The job: Nurse practitioner
The role: The role of a nurse practitioner falls somewhere between that of a registered nurse and that of a physician.
"As a nurse practitioner, they are authorized, independently, to prescribe most medications, to order laboratory tests, to order most diagnostic imaging tests, and in Ontario and some other provinces, they can admit and treat people in hospital," said Theresa Agnew, the executive director of the Nurse Practitioners' Association of Ontario.
A majority of nurse practitioners work in hospitals and community health centres, including some nurse practitioner-led clinics.
"We also have nurse practitioners working with the Department of Corrections, we have nurse practitioners in public health, working in universities and colleges, long-term care, we have nurse practitioners doing palliative care in the community, and we have nurse practitioners doing research and teaching," Ms. Agnew said. "In some provinces, they're really emphasized more on primary health care; in other provinces, like Quebec, they're emphasized more on acute care."
Education: In order to become a nurse practitioner, one must first obtain a bachelor of science degree in nursing, which is typically four years in length.
Graduates must then work for between two and five years as a registered nurse, depending on provincial requirements, before pursuing a degree as a nurse practitioner. The master's level designation is typically completed after a two-year program, and involves a mix of both in-class and on-the-job training.
"As a registered nurse, you would learn how to do a complete physical, but you might not apply that as much in your day-to-day work," Ms. Agnew said. "As a nurse practitioner, you would have to do a very detailed physical examination on infants, children, adults and the elderly."
After completing the master's program, students then must apply for certification through their provincial college of nurses or other regulatory body, and complete a written exam.
Salary: Since health care budgets are set at the provincial level and differ among various parts of the health care system, the salary of a nurse practitioner ranges between provinces as well as among health care settings.
As the province that first introduced the designation in the late sixties, Ontario is home to the largest population of nurse practitioners in Canada, with approximately 2,600 of the 4,000 working across the country. Among nurse practitioners in Ontario, 1,000 are employed by community clinics, representing one quarter of all nurse practitioners in Canada.
"The 1,000 working in the community clinics have had their wages frozen since 2006. They've had no increase," Ms. Agnew said. "In community clinics, the maximum a nurse practitioner can make is $89,203."
In comparison, those working in hospitals in Ontario, which make up another quarter of all nurse practitioners in Canada, earn between $90,000 and $120,000 a year.
Among the 1,400 nurse practitioners operating outside Ontario, salaries range from about $75,000 to $120,000, depending on province, employer and level of experience.
Job prospects: While Ontario is home to 65 per cent of nurse practitioners in Canada, Ms. Agnew believes the other provinces, which began their own nurse practitioner programs in the 1990s and 2000s, will soon strive to expand their programs as well.
"As they're implemented, I think that both the citizens of those provinces and the government see the incredible value that nurse practitioners provide, and the cost effectiveness," she said, adding that nurse practitioners are gaining attention as potential way to help cope with the challenges of an aging population and providing primary care to rural and remote parts of the country.
While other provinces are seeking to expand their nurse practitioner programs, Ontario will also require an influx of new entrants to take the place of a wave of retirees.
"We have more openings than we do graduates of the program in the community sector, hospitals and the long-term-care sector," said Ms. Agnew, referring to the job market in Ontario.
Challenges: One of the biggest challenges to nurse practitioners serving in community health centres in Ontario is undoubtedly the wage freeze that has held their salary steady for nearly a decade. Outside that group, Ms. Agnew says that the challenges of the job on a day-to-day basis are many, as nurse practitioners often work in areas where health care resources are most needed.
"Given the fact that these are highly educated, highly experienced health care professionals, they're often dealing with the most complex, complicated clients," she said. "We have a lot of nurse practitioners across Canada working with very marginalized communities or working with people with mental health problems and addictions. That's really challenging work."
Why they do it: Like many health care workers, nurse practitioners enjoy an intensely rewarding career that makes a significant impact on the communities they serve.
"I think the most satisfaction just comes out of being with a person and looking at them in a holistic way, really getting to know them as a whole person and making sure that they're connected to the appropriate services or clinical resources," Ms. Agnew said. "I think that's a part that people really love."
Misconceptions: While nurse practitioners have been operating in Ontario for more than 50 years and across the rest of the country for decades, many people are still unaware of the distinction between doctors, nurses and nurse practitioners.
"Not everyone understands the role," said Ms. Agnew, adding that nurse practitioners can, in most cases, provide the same care and resources as a physician, though they may also refer patients to a doctor or specialist if they are unable to provide the appropriate level of care.
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