The number of nurse practitioners has more than doubled over five years, including a 25-per-cent jump in a single year, newly published data show.
At the end of 2010, there were 2,486 NPs practising in Canada, up from 1,129 in 2006, according to the Canadian Institute for Health Information.
"The trend is really positive but there are some concerns," Claudia Mariano, president of the Nurse Practitioners' Association of Ontario, said in an interview.
The vast majority of NPs – registered nurses with additional, master's-level training that allows them to diagnose patients, provide some forms of treatment, refer patients to testing and prescribe some medications – practise in Ontario. In the province, NPs are an integral part of primary care reform and a move to team-based medical practice.
Of the 2,486 nurse practitioners in Canada, 1,482 work in Ontario. Quebec, the next most populous province, has only 64 NPs, while B.C. has 129 and Alberta 263. Yukon is the only jurisdiction that does not license NPs.
Policy makers believe NPs can improve access and reduce costs by doing work that was once the sole purview of physicians. NPs are especially popular in rural and northern regions where there are shortages of family doctors, and with patients who suffer a multitude of chronic illnesses and are ill-suited for a traditional seven-minute doctor's appointment.
But the data reveal that NPs are actually leaving community-based practice to work in hospitals and long-term care.
"Primary care is traditionally where NPs practise," said Ms. Mariano, who is part of the West Durham Family Health Team in Pickering, Ont. "But the pay is low and the benefits are poor so nurse practitioners are taking jobs where there is more job security, a better paycheque and things like a pension plan."
In hospitals, NPs work principally in emergency departments, where they do triage and handle less acute cases, or they oversee clinics that treat patients with chronic illnesses such as diabetes, or provide dialysis or cardiac rehabilitation.
Judith Shamian, president of the Canadian Nurses Association, said she is happy to see the number of NPs increase but is concerned about trends not captured in the numbers.
Twenty-eight nursing schools offer nurse practitioner programs and they graduate almost 400 students annually. But existing rules in many provinces don't allow NPs to work to the full scope of practice, meaning they can't prescribe drugs, order tests or discharge patients as they can in Ontario.
"We are graduating more but the jobs aren't there because the provinces haven't changed their practices and their legislation," Dr. Shamian said. "We have too many unemployed NPs in Canada and that doesn't make sense when almost five million Canadians don't have a primary care provider."
The CIHI report shows that the nursing work force continues to grow steadily. At the end of 2010 there were 354,910 regulated nurses.
Nurses work in three main professions, which have different educational requirements and scopes of practice. They include:
* 268,512 registered nurses (including nurse practitioners)
* 81,224 licensed practical nurses
* 5,174 registered psychiatric nurses, a designation that exists only in Western Canada.
"The demographics of nursing are always evolving and changing, said Carole Brulé, manager of health human resources at CIHI.
She noted, for example, that graduating nurses are now, on average, age 30, which suggests many have studied or worked in other areas before turning to nursing. It also reflects the fact that many nurses with diplomas are now returning to school to get baccalaureate or master's degrees, or doctorates.
One of the most worrisome trends, Dr. Shamian said, is that more than one in four nurses is Canada is now over age 55, which could translate into a massive wave of retirements in the coming years.
"Once the economy improves, a lot of people will start to retire," she said. "We need a better age distribution, we need to attract some younger people to nursing."