COLLABORATIVE INTEGRATION PLAN FOR THE ROLE OF NURSE PRACTITIONERS IN CANADA 2011-2015 November 2011
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TA B L E O F CONTENTS Introduction... 3 Development of the Integration Plan... 4 Integration Plan: Key Actions... 5 Legislation and Regulation... 5 Education... 6 Health Human Resources... 7 Communication... 8 Next Steps... 9 References... 10 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada 1
I N T R O D U C T I O N Nurse practitioners (NP) have been in the health-care system for more than 50 years, with the early NPs providing care in rural and remote areas. By the 1970s, interest in the NP role increased and more education programs for NPs started. NPs provide direct care to people of all ages, families, groups and communities across the continuum of care. They treat common illnesses, order tests and prescribe medications. They also focus on educating patients and their families about living healthy, preventing diseases and managing their illnesses. In essence, NPs bring together the knowledge needed to diagnose and treat illnesses with the values, skills and knowledge of nursing. They are part of a team, collaborating with clinical nurse specialists, registered nurses, doctors, social workers and others to provide quality health care. Every provincial and territorial government now has NP legislation in place. Currently, there are more than 3,000 NPs in Canada, and they are seen as an integral part of the health-care system. Evidence demonstrates the benefits of NPs in patient care as they: involve patients in decisions related to care; improve access to primary health care; reduce pressures on the health-care system; and are valued and trusted by patients. The Canadian Nurse Practitioner Initiative (CNPI) was implemented over 18 months from 2004 to 2006. It made significant progress in establishing legislation, promoting educational requirements and defining and promoting the NP role. The CNPI resulted in tools, resources and an action plan outlining 13 recommendations with 84 actions. In 2009, the Canadian Nurses Association (CNA), supported by Health Canada s Office of Nursing Policy, published a progress report stating that more than half of the actions had been fully or partially completed, and that several key actions were ongoing or not completed. As part of its work to optimize and further integrate the NP role in Canada, CNA remains committed to working with stakeholders to further the work started through the CNPI. Collaborative Integration Plan for the Role of Nurse Practitioners in Canada 3
D E V E LO P M E NT OF THE I N T E G R AT I O N PLAN During 2010, CNA established working groups to create an integration plan for NPs in Canada. Four of the original seven CNPI strategic areas form the basis for the new plan: legislation and regulation, education, health human resources and communication. Some of the actions developed during the CNPI were kept or revised; others are new, based on stakeholder feedback. Several methods were used to obtain input from stakeholders concerning the original actions, including teleconferences, key informant interviews and surveys in order to determine the new actions for this integration plan. For the legislation and regulation, and education strategic areas, stakeholders were asked the following questions: Is this action clear? Is this action relevant today? Has the status changed? What would you change? How would you rate the degree of priority of this activity? Who should lead this action? For the health human resources actions, stakeholders within provincial/territorial governments were interviewed. The communication actions are based on key informant interviews with NPs and nurse researchers to understand their views of the NP role, their expectations, the challenges and opportunities they see around promoting the role, and the audiences they feel should be aware of the role. The results of the stakeholder feedback are integrated into the action plans for each of these four strategic areas, as presented in the next section. 4 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada
