Funding, Hiring and Compensation for Nurse Practitioners

Introduction:

The Nurse Practitioners’ Association of Ontario (NPAO) frequently receives questions from physicians, health care organizations, Nurse Practitioners (NPs), students, researchers and others about the hiring of NPs, funding of NP positions, how NPs are paid, and what services NPs are permitted to provide, among others.

To address these questions, NPAO has developed these Frequently Asked Questions (FAQs).

If additional information is required please email NPAO at admin@npao.org or call 416- 593-9779

NPs can work on their own and do not need to be supervised by a physician to practice. NPs have an autonomous scope of practice, but typically work in collaboration with physicians and other health care professionals. See the College of Nurses of Ontario’s (CNO’s) Practice Standard: Nurse Practitioners for more information at https://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf

NPs are usually graduate-prepared RNs and are registered in the Extended Class by CNO. NPs work in a variety of practice settings including in the community, hospitals and long-term care and across age groups.

In Ontario, NPs are authorized under legislation and regulations to independently:

Complete a comprehensive health history and assessment;
Formulate and communicate a diagnosis, taking a differential diagnosis into consideration;
Prescribe all medications including controlled drugs and substances;
Dispense, sell, and compound medications;
Set and cast fractures and dislocated joints;
Order and interpret all laboratory tests;
Admit, treat and discharge patients from hospitals;
Order some diagnostic imaging tests; and
Consult with and refer directly to specialists.

For more information about NP scope of practice visit the following CNO website: http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/nurse-practitioners/

Thank you for your interest in finding an NP as a primary health care provider! The Ministry of Health and Long Term Care currently funds several different types of organizations that employ NPs. We can recommend several strategies to help you identify the organizations in your area that might employ NPs and may be taking patients. While we cannot guarantee that these strategies will locate an NP, you can try to locate an NP through:

1. Health Care Connect (MOHLTC)

The Ministry of Health and Long-Term Care (MOHLTC) has established Health Care Connect to provide the public with information on health care services in their communities. Click on the Health Care Connect link, then click on medical service directory and scroll to the bottom to agree to the terms of use. At the next screen click Family Health Teams, Community Health Centres and Nurse Practitioner Led Clinics. You can limit the search by distance using your postal code.

Health Care Connect offers another service for patients who do not have a primary health care provider (e.g., a family physician or a nurse practitioner). You can register with HCC and complete a health status review which will determine your priority. The HCC nurse will work to find you a health care provider. Again you are not guaranteed a nurse practitioner.

2. CNO Nurse Registry

The College of Nurses of Ontario offers a searchable database of nurses, and can be accessed by visiting: registry.cno.org/Search/Search

3. The Association of Community Health Centres (CHC)

Another website is the Association of Community Health Centres. CHCs employ NPs and physicians and provide health care to communities. You can use your postal code to access a list of CHCs in your area.

4. NP-Led Clinics and Family Health Teams

By the end of 2011, a total of 26 nurse practitioner led clinics (NPLCs) and 50 new family health teams (FHTs) will have opened across Ontario. The NPLCs will accept patients who do not currently have a primary care provider. FHTs will retain their current patients and, where feasible, will add patients with the intent of also taking unattached patients. To learn more about where these new clinics will be located, go to:

NPs are not paid in the same way as most physicians. NPs do not bill OHIP for the services they provide.

The vast majority of NPs in Ontario are paid by salary. NPs who are employed typically receive a compensation package which includes salary and benefits. Some NPs work as independent contractors, billing the organization based on an hourly or daily rate.

In some instances, NPs may bill patients from out-of-country for health services if they are not eligible for OHIP coverage. NPs may also bill patients directly for medically necessary services as well as non-health care services such as sick notes.

NPs may also be reimbursed for the completion of certain forms (e.g., WSIB, special diet allowance form, etc.) and may receive a stipend for preceptoring a student. Depending on organizational policy, the NP may be permitted to keep such compensation. NPs who are independent contractors keep the compensation.

The majority of NPs in Ontario are salaried. According to CNO, NPs are permitted to collect payments or charge fees for the completion of forms and letters, etc., as long as there is no conflict of interest. CNO advises that to reduce the risk of conflict that the NP work with their employer to ensure policies are in place to provide guidance regarding the collection of payments or fees for these types of services. If no policies are in place, NPs are encouraged to keep a record of any discussions held with their employer about fees.

NPAO encourages NPs to refer to the CNO website for practice resources related to charging fees (See http://www.cno.org/np – NP Practice Q & A, General). In addition, refer to CNO’s Professional Misconduct document for more information about professional accountabilities of NPs when charging fees.

NPs are assigned an OHIP registration numbers for the purposes of referring a patient to a specialist, and ordering laboratory tests and certain diagnostic imaging tests (e.g., mammography). These tests can be claimed by the physician who interprets the test. However, NPs cannot bill OHIP for services such as assessment, diagnosis and treatment.

Yes. Effective May 1, 2015, the definition of a consultation was amended to include a referral from a physician or an NP. In order to ensure continuity of care, the consulting physician is required to provide a report back to the referring NP.

