What do nurse practitioner-led clinics mean for health care in Alberta?
Provincial funding changes will make it easier for nurse practitioners to open clinics independently, increase care
Nurse practitioners (NPs) will be able to open their own publicly funded clinics as soon as the new year, according to a recent provincial announcement.
The new clinics will help combat the lack of access to primary health care in the province—an estimated 600,000 Albertans do not have access to a regular health-care provider.
But what do these changes mean for the 800 licensed nurse practitioners in the province, and for Albertans in need of primary care access? We talked to nurse practitioners and Athabasca University (AU) professors Dr. Jennifer Knopp-Sihota and Dr. Jennifer-Lynn Fournier for insight.
Both professors teach in AU’s nurse practitioner programs in the Faculty of Health Disciplines, which educates more nurse practitioners than any other Canadian program. More than a third of all Canadian nurse practitioner graduates are AU alumni.
What are nurse practitioners, and how can they fill gaps in care?
Nurse practitioners are highly experienced registered nurses with graduate education and training in advanced clinical practice. They can diagnose illnesses, prescribe medication, order and interpret tests, and perform procedures that are beyond the scope of registered nurses.
Knopp-Sihota said all nurse practitioners start off as registered nurses, where they build their foundational knowledge and practice a specialty.
Advancing to a nurse practitioner requires graduate-level education, often a master’s degree, with an 800-hour minimum critical component with direct clinical experience.
“Nurse practitioners are all very experienced nurses,” said Knopp-Sihota. “Most nurses come in with about 10 years of experience, though, and a specialized area.
Knopp-Sihota explained that nurse practitioner education builds on a student’s experiences as a registered nurse. They spend hours training in courses that cover care across the lifespan, from pediatrics all the way up to older adults. Specialities such as maternity, mental health, and men’s and women’s health are also covered in detail.
“Nurse practitioners are all very experienced nurses. Most nurses come in with about 10 years of experience, though, and a specialized area”– Dr. Jennifer Knopp-Sihota, professor in the nurse practitioner program at AU
Can NPs work fully independently?
While Alberta is making it easier for nurse practitioners to open their own clinics, similar models have been in place for several years elsewhere in Canada.
In 2007, Fournier was part of the first nurse practitioner-led clinic in Canada, in Sudbury, Ont., and explained that they can work fully independently and function to full scope. At that location, nurse practitioners worked to full scope independently, offering primary health care to patients of all ages.
She said the provincial changes coming in Alberta should make it easier for nurse practitioners to offer primary health care to Albertans when and where they need it most.
“Nurse practitioner-led primary health care will increase the number of Albertans connected to a regular primary health-care provider.”
Knopp-Sihota agreed, and added that nurse practitioner’s scope of practice is determined by regulation, as well as experience and education.
“In those instances, they would just have to refer the patient to a specialist or family physician, similar to what a family physician would do.”
“Nurse practitioner-led primary health care will increase the number of Albertans connected to a regular primary health-care provider.”– Dr. Jennifer-Lynn Fournier, AU professor and NP part of the first nurse practitioner-led clinic in Canada, in Sudbury, Ont
How much interest is there among your NP colleagues to set up their own clinics and do you think the government’s plan is sufficient?
Knopp-Sihota and Fournier both said that there is significant interest from nurse practitioners to open their own clinics.
“I’ve been a nurse practitioner for over 20 years and we have literally been working on this need for different funding models for 20 years,” said Knopp-Sihota. “We would need to see more concrete plans, but it’s definitely a step in the right direction.”
She explained that the nurse practitioner workforce is only growing. Even though they are trained in primary care, most nurse practitioners work in acute care, such as hospitals, and would welcome new opportunities to enhance access to primary health care for Albertans.
“There are currently just no jobs in primary care, so there is a huge need and interest.”
Fournier explained that AU graduates are trained and prepared to work independently and within interdisciplinary teams in rural and urban areas.
“AU’s new nurse practitioner program graduates will be prepared to set up and deliver primary health-care services where they are needed most,” she said.
“There are currently just no jobs in primary care, so there is a huge need and interest.”– Dr. Jennifer Knopp-Sihota
Can NP clinics help alleviate pressure on primary care, and are Albertans ready?
Knopp-Sihota said nurse practitioner clinics could certainly alleviate pressure on primary care in Alberta, and that Albertans are ready for the change.
Sending patients who don’t have a primary care provider to emergency departments, as often is the case, is certainly not the solution, she said.
“It gives me goosebumps just thinking about how bad it is now for people with no provider. I think Albertans will be ready for it.”
Though some Albertans may not understand the profession, feedback from patients who’ve seen a nurse practitioner is always positive, she added.
“Nurse practitioner clinics can augment and provide options for patients.”
Some physicians have criticized that nurse practitioner clinics could lead to more fragmentation and silos between health professions. What’s your view?
Knopp-Sihota said there are more than enough patients to go around. Nurse practitioners are trained to work in an interdisciplinary way, and research shows team-based care works best.
“I don’t think nurse practitioners are trying to take over. We’re just trying to augment, add choice and give Albertans the opportunity to have a provider and then they can make the decision.”
Fournier added that nurse practitioner-led clinics can be part of the health-care solution for rural areas.
“Sometimes there’s a nurse practitioner that happens to live in an area where there aren’t any other primary care providers available,” she said.
“Once a primary health-care provider opens practice in an underserviced area, it is common for other professionals—like dietitians, registered nurses, counsellors, and other specialized clinicians—to join the team and show interest in collaboration, especially if their roles can be publicly funded. Co-location of these professionals leads to good collaboration and more seamless care for patients.”
“Once a primary health-care provider opens practice in an underserviced area, it is common for other professionals—like dietitians, registered nurses, counsellors, and other specialized clinicians—to join the team and show interest in collaboration.”– Dr. Jennifer-Lynn Fournier
AU a leader in nursing education
Did you know that AU has the largest nurse practitioner program in Canada and educates more undergraduate nurses than any other Canadian nursing school? In fact, AU’s undergraduate enrolment in nursing increased by more than 200% between 2019-22.
“AU is distinctive within Canada, and within nursing programs in Alberta and Canada. That 200% increase is really driven by the high quality of our programs and the online, open, flexible approach is really driving this growth,” said Dr. Alex Clark, AU president.