Integration of Nurse Practitioners into the Alberta Healthcare System

The March 2015 Rural Health Services Review Final Report clearly stated that Albertans are struggling to obtain access to essential healthcare services. Feedback provided by Albertans, documented in the report, identified that Albertans support the implementation of Nurse Practitioners as an approach to improving access to essential healthcare services.

In Alberta, Nurse Practitioners are Master’s and PhD prepared autonomous health professionals who provide essential healthcare services grounded in professional, ethical and legal standards. Nurse Practitioners integrate their in-depth knowledge of advanced nursing practice and theory, health management, health promotion, disease/injury prevention, and other relevant biomedical and psychosocial theories to provide comprehensive health services.

From a funding perspective, Nurse Practitioners are labelled as a member of a multi-disciplinary team, as opposed to a primary care provider like a physician.  Therefore, while physicians are paid directly by the Alberta Health Care Insurance Program for services they provide, Nurse Practitioners are paid out of the budget for a hospital, clinic, or primary care network.  As a result, about 60 percent of Alberta's approximately 500 Nurse Practitioners are employed by Alberta Health Services in hospital settings. In contrast, throughout Canada, about 66 percent are employed in community settings and only 24 percent work in hospitals.  Municipalities have identified the opportunity to increase the number of Nurse Practitioners in rural/small community settings to improve access to healthcare. Providing a more flexible funding model would support the longer-term integration of nurse practitioners throughout the province.

AUMA’s advocacy on Nurse Practitioners started with a resolution adopted in 2015, Promoting the Use of Nurse Practitioners within the Alberta Healthcare System, which called for the Government of Alberta to allocate funding to models of remuneration that support the integration of nurse practitioners within the Alberta healthcare system.

Since 2015, the province has provided grants and developed programs related to Nurse Practitioners.  For example, in 2016, the province launched the $10 million Nurse Practitioner Demonstration Project, which explored the increased use of Nurse Practitioners in primary health care.  Based on the success of the four demonstration project sites, the province launched a Primary Care Network Nurse Practitioner Support Program in March 2019 to provide $38.5 million over three years in Primary Care Networks to support Nurse Practitioners currently working within the networks, as well as to hire 50 more Nurse Practitioners over two years.

AUMA staff recently contacted Alberta Health and obtained confirmation that the PCN Nurse Practitioner Support Program continues under the current provincial government with the level of funding maintained for the 2019-2020 fiscal year. However, Alberta Health staff indicated that funding levels for future fiscal years are uncertain at this time, though continued funding is assured for any Nurse Practitioner positions already created under the program.

The programs that the province has implemented related to Nurse Practitioners to-date have primarily benefitted metropolitan areas and have not focused on increasing the use of Nurse Practitioners in smaller and rural communities. In addition, small communities have identified that grant funding has not been sufficient to support deployment of Nurse Practitioners throughout Alberta.  Instead, there is a need for an ongoing sustainable funding model that more permanently ensures the integration of Nurse Practitioners into Alberta’s healthcare system,  as a whole. 

Legislation provides a further barrier to the integration of nurse practitioners, which the province has started taking steps to address In June 2020, Alberta Transportation amended the Operator Licensing and Vehicle Control Regulation to authorize Nurse Practitioners to complete driver medical examinations. Allowing Nurse Practitioners to complete driver medical examinations is not a change in their responsibilities, as the tasks they complete when assessing a driver’s medical fitness are already within their regulated scope of practice under the Health Professions Act. There are more opportunities for the Government of Alberta to remove legislative  barriers as part of its ongoing Red Tape Reduction Initiative.

For more information on Nurse Practitioners, see the Nurse Practitioners Association of Alberta and Alberta Health Services websites.