Nurse Practitioners in Canada: A Few Steps Forward

As of this month Canada joined the small number of countries across the globe that have legalized assisted suicide.  The regulation titled “Medical Assistance in Dying” was hotly debated by the public, media, and all levels of federal government. In this way the legislation wasn’t different from any that are closely tied to personal values and ethical viewpoints.  However, one very significant difference in this law was that it specifically identified not only physicians, but also nurse practitioners (NPs) as the health care providers who may implement assistance in dying.  As an NP and the President of the Canadian Association of Advanced Practice Nurses, representing NPs in Canada, I was very excited that NPs were finally being recognized for the autonomous and comprehensive care.

Nurse practitioners are advanced practice nurses who have completed graduate education and written a licensing exam. So, unlike some APN roles and unlike some countries, in Canada NP’s licence to practice is separate from that of the RN.  NPs have been practicing in Canada for over 40 years, but regulation within each jurisdiction (provinces and territories) commenced in Ontario in 1998 and NPs are now regulated across Canada.

Nurse Practitioners are fully autonomous health care providers which means that we conduct physical assessment, order diagnostic tests, diagnose conditions and prescribe medication and other treatments for our patients independently, without physician supervision.  Our scope of practice in every province and territory is the same. We implement research evidence into our practice and to ensure the care we provide is patient directed- not just the treatment of the disease.  Nurse practitioners practice in all settings and with all types of patients – primary care clinics, hospital settings, home care, palliative care, First Nations Communities.  Nurse practitioners often work with vulnerable patients and in locations where they are the only access to health care, such as nursing stations in rural and remote areas.

Study after study demonstrates nurse practitioner practice results in positive health outcomes such as reduction in blood pressure for a person with a diagnosis of hypertension or improved blood sugar control in a person with diabetes.  Patient satisfaction is high with NP care and studies show that NPs enable better self -care for conditions such as mental health, diabetes, breathing disorders and high blood pressure.

Despite the success of the NP role, it hasn’t been without difficulties.  There have been, and continue to be, ongoing barriers to practice which have the potential to reduce access to all care for our patients. The Canadian Association of Advanced Practice Nurses was invited to present to the Justice Committee and to the Senate with respect to the legislation.  We submitted a brief related to wording and specific issues in the proposed regulation and sent a message to each Member of Parliament and Senator by email.  Despite this, an amendment was put forward by a senator that wasn’t related to the criteria or process of assisted dying, but rather related to NP scope of practice.  The amendment, although rejected, would essentially have restricted NP’s scope of practice by requiring them to be supervised by a physician. Our concern was for patients of NPs and access to care, so there was relief when the amendment was rejected.

The issue is bigger than this legislation. There is a need for ongoing marketing of the NP role, both with legislators and the public so that NP practice is understood and the value of NPs in health care is well known.  NPs will have to continue to advocate for our patients to ensure that they are able to receive comprehensive care.  However, this isn’t a time for pessimism. Although there were hiccups in the process, NPs inclusion in the bill for medical assistance in dying was an important step in the recognition of the role of the NP in Canadian healthcare and we’re excited to see what happens next.


Roberta Heale, President of the Canadian Association of Advanced Practice Nurses, Associate Editor Evidence Based Nursing  @robertaheale  @EBNursingBMJ

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