History of the Nurse Practitioner in Saskatchewan
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.
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.
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
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.
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,
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
"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.
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.
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:
- The Drug Schedules Regulations, 1997
- The Hospital Standards Regulations, 1980
- The Housing and special care Homes Regulations
- The Medical Laboratory Licensing Regulations, 1995
- The Saskatchewan Aids to Independent Living Regulations, 1976
- The Saskatchewan Assistance Plan Supplement6ary Health Benefits
- The Saskatchewan Medical Care Insurance Payment Regulations, 1994
April 30, 2004 about 10 AM All the required bylaws were proclaimed
law in Legislature with key SRNA personnel in attendance!