Toward a national framework for implementation of the nurse practitioner role in primary health care

Aboriginal Nurse, The, Summer 2003 by Rothwell, Sue

Nurse Practitioner Planning Network update

Nurse Practitioners and Primary Health Care (PHC)

Whue there is a large body of evidence that demonstrates that nurse practitioners can provide high-quality, cost-effective primary health care and play a critical role in primary health care renewal, the implementation of the nurse practitioner role in Canada has been sporadic and inconsistent. The Canadian public has limited understanding of the role of nurse practitioners and the scope of the health services they provide. Physicians, pharmacists, and other providers have different expectations and understandings of the scope of practice and competencies of their nurse practitioner colleagues. The five provinces that have passed legislation and have certification in place are not consistent regarding scope of practice, licensure or continuing competence requirements for nurse practitioners.

To address this significant gap in the functioning of Canada's health system, the Nurse Practitioner Planning Network (NPPN) has proposed the development of a National Framework For Implementation of the Nurse Practitioner Role In Primary Health Care Delivery.

The NPPN is seeking funding from the Primary Health Care Transition Fund for this initiative.

The framework will seek to realize a vision of a renewed and strengthened primary health care system that optimizes the contributions that nurse practitioners can make to the health of all Canadians. In a Letter of Intent to Health Canada dated August 12, 2002, the NPPN proposed the development of a framework aimed at integrating and sustaining the role of the nurse practitioner in primary health care through undertaking strategic activities in five areas:

* educational preparation

* practice

* policy

* legislation, government & professional self regulation

* change management, strategic communication and social marketing.

The total budget for this initiative is estimated at $8.45M over a 36-month period.

PARTNERS

The Nurse Practitioner Planning Network (NPPN) is group representing professional associations, nursing regulatory bodies and organizations, provincial and territorial governments, and nurse educators. Organizations supporting the development of this project include the Canadian Nurses Association, the Canadian Association of University Schools of Nursing, the Aboriginal Nurses Association of Canada, the Nurse Practitioner Association of Ontario, and the provinces/territories of Newfoundland and Labrador, Nova Scotia, New Brunswick, Ontario, Saskatchewan, Manitoba, Alberta, British Columbia, the Yukon, the Northwest Territories and Nunavut; support from Quebec and PEI is also expected.

Stakeholders and Activities: Building Foundations.

This initiative is national in scope. The multiple stakeholders and diverse partnerships involved will be integral to the proposal development activities, and to the long-term sustainability of the initiative. Activities are primarily focused on consultations and the iterative development of foundation documents. Another aim is the development of "project infrastructure" as a result of the consultation process.

The NPPN hopes to formally establish links at the national level with the Canadian Medical Association, the College of Family Physicians of Canada, the Canadian Pharmacists Association, the National Aboriginal Health Organization, the Society of Rural Physicians of Canada, and the Canadian Institute of Health Information.

Within the provinces, links will be forged among nursing, medical, pharmacy and other health professional regulatory bodies. Interjurisdictionally, educational institutions and universities, regulatory bodies and health provider faculties will cooperate to address issues in education and practice.

To implement its proposed work, the NPPN is working to build itself as a network of strategic communication. Social marketing strategies will be important for educating the Canadian public about the role of Nurse Practitioners with Primary health care. The enormity of the task inherent in a National Framework will require 5 managers, each responsible for an individual project component of: Educational Preparation, Practice, Policy, Legislation/regulation, Change Management/communications. An overall project coordinator will ensure integration of these project components, along with the help of a management committee and project secretariate.

The primary resource for this preliminary planning, the proposal development phase, is the Nurse Practitioner Planning Network which will guide its content, committee membership, project leadership, future consultation, and other organizational factors necessary to an effective project infrastructure.

Consultation With Provincial and Territorial Governments

The provinces and territories are responsible for providing health care services and thus for achieving the vision of renewed primary care and the nurse practitioner's role. Therefore, their support and guidance will be central to implementing the five components of the initiative. The support of the provinces and territories is especially important to ensure that the proposal articulates the potential roles of the provincial and territorial governments (implementation). Provinces and territories are also critical as the project seeks to lay the groundwork for the long-term acceptance of the outcomes of this initiative (sustainability).