Integration of Nurse Practitioners into the Alberta Healthcare System

In Alberta, Nurse Practitioners have Master’s degrees or PhDs and, as such, are 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 primary health care services. For more information on Nurse Practitioners, see the Nurse Practitioners Association of Alberta (NPAA) https://albertanps.com/about-npaa/what-is-an-np/ and Alberta Health Services (AHS) https://www.albertahealthservices.ca/info/Page7903.aspx websites.

The March 2015 Rural Health Services Review Final Report https://alberta.cmha.ca/documents/rural-health-services-review-final-re… clearly stated that Albertans are struggling to obtain access to essential healthcare services. Feedback provided by Albertans, which is documented in the report, identified that Albertans support the implementation of Nurse Practitioners as an approach to improving access to essential healthcare 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 an AHS hospital or clinic, or a Primary Care Network (PCN). As a result, about 60 percent of Alberta's Nurse Practitioners (i.e. 500 out of approximately 800 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 enable Nurse Practitioners to practice in community-based clinics and support the longer-term integration of Nurse Practitioners throughout the Province.

ABmunis’ advocacy related to Nurse Practitioners started with a resolution adopted in 2015, Promoting the Use of Nurse Practitioners within the Alberta Healthcare System https://auma.ca/advocacy-services/resolutions/resolutions-index/promoti…, 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 the Primary Care Network Nurse Practitioner Support Program in March 2019 to provide $38.5 million over three years to Primary Care Networks to support Nurse Practitioners currently working within the networks, as well as to hire 50 more Nurse Practitioners over two years. Despite the passing of the intended end date of the Support Program (which was extended into 2022-23) grant funding for Nurse Practitioners continues to be provided to PCNs, while they negotiate a future funding model with Alberta Health. 

The funding programs that the province has implemented to support 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 limiting Nurse Practitioner authority to provide primary care has been a further barrier to the integration of Nurse Practitioners into the healthcare system. The province started taking steps to address these legislative barriers in June 2020. Changes made to legislation include:
•    Updating ambulance regulations to allow NPs to work as medical directors and provide real-time medical advice to paramedics.
•    Allowing NPs to act as independent primary care providers in nursing homes.
•    Authorizing NPs to complete driver medical examination forms.

Allowing Nurse Practitioners to take on these roles and complete these tasks is in line with their typical responsibilities, as they are already within their regulated scope of practice under the Health Professions Act. Any remaining legislation that limits the ability of Nurse Practitioners to practice as primary health care providers should be identified and amended. 

ABmunis administration and the Small Communities Committee regularly connect with representatives of the NPAA to discuss alignment of advocacy, any remaining legislative barriers to integration, and steps that both organizations are taking to promote the greater integration of Nurse Practitioners into the health care system.