Nurse Practitioner – Adult

Heather Whittle RN (EC) NP - Adult), MScN, on behalf of Nurse Practitioners’ Association of Ontario Interest Group

A day in the life

You arrive at your desk and greet your colleagues. As a Nurse Practitioner (NP) - Adult on the Geriatric Consultation service in an academic health center, you know you will have a busy day. You pull up your patient list from the electronic record and add any new consults which have arrived overnight. Then you check today’s lab results to see how your patients are doing. After a quick check of your e-mail, you are off to the inpatient units.

As the day progresses, you have two new geriatric consults to complete. One patient is an 86 year old lady with delirium after a fall and fractured hip. The other patient is a 72 year old man with suspected depression after a long and complicated hospital admission. As you complete the comprehensive geriatric assessments on both patients, you remain flexible, as you know you may be interrupted so that required tests or procedures can be completed. During a free moment, you contact the patients’ pharmacy to clarify their current medication regimens. As you develop a plan of care for each patient, you utilize Best Practice Guidelines to ensure your patients’ are receiving optimal care. You then document the suggested plan of care for the consulting team to review.

There are also a number of patients, previously assessed, to be reviewed to evaluate the results of your plan of care. You speak with the social worker about the homeless patient’s discharge destination, review the notes from the speech-language pathologist regarding the patient with aspiration pneumonia, and liaise with the nurse clinician from geriatric rehabilitation to see which of your patients might benefit from a stay on the rehab unit. The social worker from vascular surgery asks you to attend a family meeting to discuss the goals of care for an elderly patient whose prognosis is not good. Before you know it, the day is done. The role of an NP – Adult in acute care is varied and challenging, and you know that you are making a difference in the lives of your patients, so you look forward to the morning with anticipation.

Background

In 1965, education programs were developed in the United States, focusing on NP practice in remote or underserviced areas. In the 1970’s, several NP 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 1990’s. 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. In 1999 Post-Masters Acute Care Nurse Practitioner (ACNP) courses were established at the University of Toronto and the University of Western Ontario in response to an identified need for the role in teaching hospitals. In 2006, the College of Nurses of Ontario moved to protect the title of Nurse Practitioner. Since then advanced practice nurses in acute care have been required to write an examination in order to be registered in the extended class as an NP – Adult.

Specialty Education

The NP – Adult preparation is at the Masters level. The required education focuses on areas of practice such as advanced clinical knowledge, research, and leadership.

Scope of Practice

The scope of practice of the NP – Adult 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 – Adult: 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 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.

Enhancements to the Public Hospitals Act permit NPs to practice to their full practise scope in inpatient settings. Changes to Regulation 965 allow NPs to treat and discharge inpatients as of July 1, 2011, and to admit and treat inpatients as of July 1, 2012.

Practice Environment

NPs – Adult practise in specialty areas with specific patient populations. These NPs provide care in both inpatient and outpatient settings including cardiology, neurology, critical care, oncology, geriatrics and palliative care. They work collaboratively with physicians and other members of the health care team.

Liability Protection

NPs who are RNAO members are automatically eligible for liability protection through Canadian Nurses’ Protective Society (CNPS).

Current Status

1) To date there are over 400 NPs entitled to practise in the NP – Adult extended class specialty with the College of Nurses of Ontario (CNO).

Links

Nurse Practitioners’ Association of Ontario: www.npao.org
Canadian Association of Advanced Practice Nurses: www.caapn.com

References

1 www.npao.org
2 www.cno.org