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Primary Health Care Nurse Practitioner: RN (EC) Designation

What is a Primary Health Care Practitioner?

Primary Health Care Nurse Practitioners (PHC NPs) are registered nurses, who are specialists in primary health care, who provide accessible, comprehensive and effective care to clients of all ages. They are experienced nurses with additional nursing education which enables them to provide individuals, families, groups and communities with health services in health promotion, disease and injury prevention, cure, rehabilitation and support. The NP is an advanced practice nurse, functioning within the full scope of nursing practice and as such is not a second level physician nor a doctor's assistant.

Nurse Practitioner skills include the ability to:

• provide wellness care including health screening activities such as Pap smears and monitoring infant growth and development
• diagnose and treat minor illnesses such as ear and bladder infections
• diagnose and treat minor injuries such as sprains and lacerations
• screen for the presence of chronic disease, such as diabetes
• monitor people with stable chronic disease, such as hypertension

They work collaboratively with family physicians and other members of the health care team. A more detailed description of the role of the PHC NP is included here. RN(EC) Role

How Are Primary Health Care Nurse Practitioners Educated?

The Council of Ontario University Programs in Nursing (COUPN) established the Ontario Primary Health Care Nurse Practitioner (PHC NP) Programme in 1995. A consortium of ten Ontario universities offers the program: Lakehead, York, McMaster, Ottawa, Laurentian, Western, Windsor, Queens, Ryerson and Toronto. Graduates are eligible to write the extended class registration exam (ECRE) to qualify as an RN(EC).

Graduates of programs from other provinces or the United States may also be eligible to write the ECRE. Currently five programs across Canada have been accepted as equivalent to Ontarios COUPN education program. In addition, graduates of American Family Nurse Practitioner programs who are certified with the American Nurses Credentialing Centre or the American Academy of Nurse Practitioners are considered equivalent education.

Admission Criteria

• Current registration with the College of Nurses Of Ontario as a registered nurse
• Minimum overall nursing average of 70% in their baccalaureate program in nursing
• Equivalent of at least 2 years of nursing (RN) experience in the last five years

These are minimum criteria for admission to the program. Evidence of critical thinking skills, capacity to work in collaborative practice environment and participation in evidenced based nursing practice are some of the other factors taken into consideration.

Program Streams

Students have the option to choose between of two programs:

• NP certificate program (Post-Baccalaureate)
• MSN/NP (Masters in Nursing/Nurse Practitioner Certificate). This program is currently offered only at the University of Ottawa

Full-time students complete the certificate program in calendar 12 months. Part time students have up to 3 years to finish the program. The University of Ottawa and Laurentian University offer the program in French.

Academic Program

The NP certificate program is delivered through a combination of labs and tutorials at the university and distance education using the internet, CD-ROMs, computer-mediated conferencing, teleconferencing, print materials, tutorials and clinical labs and placements. Courses include:

• Pathophysiology for the Nurse Practitioner
• Advanced health assessment and diagnosis 1 & 2
• Therapeutics in primary health care 1 & 2
• Roles and responsibilities
• Integrative practicum.

How Are Primary Health Care Nurse Practitioners Regulated?

NP Regulation

PHC NPs are Registered Nurses who have demonstrated competence to perform additional controlled acts by earning the designation Extended Class or RN(EC). The College of Nurses of Ontario (CNO) regulates the practice of RN(EC)s. This credential is a protected title, the term PHC NP is not although this is the commonly accepted public terminology.

The Standards of Practice for RNs in the Extended Class (Primary Health Care NPs) are published by the CNO and include:

• practice expectations/competencies
• expectations for consultation with physicians
• standards for prescribing drugs, ordering lab tests and ordering X rays and ultrasounds
• legislation and regulations that govern practice
• appendices include the list of drugs RN(EC)s can prescribe, the list of lab tests RN(EC)s can order and guidelines for use of medical directives

Registration in the Extended Class

Initial registration is dependent on:

• provincial certification exam and
• graduation from the Ontario PHC NP Program or
• for graduates of another program or for nurses who through experience and education believe that they have achieved the competencies of the Ontario program, successful completion of the "challenge process" that consists of: provincial certification exam, portfolio of prior learning and structured oral exam

To continue registration in the Extended Class requires:

• annual quality assurance reflective practice as required for all RNs
• competence reassessment at the end of the first 3 years or 1800 hours (focus on establishment and evaluation of an appropriate network of consultants from other health professions and compliance with the Expectations for Consultation contained in the Standards of Practice document)

Scope of Practice for the Extended Class

Scope of practice includes independent authority for:

• Controlled acts authorized to nurses registered in the general class include: performing prescribed procedures below dermis/mucous membrane, administering substances by injection or inhalation and inserting instrument, hand or finger into natural or artificial body orifice
• Additional controlled acts authorized to RN(EC)s under Bill 127
• communicating a diagnosis
• ordering a form of energy (i.e. ordering ultrasounds)
• prescribing a drug
• ordering prescribed X-rays
• ordering prescribed lab tests.

For more information regarding the legal scope of practice of the RN(EC), access the College of Nurses of Ontario web site and the document: Standards of Practice for RNs in the Extended Class (PHC NPs) at: www.cno.org