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By Linda Silas
Canadian Federation of Nurses Unions
and Ivy Lynn Bourgeault
University of Ottawa
You can be forgiven if you’ve never heard of nurse practitioners. Most Canadians haven’t – and most don’t know their value to our health-care system.
You may be even more surprised to learn that nurse practitioners could be the innovative solution – or at least a critical part of the solution – to Canada’s ongoing health-care woes.
Traditional wisdom holds that Canada needs more doctors to ensure timely access to health services. Yet the increase in the supply of doctors in Canada has outpaced Canada’s population growth for a decade. Still, we continue to hear stories about Canadians without access to a family doctor.
Canada routinely underperforms in international surveys of timely access to primary health care, such as access to a family doctor. When this happens, patients often rely on the more expensive health services provided in our acute care system, arriving in hospital emergency rooms. As a result, our acute care facilities are stretched to capacity.
What’s the solution?
Recent history offers potential lessons.
In response to a perceived doctor shortage in the early 1980s, the Canada Health Act was amended so provinces could allow nurses to practise medicine as nurse practitioners. Nurse practitioners are highly-skilled health-care professionals with advanced education. They can diagnose, treat, prescribe medications, order tests, offer referrals and admit or discharge patients.
Nurse practitioners also often go beyond traditional medical care models to provide holistic health promotion and illness prevention through patient education.
In short, they’re very effective.
Decades of rigorous evidence shows that nurse practitioners improve access to personalized, cost-effective, high-quality health care that reduces wait times and costs throughout the broader health system.
This patient-centred approach is well-suited to address multiple and ongoing health conditions. Nurse practitioners are especially critical for providing health services among Canada’s growing population of seniors, Indigenous peoples and those in rural and remote locations.
We aren’t the first country to innovate this way.
The United States began integrating nurse practitioners intensively following the creation of an education program in 1965. Through a concerted effort, the number of nurse practitioners doubled over a decade; there are now more than 248,000 licensed nurse practitioners in the U.S.
In contrast, the path towards the integration and expansion of nurse practitioners in Canada’s health system has been rocky. To find answers, the Canadian Federation of Nurses Unions (CFNU) recently conducted the largest survey of nurse practitioners across Canada.
The results were illuminating – and disappointing.
We found that even though nurse practitioners have the potential to address pressing health access issues, they are largely absent or under-utilized in most parts of Canada.
Barriers due to government legislative, regulatory and policy restrictions, along with financing, funding and reimbursement issues are challenges to the widespread use of nurse practitioners across the country. There is also opposition from certain interest groups, and there are challenges in uptake at the organizational level.
Perhaps, most critically, Canada has a supply of only 14 nurse practitioners per 100,000 Canadians compared to 76 per 100,000 Americans. And more than half of nurse practitioners work only in Ontario – meaning most of the country is missing out.
We’re failing to take advantage of the capacity of nurse practitioners to improve health access and reduce costs across the system.
The buzzword in health care is innovation. Often we look to new high-tech devices and computer applications. But nurse practitioners are a long-standing health care innovation that has repeatedly proven its worth. It’s time for implementation.
There are a few excellent examples that could be scaled up across the country.
Manitoba’s Mobile Clinics, in which nurse practitioners and registered nurses provide on-the-spot primary care for people living in smaller, underserved communities, provide an excellent model. Ontario’s nurse practitioner-led clinics, as well community health centre models utilizing nurse practitioners, are leading practices that could be readily implemented nationwide.
Nurse practitioners represent an innovative opportunity for Canada to address our growing health-care needs, especially within underserved populations, communities and settings.
It’s time for governments and employers to get on-board and remove the remaining obstacles for utilizing nurse practitioners.
We should be investing in the full range of primary health-care services to increase access for all Canadians.
Linda Silas is a nurse and has been the president of the 200,000-member Canadian Federation of Nurses Unions (CFNU) since 2003. Ivy Lynn Bourgeault is CIHR chair in Gender, Work and Health at the University of Ottawa and the lead of the Empowering Women Leaders in Health project.
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