History of NP Role Development in Ontario

1960's

1965 - first NP program established at the University of Colorado
1967 - first education program for NPs working in northern nursing stations began at Dalhousie University, Halifax, Nova Scotia
Canadas health care system was experiencing:

changing role of the nurse from generalist to specialist
a physician shortage (ratio 740:1) especially in rural areas
trend towards specialization in medicine, fewer MDs in primary care
emphasis on the curative aspects of medicine

1970's

1971 - Boudreau Report makes the implementation of the expanded role of the RN a high priority in Canada's health care system
1971 - first university program in Ontario to prepare expanded role RNs
1971 - Dr. John Hastings chairs the Community Health Centre Project in support of community based care in Ontario
1973 - NPAO established as an affiliated Interest Group of the Registered Nurses Association of Ontario with the mandate to lobby for the PHCNP role
1973 - CNA/CMA Joint Committee releases joint policy statement on the role of the NP
1974 - Lalonde Report supports some of the concepts of primary health care by recognizing the influence of determinants of health on societal health and well-being and the role of the RN in health promotion and disease prevention
1975 - Ontario Council of Health releases The Nurse Practitioner in Primary Care with recommendations about necessary legislative changes and remuneration issues

1980's

Early 1980s - first NP initiative ends because of: perceived physician oversupply, lack of remuneration mechanisms, lack of legislation, lack of public awareness regarding the role and lack of support from both medicine and nursing
1980s into early 1990s - some 250 NPs continue to work mainly in community health centres and in northern nursing stations; their educational preparation and responsibilities vary greatly
1983 - last NP education program closes at McMaster University, Hamilton, Ontario
1988 - CNS-NP role implemented in Level 3 NICUs following reduction in number of Pediatric Residents
In spite of failure of the first initiative, NP role consistently cited in the recommendations of many provincial health care commissions and task forces
Government continues efforts to focus the health care system to disease and injury prevention, health promotion and community-based care
NPAO continues to actively lobby to re-establish educational programs in Ontario and for the recognition of the NP role as a viable member of the Ontario health care system.
Development of first ACNP Program, "Expanded Role Nurse" program - Neonatology

1990's

1993 - Minister of Health and NDP government announce a new Nurse Practitioner Initiative as part of improving access to primary health care. The project involves:

commissioning several significant discussion papers (Utilization of Nurse Practitioners in Ontario, Sept. 93; The Clinical Nurse Specialist, Clinical Nurse Specialist/Nurse Practitioner and Other Titled Nurse in Ontario, Nov. 94; Assessment of the Need for Nurse Practitioners in Ontario, Jan. 94)
establishing a Steering Committee with five sub-committees: fiscal, publicity and public relations, placement and service patterns, laws and regulations, and education; with release of its recommendations in July 1994
consulting with key stakeholders in the health care delivery system through focus groups
supporting the development of a university- based post-baccalaureate education program with funding for the first five years
establishing and funding a five year evaluation project to review the education program, the placement of NPs, and the impact NPs have on the health care system

December 1994 - "Nurse Practitioners in Ontario: A Plan for their Education and Employment of NPs" is released with specific steps for implementation; it proposes a salary range of $60-80,000 per annum
1994 - College of Nurses of Ontario (CNO) approves a new class of registration in the RN category, the Extended Class
1994 - Council of Ontario University Programs in Nursing (COUPN) involving a consortium of 10 nursing faculties develops the new PHCNP Program
1995 (April) - CNO refers proposed legislation changes to the Health Professionals Regulatory Advisory Council (HPRAC)
1995 (September) - the PHCNP education program begins
1996 - first graduates of the PHCNP program.
1996 (June) - following extensive consultation with the public and health care professionals, HPRAC releases 8 recommendations in support of legislative authority for PHCNPs.
1997 (April) - Bill 127, the Expanded Nursing Services for Patients Act receives first reading
1997 (June) - final reading of Bill 127 receives unanimous support of all three political parties
1997 (September) - University of Toronto, Masters of Nursing offers two program streams: Acute Care NP Adult Health and Acute Care NP Child Health
1998 (February 18) - Bill 127 proclaimed
1998 (April) - NPAO expands its mandate to include all nurse practitioners 1998 - CNO initiates the Extended Class registration process with first registrants
1998 (November) Initial ACNP meetings to identify common issues and plan strategies to support the role
1998 - Minister of Health and Conservative government announce release of $5 million for PHCNP positions in community based agencies including community health centres, aboriginal health access centres, and nursing stations.
1998 \(September) Minister appoints Nursing Task Force in response to growing concerns about the instability of the current nursing workforce; is NPAO submission discusses the role of both the PHCNP and ACNP
1999 (February) - Nursing Task Force Report is released
1999 (March) - Minister of Health announces support for recommendations of Nursing Task Force including -investment of $375 million in nursing, including 106 PHCNP positions (80 in Underserviced Areas and 20 positions in long term care homes)
1999 - Ministry of Health extends COUPN funding for another 5 years
Teaching hospitals express interest in ACNP role for acutely ill patients related to decreasing numbers of medical house staff and resident physicians
Development of Post-Masters ACNP certificate programs Toronto and London

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