APN Role Exists in Country Today:
Clinical Nurse Specialist
Recognize Foreign Licensure:
Initially, the APN role started in the 1970s (Sheer & Wong, 2008). It was after individuals from new Nurse Practitioner programs in 1973 in Ontario banded together to create the Nurse Practitioners’ Association of Ontario, that they began to develop a presence and push for a recognized role in Canada (Sheer & Wong, 2008). While the role was minimal initially, it wasn’t until the 1990’s with additional health care reform that Nurse Practitioners became more prevalent in Canada (Pulcini, Jelic, Gul, & Loke, 2009). The role was initially designed to meet the primary health care needs of the country (Pulcini et al., 2009). Since that time, the role of Advanced Practice Nursing (APN) in Canada is represented by Nurse Practitioners and Clinical Nurse Specialists.
More prevalent and increasing in number is the Nurse Practitioner role in Canada. The CNA (2013a) identifies, “Nurse practitioners provide direct patient care, focusing on health promotion and the treatment and management of health conditions. They have an expanded scope of practice and can diagnose, order and interpret diagnostic tests. They can also prescribe medications and perform certain procedures.”
The role of the Nurse Practitioner in Canada does allow for significant autonomy, as is regulated according to province. Recently, there has been an emerging trend of Nurse Practitioner-Led Clinics in Canada greatly fostered by the desire to meet the primary care needs of Canada, fostered by the developed role of the Nurse Practitioner in the country (DiCenso et al., 2010). While autonomy is available for Nurse Practitioners in Canada, the majority are employed as a part of practices with physicians (DiCenso et al., 2010). Such clinics have currently been developing or already functioning in the provinces of Manitoba and Ontario (Krahn, 2013; Adler, 2013).
Clinical Nurse Specialist
According to the Canadian Nurses Association (CNA, 2013a), “Clinical nurse specialists provide expert nursing care and play a leading role in the development of clinical guidelines and protocols. They promote the use of evidence, promote expert support and consultation, and facilitate system change.”
Essentially, the role of the CNS does not have any expounded role to that of Registered Nurses and as a result, there is no further legislation required to identify the role of the CNS, and resultantly the title is not protected. According to DiCenso et al. (2010) there have been reports of varying levels of practice, to the point that individuals have been observed to very limited prescribing rights in isolated situations (DiCenso et al., 2010). As a result, there is significant room for role clarity in the future.
Education and Certification
To become a Nurse Practitioner (NP) in Canada, an individual must be minimally educated at the graduate level and pass the Canadian Nurse Practitioner Exam written by the Canadian Nurses Association (2013a). Additionally, NPs are then required to hold a license in the province they desire to practice (Robinson & Griffiths, 2007).
As the Clinical Nurse Specialist (CNS) is inconsistent, there has been efforts to distinctly separate the NP and CNS roles in education. However individuals who are identified as CNSs are educated at the graduate level, holding a masters or doctorate degree (Robinson & Griffiths, 2007).
Certification for nursing specialties is an optional certification available to nurses after two years of clinical experience. Once qualified, an individual is required to take a certification exam in the specific specialty desired. This role requires an individual to be a Registered Nurse (RN) and does not require graduate level education.
Nurse Practitioner specialties are primarily not offered throughout the various schools of advanced nursing practice in Canada, as most individuals receive generalist NP degrees (DiCenso et al., 2010). There are several exceptions, primarily in neonatology throughout Canada, and in Quebec where specialty roles are offered in cardiology, nephrology, and neonatology.
Adler, M. (2013, September 20). Hong Fook Nurse Practitioner-Led Clinic welcomed in Agincourt. Scarborough Mirror. Retrieved from: http://www.insidetoronto.com/news-story/4116601-hong-fook-nurse-practitioner-led-clinic-welcomed-in-agincourt/
Canadian Nurses Association [CNA] (2013a). Nurse Practitioner and Clinical Specialists. Retrieved from: http://www.cna-aiic.ca/en/professional-development/nurse-practitioner-and-clinical-specialists
Canadian Nurses Association [CNA] (2013b). Position Statement: Advanced Nursing Practice [Electronic document]. Retrieved from: http://www.cna-aiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/23/ps60_advanced_nursing_practice_2007_e.pdf
Delamaire, M. & Lafortune, G. (2010). Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries. OECD Health Working Papers, 54, OECD Publishing.http://dx.doi.org/10.1787/5kmbrcfms5g7-en
DiCenso, A., Bourgeault, I., Abelson, J., Martin-Misener, R., Kaasalainen, S. …Kilpatrick, K. (2010). Utilization of nurse practitioners to increase patient access to primary healthcare in Canada–Thinking outside the box. Nursing Leadership (Toronto, Ontario). 2010, 239-259.
Krahn, H. (2013, September 25). Letters to the editor: Fragmenting a workable system. Winnipeg Free Press. Retrieved from: http://www.winnipegfreepress.com/opinion/letters_to_the_editor/fragmenting-a-workable-system-225147162.html
Pulcini, J., Jelic, M., Gul, R, & Loke, A.Y. (2009). An international survey on advanced practice nursing, education, practice, and regulation. Journal of Nursing Scholarship, 42(1),31-39. doi: 10.1111/j.1547-5069.2009.01322.x
Robinson, S. & Griffiths, P. (2007). Nursing education and regulation: International profiles and perspectives [online publication]. Retrieved from:http://eprints.soton.ac.uk/348772/1/NurseEduProfiles.pdf
Sheer, B. & Wong, F.K. (2008). The development of advanced nursing practice globally. Journal of Nursing Scholarship, 40(3),204-211.