RNAO’s NP Task Force releases groundbreaking report – Vision for Tomorrow
On Feb. 25, RNAO’s NP Task Force released the groundbreaking report, Vision for Tomorrow, which brings to life not only the evidence on why NPs are crucial in our health-care system, but also the lived experiences of those NPs who are already making a difference to patient outcomes in their day-to-day practice. It is a comprehensive blueprint that calls for the NP role to be expanded and to fully utilize NPs to advance the health of Ontarians and strengthen the health system. Overall, it calls for the supply of NPs in Ontario to increase by 1,875 (or more than 50 per cent) by 2030. This increase is necessary just to address the specific needs of vulnerable and underserved populations.
Vision for Tomorrow includes eight recommendations, and each comes with specific calls to action aimed at the government and other partners. The recommendations include:
- Increase the supply of NPs across all sectors and settings.
- Optimize the utilization of NPs within current scope.
- Expand the scope of practice for NPs.
- Align NP curriculum with expanding scope of practice.
- Harmonize NP compensation across all sectors and settings.
- Invest in research to support NP practice and improved health outcomes.
- Optimize access and continuity of care by ensuring all insurance benefit carriers, and other such payers, accept NP services analogous to physician counterparts.
- Showcase impact of NPs through public education campaigns to advance full utilization of NPs across all sectors and settings.
“NPs are a resource for our health system and their role has evolved thanks to our advocacy. However, if we are serious about health-system transformation and integration, there is much more we must do so more Ontarians benefit from their expert care,” says task force co-chair and RNAO CEO Dr. Doris Grinspun. “NPs are key to delivering on the Quadruple Aim, which seeks to improve the patient care experience, improve health outcomes, improve the care provider’s experience, and reduce health costs. This is front-and-centre in our report and our recommendations.”
The significance of the Vision for Tomorrow report is that its impact extends beyond Ontario and even beyond Canadian borders.
“With a framework grounded in the Quadruple Aim concept and the report’s attention to the United Nations’ Sustainable Development Goals, which strive to end poverty, protect the planet and ensure people’s well-being, I am confident the report will have far-reaching impact,” says Dr. Elissa Ladd, co-chair of the task force and director of Global Health Equity and Innovations at the MGH Institute of Health Professions in Boston. Ladd also serves as a deputy director of the International Council of Nurses’ Nurse Practitioner/Advanced Practice Nurse Network Global Research Academy.
For the release of this report, RNAO invited NPs and task force members to be part of an informative panel discussion. Each spoke of their respective work and impact in primary care, long-term care (LTC), acute care and Indigenous communities.
COVID-19 has underlined the need for the Ontario government to ensure NPs are utilized to their full potential for the benefit of patients and overall population health. The pandemic has compounded the health impacts of poverty and growing inequities in communities across the province. NPs who are already making a difference in this sector include task force member Tara Leach, who is an NP and founder of an Ottawa clinic that provides trauma-informed care to those who experience sexual exploitation, coercion and/or human trafficking. She spoke on behalf of primary care NPs during the Feb. 25 panel discussion, sharing details of how she and her NP colleagues in this sector are a safety net, ensuring timely assessment, diagnosis, treatment, prescriptions, referrals and follow-up for marginalized, vulnerable and underserved populations.
The impact of COVID-19 on the province’s LTC sector is staggering. A record number of residents have died. They are victims of long-standing severe staffing shortages and systemic issues that could be addressed with better utilization of the education, competencies and skills of NPs. Priya Shah, an NP and member of a nurse-led outreach team for the Hamilton Niagara Haldimand Brant Local Health Integration Network, represented LTC NPs during the panel discussion. She spoke about her role in preventing unnecessary emergency department visits and hospital admissions for the elderly population in LTC. She also addressed the vital working relationship she has with attending NPs in LTC who are most responsible provider for this population.
In acute care, NPs have legislative authority to: admit, diagnose, treat, transfer and discharge patients; order diagnostic tests; prescribe medications; and more. Yet, significant roadblocks still stand in their way, preventing them from unleashing their full potential to benefit Ontarians and health-system effectiveness.
Task force member Suzanne Robichaud, VP of clinical services and chief nursing executive for Hôpital Montfort, spoke to the role of NPs in acute care, and how more are required to adequately care for frequent users in hospitals and those with complex medical needs. Fully engaged NPs in acute care can be effective recruiters for the role, and preceptors for student NPs, she said.
Such leadership is vital in all sectors, and it is particularly important in rural and remote Indigenous communities, according to task force member Dr. Victoria Smye, director and associate professor at the Arthur Labatt Family School of Nursing, Western University, London. She spoke about the need to align NP curriculum with expanding scope of practice, and securing more preceptors and more diverse placements available to NP students. Academic institutions have a lot of work to do to engage with Indigenous communities so NP students are better prepared to provide equity-oriented, trauma-informed, culturally safe care in these communities.
When it comes to the sheer number of NPs, Canada and Ontario also have a lot of catching up to do compared with the U.S., which boasts 61.1 NPs per 100,000 people. In contrast, Canada has 15.3 NPs per 100,000. Ontario is only slightly higher at 22.5 NPs per 100,000. Currently, there are 3,426 NPs practising in primary care, acute care and LTC in the province. As stated above, the report calls for an additional 1,875 NPs by 2030 – just to address the needs of vulnerable and underserved populations.
“This Vision for Tomorrow report marks the end of one phase, but the beginning of a set of actions,” Grinspun says. “Task force members will now take on an advisory role, meeting once or twice a year as we advocate to see each of these recommendations come to fruition. NPs and their patients are waiting and they deserve to see each one of these recommendations and companion actions come to life.”
Read the full report for more detailed analysis and next steps.