I N T E G R AT I O N PLAN: KEY A C T I O N S This integration plan is based on the original key actions developed for seven strategic areas during the CNPI (CNA, 2009). For this latest review, stakeholders kept, revised or added actions, as indicated in the tables below. The stakeholders emphasized the need to review each action within a specific timeline and recommended leaders and supporters where applicable for each. It was determined that this integration plan would specify actions for NPs that would be applicable to any patient population to whom they provide care. Legislation and Regulation Key Actions Lead/Support Timeline for Review Enact a broad scope of practice for NPs based on pan-canadian core competencies. Promote information about the NP role to consumers and the public. Initial and Continued Competency Adopt the Canadian Nurse Practitioner: Core Competency Framework (CNA, 2010). Regulatory bodies/associations and P/T governments Support by CNA/educators Regulatory bodies/associations/ CNA/CAAPN 2013 2015 Regulatory bodies 2011 Adopt standardized requirements for registration/licensure of nurse NPs. Regulatory bodies 2014 Adopt the Canadian Nurse Practitioner Examination: Family/All Ages (CNPE: F/AA). Adopt a uniform entry-to-practice exam for NPs in different streams of practice (e.g., adult and pediatric). Standardize approaches to NP initial competence and credential assessment, continuing competence assessment and prior learning assessment and recognition in Canada. Regulatory Effectiveness Evaluate the need for a pan-canadian approach to bridging programs for NPs who require additional education/skills development. Explore the need for a pan-canadian assessment centre to screen potential applicants P/T regulatory authorities. Amend existing F/P/T statutes to be consistent with NP practice. Regulatory bodies 2013 Regulatory bodies 2013 Regulatory bodies 2014 Regulatory bodies 2013 Regulatory bodies 2013 F/P/T government/regulatory bodies/cna 2015 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada 5
Education Key Actions Lead/Support Timeline for Review Guiding Philosophy, Assumptions and Values Reflect the guiding philosophy, assumptions and values found in the Education Framework for Nurse Practitioners in Canada (CNA, 2006a). Follow up with new NP programs (e.g., admission criteria) to include RN designation and minimum of two years of full-time equivalent clinical nursing experience. CNA/CASN 2012 CNA/CASN 2015 Entry to Nurse Practitioner Educational Programs Adopt and apply the principles found in the Prior Learning Assessment and Recognition Framework for Nurse Practitioner Education and Regulation in Canada (CNA, 2006b). NP program 2015 Promote the establishment of a pan-canadian approach to transfer of credits. Curriculum Alignment and Linkages Develop national position statement for NP education to include information on standards. NP program/directors of university schools of nursing 2015 CASN 2012 Develop essential components of NP education. CASN 2012 Explore feasibility of a pan-canadian accreditation process for NP educational programs. Be consistent with the Canadian Nurse Practitioner: Core Competency Framework (CNA, 2010) and the standards inherent in the NP program approval process. CASN 2015 Regulatory bodies/casn/np programs Adopt the master s degree (MN/MScN) as the required exit credential, Regulatory bodies/np programs 2015 Develop and institute bridging mechanisms to support program transition to a graduate degree (MN/MScN) as the standardized exit credential. Nurse Practitioner Education Delivery Ensure that doctoral-prepared faculty and masters-prepared NPs teach in NP programs and/or use teaching or shared resource models. Recognize NP faculty clinical hours as teaching hours if supervising students during clinical practice. 2012 Regulatory bodies/np programs 2015 NP programs 2012 NP programs 2011 Develop a clinical practice model. NP programs 2012 Initiate a coordinated effort across all provinces and territories to sustain and increase the supply of available preceptors. NP programs 2013 Support preceptor preparation programs. NP programs 2013 Develop pan-canadian standards for NP distance education. CASN 2015 Explore innovative approaches to support collaborative programming and pursue and implement funding for such approaches. NP programs 2015 6 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada
Key Actions Lead/Support Timeline for Review Develop and offer interprofessional courses. NP programs 2015 Implement evidence-based student evaluation and testing methodologies. Establish a pan-canadian resource bank, including approaches and tools. Initiate investigations with schools to share tools/resources. NP programs 2012 CASN 2015 Promote infrastructure/technologies to support distance education. CNA/CASN 2013 Promote continuing education opportunities for NPs (e.g., NurseONE, Network News for associate and affiliate members and emerging groups, CNA webinars). CNA/CAAPN/associations 2011-2015 Licensure to Practice Implement cross-jurisdictional collaboration among schools and regulatory bodies to ensure that the license-to-practise process for NP