2024 Pre-Budget Written Submission

Summary of NPAO Recommendations:
1) Integrate Nurse Practitioners Across the Health System and Sectors
through Adequate Compensation and Funding Models
2) Support Nurse Practitioners in the Delivery of Quality Long-Term Care
3) Support Ontarians by Adapting Nurse Practitioner Funding Models to
Include Mental Health Care

Recommendation One: Integrate Nurse Practitioners Across the Health System and Sectors Through Adequate Compensation and Funding Models

Nurse Practitioners (NPs) perform crucial work that can address the healthcare crisis. They address all core areas of patient care, including: autonomously assessing, diagnosing, treating, admitting, and discharging patients, and also ordering tests, prescribing medications, providing MAID, and referring to specialists. NPAO recommends that the 2024 Ontario Budget include solutions that integrate and sustain NPs through adequate compensation and funding models that address the HHR and access obstacles. Despite NPs ability and willingness to fill healthcare gaps and improve health outcomes, they remain widely underutilized. The existing lack of appropriate flexible funding models limits the number of public positions and settings, preventing NPs from practicing where they are needed most, and pushes many to work in private clinics where they can serve their communities according to their needs and demands.

Public sector compensation for Nurse Practitioners must be increased to boost respect, retention and harmonization. The current public payscale fails to reflect the fact that NPs are highly trained and educated professionals, with extensive experience as clinicians, leaders, educators and preceptors. This results in significant wage disparity, pay inequity and sector instability, challenging vacancy rates, recruitment and retention of NPs in primary, secondary and tertiary care. Bill 124 has widespread NP compensation impacts. Funding rates for NPs in Nurse Practitioner-Led Clinics (NPLCs) have not been adjusted since 2020, impacting the 25 NPLCs serving over 100,000 Ontarians. Salaries for community NPs are funded at the maximum rate of $122,200, which is 15% less than the recommended 2017 rate, and nearly 17% less than the 2023 rate. An 11% increase awarded to hospital NPs widens the compensation gap, as well as the lack of flexible funding to address NPs inability to bill care, similarly to physician care.

Ontarians suffer when the public healthcare system cannot retain professional talent. Updated funding models and improved compensation are critical, both for the livelihood of Nurse Practitioners and for the health and well-being of their patients. NPAO recommends salary harmonization across all sectors to retain and recruit NP talent where they are needed most.

Recommendation Two: Support Nurse Practitioners in the Delivery of Quality Long-Term Care

Nurse Practitioners play a pivotal role in Long-Term Care. NPAO recommends that the 2024 Ontario Budget includes funding to support Nurse Practitioners in the delivery of quality long-term care to Ontario’s aging population.

Notwithstanding their outstanding contribution to patient care, Nurse Practitioners compensation in long term care settings is not competitive, which creates challenges in recruitment and retention. Ontarians in long-term care homes suffered greatly during the pandemic as a result of lack of access to care and healthcare labour shortages. These shortages continue to affect delivery of care. Nurse Practitioners’ broad scope of work, extensive education, and vast experience allows them to fill these gaps, and bring much needed, high-quality, and timely medical care into these environments.

Nurse Practitioners are poised to improve the quality of life of long-term care residents. They are authorized to be Attending Practitioners, they admit, diagnose, order tests and treatments and issue prescriptions without requiring patients to be moved to emergency rooms where their health and care plans can increase their risk and not respect their wishes. NPs are also authorized to deliver behavioural supports, pain and symptom management, palliative care, and assess and provide MAID services to Ontarians who seek end of-life care. Leveraging Nurse Practitioners in long-term care settings ensures Ontarians can age with grace and dignity and support building team capacity. NPs also served as Medical Directors during COVID and provided in-person continuity of care.

Additional funding must be made available to support Nurse Practitioners in long-term care delivery. Improving funding models will allow long-term care homes to bring quality medical and nursing holistic care and deliver the care residents, families, care teams and Ontarians deserve.

Recommendation Three: Support Ontarians by Adapting Nurse Practitioner Funding Models to Include Mental Health Care

Demand for Mental Health Care is rising. NPAO recommends that the Ontario 2024 budget include provisions that support Ontarians by adapting Nurse Practitioners funding models to include mental health care.

Nurse Practitioners focus on a comprehensive approach to care that encompasses all aspects of patients’ health and well-being; they work with a prevention and health promotion focus, coupling an holistic approach with medical knowledge that sets them apart from other primary care providers.

As part of this comprehensive approach to care, Nurse Practitioners can support Ontarians with access to mental health care directly in their communities. Currently, however, Nurse Practitioners are not compensated for this additional service delivery. Improving funding models to address and correct this will reduce barriers to mental health care in Ontario, connecting those in need with professionals who can help. Physical and psychological access to health care is vital.

As of January 2024 Ontario could benefit from enabling, empowering, optimizing and leveraging the 5039 Nurse Practitioners’ as a health workforce solution.

About NPAO

Established in 1973, NPAO works to represent Nurse Practitioners in primary, secondary, and tertiary healthcare settings in Ontario. As Nurse Practitioners speaking for Nurse Practitioners, we strive to deliver exceptional healthcare for all, grounded in the belief that Nurse Practitioners make critical contributions to healthcare systems, and Ontarians’ quality of life.

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