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Specialty NP Project

Integration of Specialty Nurse Practitioners into the Ontario Health Care System

Ministry of Health and Long Term Care Grant #06430
Principal Investigator:  Mary vanSoeren RN PhD
Co-Investigator:  Christina (Tina) Hurlock-Chorostecki RN(EC) MScN

The Canadian introduction of nurse practitioners (NPs) as a healthcare provider with knowledge and skills beyond the general registered nurse was more than 40 years ago. In the late 1980s, education was developed for NP roles in primary health care and in specialized hospital based care of neonatal, paediatrics and adult. Government support for the primary health care NP (PHC NP) role expanded with the political agenda of primary healthcare renewal, and legislation was passed in 1998 to expand the scope of practice. The PHC NP role has been well studied and documented[1] (CNPI, 2006). Currently, 12 of 13 provinces and territories have enacted legislation to support NPs.

In Ontario there has been a gradual increase in NPs employed in hospitals since the 1980s. This has occurred in the absence of formal legislative, regulatory and financial recognition of the role.

Approximately 60% of all Canadian NPs work in Ontario, and over 400 work in hospitals[2]. With Ontario at a juncture of change in the healthcare system and the need to improve human resource planning and utilization, it is important to understand and describe the NP role within hospital settings.

Using a mixed methods design, the researchers explored the extent of NP role implementation using the Canadian Nurses Association’s Advanced Nursing Practice Framework, NP impact on patient access to services, NP impact on adherence to best practice or evidence, team function and satisfaction with NP roles, and patient satisfaction with care.

Forty-six hospital-based NPs from nine different hospitals across the province participated in this 18 month study. The findings support the NP role in hospitals as valuable and additive. The role is primarily clinical, with teams and administrators valuing added outcomes from involvement in research and leadership. The NP was found to be highly collaborative, an enabler for other professionals, trustworthy and available. Team descriptors of the NP included “glue” or “hub” indicating a major role in team function. Findings also describe barriers to role implementation.

Included in the report are tools to aid in NP role implementation. These include an annotated bibliography of hospital based NP related literature, a review of theoretical frameworks for NP practice and a review of implementation frameworks available. The report also contains an extensive history of the hospital based NP role and a discussion of models to augment medical care.


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