The Nurse Practitioners’ Association of Ontario (NPAO) advances and supports clear and consistent language and terminology when describing Nurse Practitioner (NP) care.
As Ontario innovates approaches to primary care in addition to other health care sectors, it is important to distinguish between the diverse ways NP services are delivered. In particular, it is critical to distinguish between NP-led practice, and when NPs function as the Most Responsible Providers (MRP). As each practice model has certain benefits relevant to different contexts, these terms reflect the different levels of clinical autonomy, accountability, attachment, continuity of care and leadership within each model.
“NP-led” describes a practice model in which NPs demonstrate a central role, both clinically and organizationally. The designation should reflect more than the presence of an NP within a practice or program: it should be used to describe contexts in which NPs have substantive responsibility for direction, leadership, governance, and decision-making alongside their practice role in delivering clinical care. This may include NP influence over the development and implementation of clinical policies, practice standards, quality improvement initiatives, staffing and resource decisions, and the design and evaluation of services. NPs should also have meaningful accountability for the practice’s clinical direction, opportunities to participate in strategic planning and operational decision-making, and an organizational structure that supports NP autonomy, leadership, and professional accountability. The designation should therefore be based on the actual role and responsibilities of NPs within a practice, rather than on the type or name of the organization in which they work.
This is distinct from a model where an NP is the Most Responsible Provider (MRP) for an attached patient population, but does not have a substantive role in organizational leadership or governance. In these settings, NPs exercise clinical autonomy within their scope of practice and are accountable for the ongoing care of their patients. It may be appropriate to describe the NP as the MRP or primary care provider, but the broader practice should not automatically be characterized as “NP-led” solely because an NP provides care or serves as the MRP.
A further distinction applies when NPs provide care to unattached patients without maintaining responsibility for their own attached patient panel. NPs may exercise significant clinical autonomy and play an important role in improving access to primary care, however the nature of this care and the associated responsibilities differ from those involved in maintaining an ongoing attached patient population.
NPAO underscores the importance of using terminology that both identifies the contribution of NPs, and accurately describes the purpose of their services. For example, terms such as “NP-supported unattached clinic” or “NP-supported stabilization clinic” may appropriately recognize the role contribution of NPs, while distinguishing these services from an NP-led practice model or functioning as formal MRP. This distinction matters because NP-led, NP as MRP, and NP-provided care are not synonymous: an NP may provide care without leading a practice, may be the MRP for an attached patient population without participating in organizational leadership or governance, or may provide care to unattached patients without maintaining an attached panel.
NPAO encourages organizations, policymakers, government officials, and individuals to consider the substance of the roles and responsibilities that NPs perform before applying the term “NP-led.” This term should be used purposefully when the appropriate criteria are met, that being specifically when NPs play a central role both in clinical practice and organizational leadership.
Download the position statement here.
