Nurse practitioners have come a long way
There were struggles when nurse practitioners were introduced into Ontario's health care system, but, looking back, Roberta Heale can scarcely believe how far the profession has come in 20 years.
Heale is an associate professor in Laurentian University's nursing program and a practising nurse practitioner who works one day a week at the Sudbury East Community Health Centre.
Heale wasn't an NP in 1995 when a consortium of 10 universities, among them Laurentian, worked together to develop and deliver a nurse practitioner program for the province.
Nine universities continue to offer the program, Laurentian and the University of Ottawa teaching it in both official languages.
A registered nurse, Heale enrolled in the Laurentian program in 1998, graduating in 1999. She reflected this week, which the Ontario Nurses' Association is marking as Nurse Practitioner Week, on how her profession has changed in two decades.
When Heale entered the program, you had to be a registered nurse with two years' full-time equivalent work on the front lines, and the NP program was a graduate certificate that was completed in one year.
Those same entry qualifications are still required, but the program has been merged with master's and other programs and takes at least two years to complete at Laurentian.
It was three years after the nurse practitioner program was developed in Ontario universities before NPs were regulated by the Government of Ontario and given the authority to practise.
"There were huge struggles at the beginning," said Heale of those first years. Pioneering nurse practitioners like Sudbury's Marilyn Butcher knew licensing and regulation of nurse practitioners was "on the way" so she and many other NPs did regular nursing duties or volunteered until legislation allowed NPs to work in an autonomous role.
"It was kind of a vicious circle there for awhile," said Heale. "Things progressed. It seemed slow at the time, but looking back, it was quick."
It would be 2011, after minor tweaks to the first legislation, before regulations were changed to significantly broaden nurse practitioners' scope of practice. The changes gave them the authority to prescribe a wider range of medications, and to order blood work, ultrasounds and some other diagnostic tests.
"That made a huge difference," said Heale.
Before that, Heale and Butcher had embarked upon a campaign to create a new model of primary health care delivery that was led by nurse practitioners and not physicians, as was the practice at the time.
The women presented different proposals to the Ministry of Health and Long-Term Care, one of them for a nurse practitioner-led family health team. That idea was rejected, but Heale and Butcher didn't give up.
They proposed the first nurse practitioner-led clinic in Ontario here in Sudbury. The Sudbury District Nurse Practitioner Clinic offered the same collaborative approach to health care that emerging family health teams did.
"Marilyn and I understood there was a huge gap in primary health care services at the time," said Heale, "and that there were unemployed and underemployed NPs who could be utilized."
That first clinic, on Riverside Drive, opened in July 2007. A second site, in Lively, opened in 2010.
Then Premier Dalton McGuinty attended a late grand opening for the Riverside site in April 2008, an event then Health Minister George Smitherman also was at.
The day after that visit, the province announced that 25 more nurse practitioner-led clinics would be established in Ontario, following the model of the Sudbury clinic that hadn't even been open a year at that point.
Butcher and Heale had realized NP-led clinics could help address the issue of 30,000 people in Sudbury not having a family doctor.
There are now five more NP-led clinics in the area covered by the North East Local Health Integration Network -- in Capreol, French River/Alban, North Bay, Thessalon and Sault Ste. Marie.
Heale was one of many NPs who celebrated the 20th anniversary of Laurentian's program a few months ago. It was a time to look back on the development of the profession, although Heale is looking forward to changes that will again expand NPs' scope of practice.
Nurse practitioners are now working in nearly every sector of the health care system. In Sudbury, those sectors include the emergency department at Health Sciences North, the eating disorders program, the diabetes education centre, the bariatric centre and in pediatrics.
Heale calls that "a huge and wonderful change."
NPs are fulfilling an especially important role in northern and rural communities where they may be the only health care professionals offering care.
There is one issue, however, that is causing some NPs to leave community practices to work in hospitals and community care access centres. For eight years, the Government of Ontario has imposed a wage freeze on NPs and other professionals working in the community. That is making it harder to recruit NPs to community practices, said Heale.
"Remuneration is a big issue," she said, because the difference in salary between a community and institutional NP position can be as great as $20,000 a year.
"It's a bit frustrating when you know other health care centres and other health care providers have had increases, then we get caught in this age of austerity," she said.
Still, Heale feels good about the future. There have been amazing accomplishments in the last 20 years and the environment in which NPs work is mostly good.
"I'm happy to be able to say that at this point. There were a lot of hurdles along the way," she said.
Nurse Practitioner Week is being celebrated Nov. 8-14 to bring awareness and recognition to the exceptional care provided by the province's 2,669 nurse practitioners, said ONA president Linda Haslam-Stroud.
"Nurse practitioners provide high-quality health care in hospitals, long-term care facilities and the community each and every day," said Haslam-Stroud.
Originally published in The Sudbury Star