Ministry Reports

Report on the Integration of Primary Health Care Nurse Practitioners into the Province of Ontario

Revised : January, 2005


Background

In Ontario, the term NP is used interchangeably to describe a number of advanced practice nursing roles, such as primary health care NPs and acute care NPs . In this report, the term NP refers specifically to primary health care NPs who are registered in the extended class (RN[EC]) with the College of Nurses of Ontario.

In 1998, the Expanded Nursing Services for Patients Act amended the Regulated Health Professions Act and Nursing Act (as well as other legislation) to provide NPs in the province of Ontario with an expanded scope of practice. With these amendments, NPs registered in the College of Nurses' “extended class” have the authority to communicate a diagnosis, order specified tests such as diagnostic ultrasound or x-rays, order electrocardiograms in non-acute circumstances, prescribe and administer specified drugs and order specified laboratory tests. Pursuant to the Expanded Nursing Services for Patients Act, the College of Nurses of Ontario regulates the NP scope of practice.

Since 1998, 402 NP positions have been funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC) in Community Health Centres, the Underserviced Area Program, long-term care facilities, Aboriginal Health Access Centres, Primary Care Networks and Public Health Units. The following are the major funding initiatives related to these positions :

  • 1998 - 22.5 new positions were created in Community Health Centres and 90.5 nursing positions in Community Health Centres and Aboriginal Health Access Centres were upgraded to NP positions;
  • 1999 - 107 positions were created in the Underserviced Area Program, Aboriginal Health Access Centres, long-term care facilities and Primary Care Networks;
  • 2000 - 5 positions were created in Public Health Units in the Cervical Cancer Screening Program;
  • 2001 - 10 positions were created in Public Health Units in the Early Childhood Development Pre and Post Natal Program;
  • 2002 - 20 positions were created for demonstration projects in communities that have limited access to family physicians; and
  • 2002 - funding for 117 positions in underserviced communities was announced.

In addition to these major funding initiatives, 30 NP positions have been funded since 1998 in Community Health Centres and Health Service Organizations.

The MOHLTC is committed to creating an additional 348 NP positions over the next three years. In addition, the government invests $1.7 million annually for the NP education program.

Objectives of the Study

The primary focus of the Primary Health Care NP Integration Study was to determine how best to integrate primary health care NPs into Ontario's health care system and specifically into various practice settings. The key questions to be answered by the study were :

  1. What barriers must be overcome and what facilitators must be encouraged to further integrate NPs into specific practice settings?
  2. What can be learned about the practice models in which NPs function; specifically, which models do not work well and why and which models work best to support integration of NPs ?

The complete Report and Appendices are available for download at the links below.

Read the Speech by the Minister of Health and Long-Term Care, George Smitherman, which was presented at the Nurse Practitioner Research and Professional Practice Conference on January 30, 2004.

Document Download

Executive Summary
32 pages | 128 k | PDFformat

Full Report
Report on the Integration of Primary Health Care Nurse Practitioners into the Province of Ontario
278 pages | 1.63 Mb | PDF format

Report Cover
2 pages | 35 kb | PDF format

Appendices

Appendices Dividers
14 pages | 58 kb | PDF format

Appendix A :
Abbreviations
10 pages | 1 kb | PDF format

Appendix B :
Canadian Literature
25 pages | 157 kb | PDF format

Appendix C :
International Literature
21 pages | 126 kb | PDF format

Appendix D :
- Primary Health Care Nurse Practitioner Survey
20 pages | 122 kb | PDF format
- IBM NP Letter
2 pages | 1.6 Mb | PDF format

Appendix E :
- Primary Care Physician Survey - Role of Nurse Practitioners : Survey A
8 pages | 74 kb | PDF format
- MDs cover letter for Survey A
2 pages | 43 kb | PDF format

Appendix F :
- Primary Care Physician General Survey : Survey B
2 pages | 43 kb | PDF format
- MDs cover letter for Survey B
4 pages | 41 kb | PDF format

Appendix G :
List of Variables Tested in Regression Analysis
1 page | 9.7 kb | PDF format

Appendix H :
Site Visit Interview Guides
14 pages | 71 kb | PDF format

Appendix I :
Patient Survey
English
4 pages | 40 kb | PDF format
French
4 pages | 42 kb | PDF format

Information for Survey Participants for
the Nurse Practitioner Integration Study
English
3 pages | 40 kb | PDF format
French
3 pages | 41 kb | PDF format

NP Patient Survey Cover Letter
English
2 pages | 26 kb | PDF format
French
2 pages | 24 kb | PDF format

Appendix J :
Summary of NP Practice Dimensions and Elements
1 page | 57 kb | PDF format

Appendix K :
List of Steering Committee Members
3 pages | 14 kb | PDF format

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