NPAO 2018 Election Platform
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The Nurse Practitioners’ Association of Ontario (NPAO) is the professional voice for Nurse Practitioners in Ontario. Formed in 1973, NPAO has been active in policy development, advocacy, awareness, professional development and knowledge dissemination for than 45 years. NPAO speaks on behalf of more than 3,300 NPs in the Province. NPAO works collaboratively with many stakeholders to ensure accessible, high quality care through the full integration of Nurse Practitioners across Ontario.
Nurse Practitioners are registered nurses with advanced university education and experience, regulated by the College of Nurses of Ontario (CNO), who provide a full range of health care services. Nurse Practitioners are authorized to:
- independently assess a patient and make a diagnosis;
- prescribe all medications including controlled drugs and substances
- order and interpret all laboratory tests and most diagnostic imaging tests; admit, treat and discharge hospital patients;
- perform minor surgical procedures.
Nurse Practitioners work across the health care system in a wide variety of settings including hospitals, Family Health Teams, Community Health Centres, Nurse Practitioner Led Clinics, long term care homes, retirement homes, public health units, and with home care and palliative care teams. In primary care, NPs provide services to millions of individuals and families, from newborns to the elderly. In other settings, NPs provide very specialized care, assessing and treating complex patients. In all settings, Nurse Practitioners focus on evidenced-based, comprehensive, patient-centered care.
NPAOs Vision for a Healthy Ontario
NPAO strongly supports an efficient health care system that provides “the right care, at the right time, in the right place, and by the right provider”. Nurse Practitioners, by virtue of their nursing education, focus on promoting health, preventing illness and injury and reducing complications. With such a focus, NPs aim to reduce unnecessary emergency room visits, reduce the length of hospital stay, improve quality of care and ensure that people are well cared for as close to home as possible. The cornerstone of a high performing and sustainable health care system must be a strong and well thought out primary care system.
NPAO is committed to ensuring that Ontarians receive value for their tax dollars. If implemented properly, the following recommendations would save money, improve access and continuity of care, and achieve better outcomes for the people of this province.
“Millions of Ontarians count on Nurse Practitioners to provide efficient, effective and timely access to their health care. Across the health care sector from intensive care to end-of-life care, patients rely on Nurse Practitioners to help them navigate their journey towards best health or a peaceful death. Nurse Practitioners are a key part of a safe, effective and innovative solution to an overburdened health care system. The time is now to expand and support Nurse Practitioners as health care team leaders, particularly in areas where access to care remains an issue.”
– Marnee Wilson, President of the NPAO
“I know that Nurse Practitioners deliver quality health care and are dedicated to building a strong and vibrant health care system. Nurse Practitioners are passionate about making a difference in peoples’ lives. We are a vibrant and innovative workforce, committed to improving the lives of Ontarians through compassion and timely access to care.”
– Dawn Tymianski, CEO of NPAO
Nurse Practitioners and their Patients are Asking Hard Questions
1. Will you invest in professional equalization, ensuring equal pay for equal work for ALL Nurse Practitioners working across ALL sectors?
For almost a decade, Nurse Practitioners wages were frozen. Finally, with the announcement of the Primary Care Recruitment and Retention Funding in the 2016 and 2017 Provincial Budgets, improvements were made to compensation standards. NP salaries increased to $103,822 with another 3 year-roll-out of funding to be announced before December 2018. This increase will bring NP salaries in primary care interprofessional organizations to the 2017 rate, as recommended by the Korn Ferry (Hay Group) “Conducting a ‘Refresh’ of the Common Salary Structure for Primary Care Organizations in Ontario: 2017 Report.”
However, this does not address compensation for NPs employed in other healthcare sectors. Most Nurse Practitioners working outside of the organizations covered by the recruitment and retention funding continue to make well below the minimum suggested salary rate identified in the “Developing a Provincial Compensation Structure for Primary Care Organizations – 2012 Report” produced by the Hay Group.
Nurse Practitioners work across the health care system in a wide variety of settings. In this current compensation model, compensation equalization does not exist, resulting in NPs with similar responsibilities not getting equal pay for the same work.
For this reason, the NPAO recommends a targeted investment to equalize Nurse Practitioner compensation across ALL sectors.
2. Will you create an integrated funding structure for healthcare, based on quality outcomes that will:
A. Ensure that the best care is provided by the most appropriate and costeffective provider?
In order for our health care system to function optimally, it is vital to deploy health professionals to the right setting, where evidence suggests they can provide real value to patients.
For example, Nurse Practitioner salaries are paid from the organization’s global budget, while compensation for physicians is provided through the Ontario Health Insurance Plan (OHIP). To reduce costs, some organizations are now replacing Nurse Practitioners with Physicians. This defers funds away from the overall global budget.
NPs are also being replaced by Physician Assistants, not because organizations believe that it makes the most sense from a patient or system perspective, but for financial considerations: the MOHLTC has subsidized the hiring of PAs, while no such subsidy exists for NPs.
Health human resource planning needs to occur in a deliberate, evidenced-based way. Funding of health services needs to be done in a way that achieves an excellent return-on-investment and improve patient care outcomes. Funding should wrap around the patient and family, not the provider.
B. Create innovative funding mechanisms that allows for NPs to be compensated for the work they do.
There is in general, no mechanism in place for NPs to receive compensation for services provided through the public system.