Physicians billing a consultation service must include the NPs six digit OHIP identification number for the claim to be processed. (See OHIP INFOBulletin #4653, May 8^th, 2015 at https://www.ontariocanada.com/registry/view.do?postingId=18922&language=en#:~:text=Effective%20May%201%2C%202015%2C%20physicians,NPs%20to%20a%20physician%2Fspecialist.

OHIP issued a new INFOBulletin on July 25 called Nurse Practitioners: Referrals and Delegated Procedures . This Bulletin was published to address processing glitches that had been occurring related to NP specialist referral and to clarify other physician payments related to NPs. Payment issues related to NPs referring to specialists have been resolved.

The government funds the majority of NP positions in Ontario either directly or indirectly. For example, the government currently funds 25 Nurse Practitioner Led Clinics, 100 NP positions in long-term care, approximately 500 positions in FHTs, 425 in Community Health Centres, 117 in Community Care Access Centres and 145 in other communities settings. Government funded NP positions usually include salary, benefits and some overhead.

NP positions are also funded in Ontario through global hospital and long-term care home budgets.

Sometimes NPs like RNs and RPNs, are hired by physician’s offices to provide health care services. These positions are generally not funded by the government. To fund these positions, physicians or other health organizations interested in doing so may pool resources, for example through partner physicians’ or administrative budgets. There are exceptions, for instance, positions funded through the FHTs.

Historically, NP positions across the province have been funded to respond to the needs of Ontarians, especially in under-serviced areas or within a vulnerable population.

To find out about government funded NP positions contact Health Force Ontario at http://www.healthforceontario.ca/en/M1/Contact_Us

In 2014 the Liberal Government announced 75 new Attending NP positions in Long-Term Care. NPAO continues to advocate for more funding of NP positions across health care settings to help ensure that all patients have access to a nurse practitioner.

Yes, NPAO posts jobs on its members-only page of the website. To post a job, please click here.

Yes. The Learn And Stay (previously Grow Your Own Nurse Practitioner Initiative (GYONP)) sponsors an RN to complete their post-graduate Primary Health Care NP education.

For more information click here: https://www.ontario.ca/page/ontario-learn-and-stay-grant

Salaries for NPs vary depending on where NPs works and the NPs’ employment relationship (e.g., full-time employee, independent contractor, etc.). The recommended salary for NPs according to a Hay group report commissioned by NPAO, AFHTO & AOHC in 2013 is $103,000 – 135,000. Compensation packages for employed NPs usually includes salary, benefits and overhead expenses.

A full-time equivalent NP position is typically compensated for 37.5 hours per week regardless of practice settings. However, many NPs work more hours than this in a typical work week.

Work hours worked in a clinic will depend on the work arrangement agreed on between employees and the employer. Work hours may be the usual Monday-Friday work week, and/or may include call or weekend off-hours service. Work hours are generally specified in the employment or contractor agreement between the NP and the employer.

Yes. An NP can work part-time as employees, as independent contractors, provide locum services a few days per week, etc. Arrangements for the number of days worked in a clinic are agreed on and generally specified in the employment or contractor agreement with the NP.

Minimum eligibility requirements for the Ontario Primary Health Care Nurse Practitioner Program

Current Ontario Certificate of Competence (RN)
Completed undergraduate nursing program (BScN) or equivalent nursing degree (e.g. BN, etc.) with a minimum B average
Equivalent of two years of direct nursing (RN) experience in the last five years (> 3,640 hours) completed by the February 1st application deadline.
Preference will be given to Ontario residents.
For the Nurse Practitioner Graduate Diploma program only – must also have a completed Master’s degree in Nursing.

Nurse Practitioner (NP) Programs

The Primary Health Care Nurse Practitioner programs (PHCNP) were established by the Council of Ontario University Programs in Nursing (COUPN) and are offered by 9 universities.

The following Nurse Practitioner nursing programs have been reviewed and approved; these programs meet all mandatory requirements. Graduates from these programs are eligible to register with the College of Nurses of Ontario (CNO).

Please contact the schools directly if you have any questions about their NP programs.

Lakehead University Primary Health Nurse Care Practitioner (Masters)

Laurentian University Primary Health Care Nurse Practitioner (Masters) (English/French)

McMaster University Primary Health Care Nurse Practitioner (Masters)

McMaster University Primary Health Care Nurse Practitioner Graduate Diploma (Post Masters)

Queen’s University Primary Health Care Nurse Practitioner (Masters)

Queen’s University Primary Health Care Nurse Practitioner Diploma (Post Masters)

Toronto Metropolitan University MN/Primary Health Care Nurse Practitioner (Masters)

Toronto Metropolitan University Primary Health Care Nurse Practitioner Certificate (Post Masters)

University of Ottawa Master of Science Nursing/ Diploma Primary Healthcare for Nurse Practitioner (English/French)

University of Ottawa Diploma Primary Health Care for Nurse Practitioner (Post Masters)

University of Windsor Primary Health Care Nurse Practitioner (Masters)