heather Whittle RN (EC) NP - Adult, MScN, and Joan Mitchell RN (EC) NP – PHC on behalf of Nurse Practitioners’ Association of Ontario Interest Group
A day in the life
You flip on your office light switch. You turn on your computer. You say ‘good morning’ to your colleagues. Today’s Electronic Medical Record (EMR) schedule of 10 patient appointments ‘so far’ is loaded and you ‘smile’ as you see some familiar names and ‘wonder’ when you see a few new ones. You review today’s lab results and make a mental note of those you will telephone later to inform them that yesterday’s diagnosis was confirmed and to see how they are doing today. You sign off most of your lab reports with a sense of satisfaction when targets are met and normal results are revealed
It is now 0900. Your first patient has signed in and you are ready. You see a six month old baby for her well baby exam complete with immunizations, a middle age gentleman for his quarterly diabetes and another for his blood pressure check, a 23 year old with a urinary tract infection, a 27 year old who wants to try to stop smoking, a worried 36 year old teacher with cough for a day, an elderly woman brought in by her daughter who is concerned about her Mom’s memory, a 16 year old who is afraid she is pregnant, a 49 year old for a complete physical who is unsure if she can tolerate more hot flashes, a 10 year old soccer player who went over on his ankle last night at practice and a 59 year old female former smoker sent to you for spirometry. You see a new rash which you consult your physician partner about since you want to confirm your diagnosis and treatment plan. Amidst listening to updates of each of these patients’ lives and getting to know those you were just meeting, you assess and manage their presenting health issue and are vigilant for any other concerning issues. You look for opportunities to provide counseling on lifestyle issues with close attention to socio-economic status and other social determinants of health, which contribute to overall health now or in the future. You screen according to Best Practice Guidelines and offer supportive and health promotion-based counseling whenever you can. You document after each patient encounter, try being comprehensive and concise! You recheck your labs results and emails, call the pharmacy with the prescriptions, and then review your diagnostic reports. You telephone your patients in follow up and ‘feel good inside’ when you hear that heartfelt ‘Thanks so much for calling. I feel so much better now’.
You shut off your computer. You flip off your office light switch. You smile as you reflect with satisfaction that your patients today have provided you with the variety and challenge that you love about being a Primary Health Care Nurse Practitioner.
In 1965, education programs were developed in the United States, focusing on NP practice in remote or underserviced areas. In the 1970’s, several educational programs were developed in Canada. In Ontario, the role declined due to lack of funding and legislative support. Political interest in the role in primary care resurfaced in the early 1990s. Education programs for NPs in primary care were introduced. The Expanded Nursing Services for Patients Act was proclaimed in 1998. This legislation enabled the College of Nurses of Ontario (CNO) to establish the Registered Nurse in the Extended Class - RN (EC) category.
The Ontario Primary Health Care Nurse Practitioner (PHC NP) program was established in 1995. It is offered by a consortium of universities. There are two programs offered: (1) NP certificate program (Post-Baccalaureate or (2) MN/NP (Masters in Nursing/Nurse Practitioner Certificate). Graduates are eligible to write the extended class registration exam. Graduates from other programs or the United States may also be eligible to write the extended class registration exam. Please see the educational requirements at www.cno.org.
Scope of Practice
The scope of practice of the NP – PHC includes independent authority for the controlled acts authorized to nurses registered in the general class: performing prescribed procedures below the dermis/mucous membrane, administering substances by injection or inhalation and inserting an instrument, hand or finger into a natural or artificial body orifice.
In addition the Expanded Nursing Services for Patients Act authorized additional controlled acts to NPs – PHC: communicating a diagnosis, ordering a form of energy (such as ultrasounds), prescribing a drug, ordering specified x-rays, and ordering specified lab tests.
The Regulated Health Professions Statute Law Amendment Act now authorizes three additional controlled acts to NPs:
(1) dispensing, compounding, or selling a drug in accordance with regulations,
(2) applying a prescribed form of energy, and
(3) setting or casting a fracture of a bone or dislocation of a joint. As well, additional authorities will include broadly prescribing drugs in accordance with the regulations (removal of drug lists) and removal of restrictions on certain types of x-rays to order.
NPs – PHC work in both rural and urban settings. These settings include family health teams, community health centres, nurse practitioner-led clinics, emergency and outpatient departments, home health care agencies, and long term care homes. There are Nurse Practitioner-Led Clinics open across the province, with a total of 26 in operation at the end of 2012.
Nurse Practitioners who are RNAO members are automatically eligible for liability protection through Canadian Nurses’ Protective Society (CNPS).
Currently there are over 1500 NPs entitled to practise in the NP-Primary Health Care specialty in Ontario.