The theme of this year’s National Nursing Week — “the power of nurses to transform health” — feels especially fitting, with the transformative impact nurses made during the pandemic still resonating today.
Nurses have increasingly stepped into leadership roles within hospitals, clinics and long-term care settings, taking on more responsibility for patient assessment, care coordination and health promotion. Nurse practitioners (NPs), in particular, have become essential primary and preventative care providers, often serving as patients’ first point of contact.
In the past few years, the scope of practice for every category of nursing has evolved: changes for registered practical nurses (RPNs) in 2023; changes for registered nurses (RNs) in 2024; and changes to the NP scope coming this year.
In July, the Ontario government will implement further scope-of-practice changes impacting the province’s nurses. NPs will have the authority to order and apply a defibrillator in the event of a cardiac arrest, order and apply a cardiac pacemaker, order and perform electrocoagulation, and certify a death in more circumstances. RNs will also be able to certify a death when it is expected.
CEO of the College of Nurses of Ontario, Silvie Crawford, said this evolution is a significant step forward. “The expanded scope of practice has the potential to drive efficient health service delivery, enhance health care outcomes, and increase access to quality care for patients,” Crawford said.
According to Michelle Acorn, the CEO of the Nurse Practitioners Association of Ontario, the scope-of-practice expansions for NPs relating to ordering and implementing defibrillators and cardiac pacemakers will be important for nurse practitioners working in hospital settings or emergency departments.
Acorn said the scope-of-practice expansions are necessary to enhance NPs’ abilities to provide timely and comprehensive care across various practice settings. She underscores the significance of the role NPs already play in the province’s health-care system, saying, “We need to shift the focus from nurse practitioners as clinicians to recognize them as health-care leaders.
“We can leverage their expertise to drive system improvements, patient or resident outcomes and organizational effectiveness,” said Acorn. “Nurse practitioners have the specific clinical background, education and training to take on leadership roles within the health-care system, and they’re particularly suited to lead professional teams.”
A strong example of that leadership in action is evident in the province’s 27 Nurse Practitioner-Led Clinics (NPLCs), where NPs are the lead providers and responsible for the full spectrum of care — from assessment and diagnosis to treatment and monitoring.
Leanna Lefebvre is a primary care nurse practitioner and lead of the North Muskoka practitioner-led clinic in Huntsville, Ont. She said the clinic’s goal is to help people who would otherwise not have access to primary care. With approximately 2.5 million Ontarians without a primary health-care provider, Lefebvre said expanding NPs’ scope of practice isn’t just sensible — it’s essential to addressing the care gap.
“Since I started working as a nurse practitioner 16 years ago, we’ve had several scope expansions,” she said. “They’ve provided various tools that have really helped people get the care they need when they need it.”
Lefebvre said she is proud of what NLPCs have accomplished for the province. “They’re so successful,” she said. “And the province has a great opportunity to start looking at how to expand them across Ontario so that more communities can be served.”
For educators of the province’s future nurses, serving as the bridge between policy changes and frontline readiness means ensuring the next generation of nurses is not only qualified, but empowered to meet the province’s evolving health-care needs.
Victoria Smye, board chair of the Ontario Primary Health Care Nurse Practitioner (PHCNP) program, a nine-university consortium, said universities and colleges have a key role in helping drive meaningful change across the entire health-care system.
“There’s a real transformative power in advanced practice nursing,” said Smye, director and professor at Western University’s School of Nursing. “Advanced practice nurses are not only focused on individual patient care — they’re also engaged in leadership, policy, practice and research. As a collective, they can create opportunities for change in our health-care system.”