students is supported by NP educational program content and teaching and learning processes. Regulatory bodies/np programs 2012 Transition to the Workplace Develop and implement processes and structures to facilitate the transition of NPs from their educational program to the workplace and from novice to expert. Regulatory bodies/np programs/ employers 2012 Establish mentorship and a mentorship culture as standard features of the NP learning experience. NP programs 2012 Develop strategies to increase clinical placement opportunities for NPs. NP programs 2012 Health Human Resources Key Actions Lead/Support Timeline for Review Pilot test the tool Guideline for HHR Planning for Primary Health Care Nurse Practitioners for content, relevance and usefulness. CNA 2012 Lobby for existing organizational and funding model options for NPs. CNA/CAAPN 2012 Develop a summary table listing NP salaries by province/territory. CNA/CAAPN/CNFU 2012 Develop fact sheets on the NP role specific to settings (e.g., emergency department, long-term care settings). Explore the feasibility of amending labour contracts to protect time for domains of the advanced nursing practice role (e.g., research, teaching). Develop or strengthen the capacity of existing F/P/T NP associations to provide professional networks and mentorship programs. Explore feasibility of adapting the document Achieving Excellence in Professional Practice: A Guide to Preceptorship and Mentoring (CNA, 2004) to the NP role. CNA 2012 CFNU/CNA 2015 CNA/CAAPN 2013 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada 7
Communication Key Actions Lead Timeline for Review Promote information about the NP role to consumers and the public. Develop and implement a communications plan on the NP role for the public, government and other health-care professionals. Create an understanding, acceptance and utilization of NPs to meeting health system priorities: chronic disease management, access and wait times. Regulatory bodies/associations/ CNA/CAAPN CNA/regulatory bodies/ associations CNA/regulatory bodies/ associations/caapn 2015 2011-2013 2011-2013 Build demand and support for NPs. CNA/CAAPN 2011-2013 Establish partnerships with nursing associations in the provinces/ territories in which the campaign will run. Conduct research to understand the specific health-care priorities and issues in each province/territory. CNA/CAAPN 2011-2013 CNA 2011 (ongoing) Develop campaign materials. CNA 2011-2012 Deploy campaign: Create a campaign website. Develop social media. Arrange meetings with key stakeholders. Develop and place ads, articles, posters. CNA 2011-2014 Solicit media/evaluate campaign. CNA 2015 8 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada
N E X T STEPS CNA is pleased to be working with the Office of Nursing Policy, nursing regulatory bodies and associations, the Canadian Association of Schools of Nursing and the Canadian Association of Advanced Practice Nurses on the continued integration of the NP role in Canada. It is essential that collaboration continues among key stakeholders for an optimal integration of the NP role in Canada. CNA is committed to leading, supporting and following the progress of the proposed actions identified in this report. Collaborative Integration Plan for the Role of Nurse Practitioners in Canada 9
R E F E R E N C ES Canadian Nurses Association. (2004). Achieving excellence in professional practice: A guide to preceptorship and mentoring. Ottawa: Author. Retrieved from http://www.cna-aiic.ca/ CNA/documents/pdf/publications/Achieving_Excellence_2004_e.pdf Canadian Nurses Association. (2006a ). Education framework for nurse practitioners in Canada. Ottawa: Author. Retrieved from http://www.cna-aiic.ca/cna/documents/pdf/publications/ cnpi/tech-report/section5/06_education%20framework.pdf Canadian Nurses Association. (2006b). Prior learning assessment and recognition framework for nurse practitioner education and regulation in Canada. Ottawa: Author. Retrieved fromhttp://www.cna-aiic.ca/cna/documents/pdf/publications/cnpi/tech-report/ section1/10_report_too5.pdf Canadian Nurses Association. (2009). Recommendations of the Canadian nurse practitioner initiative progress report progress report. Ottawa: Author. Retrieved from http://www.cna-aiic.ca/cna/documents/pdf/publications/cnpi_report_2009_e.pdf Canadian Nurses Association. (2010). Canadian nurse practitioner: Core competency framework. Ottawa: Author. Retrieved from http://www.cna-aiic.ca/cna/ documents/pdf/publications/competency_framework_2010_e.pdf 10 Collaborative Integration Plan for the Role of Nurse Practitioners in Canada
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