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History of the Nurse Practitioner in Saskatchewan The 1970s The role of the Nurse Practitioner (NP) in Saskatchewan has its roots in the remote north, where nurses in isolated nursing stations have practiced an expanded RN role since the beginning of modern Canadian history. Where there was often no physician, nurses diagnosed, performed and ordered lab tests and x-rays, as well as treated most illnesses and injuries. The authority for the expanded RN role was, and in many cases is still, through delegation of medical function. A need was identified for independent primary care practitioners to serve the rural relatively isolated communities in southern Saskatchewan. The Saskatchewan Nurse Practitioner Demonstration Project was developed collaboratively by a Joint Committee of many health and government sectors. Funding was announced by the Minister of Health in June, 1973. The College of Nursing accepted the role of creating the six month post-masters of nursing program in order to prepare four experienced nurses to function independently and collaboratively in primary care. The nurses would also provide monitoring, continuing care and health supervision to patients and families. The program focused on a physical exam and assessment skills, expanded knowledge of treatment and referral procedures. A high priority was put on development of clinical judgment, and on increasing the nurse’s confidence for the independent role that this form of nursing practice requires. Professional responsibilities, counseling and health education were emphasized throughout a wide range of clinical experiences. The four nurse practitioners worked in three southern agricultural communities and one Métis region including three villages. They were responsible for providing diagnostic, treatment and preventative services within the framework of nursing, medical and pharmaceutical guidelines, and the objectives and standards of the project. They maintained careful statistics, as well as collected qualitative and quantitative data. Despite positive evidence of cost effectiveness, full utilization, high quality of care, competent clinical performance evaluation and record audits, and responsiveness to community needs, the project was droppedin October of 1976. The 1990s By the 1990s, there still was no legislation supporting the Nurse Practitioner title or role. Nurses continued practicing advanced clinical nursing, still almost exclusively in the north, by transfer of medical function. "Health reform" discussions were starting to talk about strengthening primary health care and optimizing the skills of all health professionals. Expanding the role of nurses is one aspect of this health reform. A need was identified for a comprehensive program to prepare RN’s to fill this role. Another multi-disciplinary/multi-sectoral committee – working with partners including the Saskatchewan Institute of Applied Science and Technology (SIAST) Wascana – created the two-year, post-RN, Advanced Clinical Nursing program. The program had much of the content of the "Project" program in the 70’s, with strength in clinical care. The first graduates were in 1994. The program has been responsive to the changing legislation and regulation, and to employer and communities needs and has evolved and expanded to become the Primary Care Nurse Practitioner Program. This is the only approved NP program in Saskatchewan. 2000 By 2000, there was now work towards creating the title of Nurse Practitioner. The advanced clinical nurses were now dubbed Primary Care Nurses. This label also helped promote the movement towards primary health care reform, at least in theory. Some people still use these terms interchangeably; but, despite overlap in the roles, there is a difference. In Saskatchewan, a Primary Care Nurse is a nurse who provides both primary health care and primary care, and obtains the privileges of diagnosing, prescribing and ordering tests and x-rays by transfer of medical function. The Nurse Practitioner’s authority is by virtue of his or her RN (NP) license. The Advanced Clinical Nurse graduates had few employment options other than the north. Saskatchewan Health was offering resources and a primary care nurse position to Physician practices who tried to meet the government definition of a primary care team. 2001 In January of 2001, the Saskatchewan Registered Nurses Association (SRNA) created Nurse Practitioners of Saskatchewan, a special interest group of the SRNA for nurses working in expanded practice. This was mainly for Nurse Practitioner students and licensed R.N.-N.P.’s. As a result of the initiative, drive and resolve of Heather Keith, R.N., the inaugural meeting of the NPOS was held in Prince Albert, Saskatchewan. The NPOS has played an important role in moving to the historic licensing of the Nurse Practitioner by the Saskatchewan Registered Nurses Association. After much consultation and input from all stakeholders including many nurses, the Amendments to the RN ACT, 1988, Section 24, enabled the regulation of the RN (NP) role within Saskatchewan. The most important phrases are: "a) order, perform, receive and interpret reports of screening and diagnostic tests that are designated in the bylaws b)prescribe and dispense drugs ... c) perform minor surgical and invasive procedures... d) diagnose and treat common medical disorders" The amended act opened further consultative work on the SRNA bylaws which took two years to complete. 2003 In April of 2003, the Canadian Nurses Protective Society increased the limit of assistance to NP’s without increasing fees, based on the record of safe NP care with no NP claims. The Canadian Nurses’ Association was granted a portion of the federal primary health transition fund to facilitate integration of the NP into the health care system, to create mechanisms and processes to support the integration and to sustain the NP role. The Canadian Nurse Practitioner Initiative (CNPI) was formed to avoid the fizzle and neglect of NP’s that happened in the 1970’s. Many of Saskatchewan’s RN’s and NP’s participated in the CNPI interviews, focus groups, stakeholder meetings, etc in the process of creating the CNPI. In October, the SRNA released the "Registered Nurse (Nurse Practitioner) Standards and Core Competencies" after much inter-jurisdictional and member consultation to reflect practice, client needs, and fit with national competencies In 2003, potential NP’s currently working in primary care nurse roles began a lengthy process of application for approval. 2004 In March, potential NPs received a letter from SRNA acknowledging receipt of all the necessary documentation application for RN(NP) license, with only one final form to complete and return to SRNA! In April, the final status of NPs was close but still delayed pending Cabinet approval of the Attending Health Professionals Regulations and amendments to:
April 30, 2004 about 10 AM All the required bylaws were proclaimed law in Legislature with key SRNA personnel in attendance! |
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