Like physicians, NPs have been providing Medical Assistance in Dying (MAiD) services both as primary and secondary clinicians in Ontario. Since the development of the MOHLTC’s Clinician Referral Service in 2016, approximately 50% of the practitioners listed are NPs.
This lack of compensation affects all Nurse Practitioners roles including NPs working within the Hospital or Private Clinics. In non-MOHLTC funded NP role opportunities, a physician interested in having an NP is required to pay salary without receiving compensation. Furthermore, NPs interested in opening their own practice to meet underserviced population, have no mechanism to receiving for their services.
In order to support access to MAiD services, many NPs work outside of regular employment hours or as independent practitioners. Under the current model, NPs providing services in this way receive NO compensation. Moreover, there is NO payment mechanism in place to compensate the work being done by this dedicated NP workforce caring for patients at end-of-life.
A direct funding mechanism for NPs compensation is the only way to ensure that all NPs working in all settings and providing all types of services are able to receive compensation.
3. Will you ensure every Ontarian has timely access to an NP or family physician by:
A. Targeting investments in community primary care?
More than 13 million Ontarians now report that they have a Nurse Practitioner, family doctor or GP, whom they see for regular check-ups or when ill. (HCES, MOHLTC, 2017). However, almost 800,000 Ontarians still report that they do not have access to a primary care provider on a regular basis.
Furthermore, only 41% of Ontarians are able to see their Nurse Practitioner or Doctor the same day or next day when ill (ibid). Canada ranks very low – 10th out of 11 commonwealth nations – when it comes to accessing health care (Mirror, Mirror, 2017). We know that access is worse in northern, rural and remote communities. But many people living in urban communities who are marginalized and/or have complex health conditions also have difficulty getting timely access to primary care.
In 2014, Premier Wynne promised that every Ontarian who wanted access to a Nurse Practitioner or GP/Family Doctor by 2018 would be able to do so. However, the government has not invested in more Nurse Practitioner positions in CHCs, FHTs or NPLCs or other primary care teams in the past 4 years.
To ensure every Ontarian has access to a primary care provider, funding for more Nurse Practitioners positions and more NP-led models of care are needed across the health care system.
B. Expanding access to NP-led models of care such as Nurse Practitioner Led Clinics (NPLCs) in communities where there is a demonstrated need?
Ontario now has 24 Nurse Practitioner Led Clinic serving more than 60,000 previously orphaned Ontarians. NPLCs are primary care clinics which are comprised of a multidisciplinary team. These NPLCs are proving to be an innovative and cost-effective primary care model. However, approximately 25% of NP Led Clinics are operating at maximum capacity with new patient wait lists. These NPLCs need to be expanded or they need to establish satellite clinics to meet demand.
There is an opportunity to leverage the existing investment in infrastructure and overhead by providing additional targeted funding for those NPLCs that are operating at maximum capacity. NPAO has received expressions of interest from approximately 25 under-serviced communities across Ontario that want a Nurse Practitioner Led Clinic. Funding needs to be allocated so that Ontarians get the right care, at the right time, as close to home as possible and in a cost-effective way. Nurse Practitioner Led Clinics are that solution.
4. Will you commit to increase the number of NPs available to care for high-risk populations?
Nurse Practitioners have been instrumental in providing care to the long-term care community, patients requiring mental health services and in acute care settings, such as the neo-natal intensive care unit. Increasing acuity across vulnerable populations requires a dedicated, educated workforce. This workforce requires commitment from the Ministry of Health and Long-Term Care to support the growing need for services.
NPAO strongly believes an increased investment would result in better care, improved satisfaction and improved efficiencies in the health care system overall.
Across all of these settings, good evidence shows the benefit of having the right provider for the right patient. Evidence suggests Nurse Practitioners decrease emergency department transfers, hospitalization rates and length of hospital stay. Furthermore, having a consistent provider increases staff and patient satisfaction rates and improves compliance to healthy plans of care (Christian & Baker, 2009; Donald et al., 2013).
5. Will your government commit to extend the “Medical Liability Protection Reimbursement Program” to all actively practicing Nurse Practitioners?
The College of Nurses of Ontario requires that all actively practicing Nurse Practitioners in the Province have Professional Liability Protection (PLP), which provides essential protection to NPs, employers and the patients that they serve. Moreover, PLP strengthens team-based care.
NPAO believes ALL Nurse Practitioners should have access to ministry-funded PLP subsidy.
For that reason, NPAO suggests the Ministry of Health and Long-Term Care reviews current policies and scope of the Medical Liability Protection Reimbursement Program to include all Nurse Practitioners.
6. How will you invest in NP education and Continuing Professional Education?
NPAO supports the Government’s plan to ensure every Ontarian has same day or next day access to a primary care provider. Investments in NP Education and initiatives will ensure that this workforce continues to be highly skilled and provide evidence-informed competent healthcare. Further investments to the Primary Health Care Nurse Practitioner Program, will ensure more NPs are graduating and joining the workforce every year. This contributes to meeting priorities set by the Patient’s First Act
In acute care settings, sustained support for NP education is necessary to manage the increasing required sub-specialty, and the increasing complexity of patient care requirements and healthcare roles.
At a time when the scope of practice of NPs is expanding, investments in New Grad NP initiatives, fellowships and mentorship programs are essential to make the transition from novice NPs into the workforce as supported as possible, this has in return been shown to increase workplace retention and overall satisfaction.
Support ensures sustainability of an educated workforce pivotal in meeting the needs of Ontarians, particularly in underserviced areas.
To download our election platform, please click here.