Not only is the role of the nurse practitioner continuing to expand in Ontario, so are the opportunities in the province as the country grapples with an overwhelming demand on health services.
The provincial government recently announced that, as of this summer, nurse practitioners will be able to order and apply a defibrillator to someone in cardiac arrest as well as a cardiac pacemaker.
They will also be able to order and perform electrocoagulation used to treat skin conditions and lesions, such as skin tags.
And they will be able to certify a death in more circumstances, improving the end-of-life experience for families.
“It’s seemingly a newer thing, but it’s been around for quite some time,” says Wendy McCrady, nurse practitioner at the Georgian Nurse Practitioner-Led Clinic.
During her 25 years as a nurse practitioner, McCrady has certainly seen the expanded use of nurse practitioners in Ontario, largely in response to the challenges many face accessing heath care.
She is one of eight nurse practitioners at the clinic, which is based near Barrie’s Royal Victoria Regional Health Centre (RVH) and also has a second location in Innisfil.
The clinic’s roster of patients is increasing to a total of 6,400 through Health Care Connect to provide health services to those without a family practitioner.
McCrady worked as a nurse for 10 years before returning to school to become a nurse practitioner, which was not yet licensed at the time.
Now, says McCrady, who was coordinator of Western University’s nurse practitioner program, registered nurses are required to work at least two years before they can start their master’s degree to become a nurse practitioner.
In the consortium of nine universities, excluding the University of Toronto, the number of students graduating from Ontario nurse practitioner programs has climbed to 250 per year from about 100 in the late 1990s, she says.
During her 25 years, McCrady has seen the role expanded, allowing nurse practitioners to prescribe medications and work in various areas of medicine.
“I’ve always worked in primary health care,” she says. “We do a lot of the same thing as doctors would do.”
But the approach is often different, as nurse practitioners have more time with patients to discuss issues. They also continue to use physician consultants who can sign off on bone scans, which is one of the few things that nurse practitioners can’t do.
Over at RVH, Lindsay Bruer works as an alternate level of care hospitalist helping patients who are considered medically stable, but are unable to leave the hospital due to functional or cognitive concerns.
Bruer began working as a registered nurse in 2014 in labour in delivery at the North York General Hospital and four years later found herself in the University of Toronto Masters in Nursing program, earning her nurse practitioner certificate.
In 2021, after working in long-term care, she joined the Barrie hospital and now works primarily with geriatrics, treating chronic diseases and doing a lot of palliative care, in which she also has a certificate.
She has developed a particular passion for palliative care, given the philosophy behind it is to focus on the whole person. And that involves understanding an individual and their wishes as they deal with cognitive impairment like dementia and heart failure.
“Often times with my patients with cognitive impairment that means a heavy involvement in families … how can we best treat them with their wishes,” says Bruer, adding that nurse practitioners are able to spend more time with their patients. “Offering palliative care services, it makes such a difference for patients and families, to be able to acknowledge what’s happening and be able to live their out final days, months, years in a way that people want to by honouring their wishes.”
That extra time up front can save time down the road, as the information she obtains early on helps to inform future decisions, ensuring that the patient is best served.
Bruer says she didn’t start in nursing to become a nurse practitioner; that came after she worked as a registered nurse who wanted to have more autonomy in her work.
Nurse practitioners bring a unique blend of expertise and compassion to patient care to the hospital, says Leanne Weeks, RVH's vice-president, clinical and chief nursing executive.
“From assessing and managing chronic conditions to promoting wellness and guiding patients through the complexities of the health-care system, they play a pivotal role in delivering accessible, patient-centred care,” she says. “Many of our nurse practitioners also mentor and educate the next generation of health-care providers, fostering a supportive environment of learning at RVH.”
Morgan Krauter, who serves as the lead nurse practitioner for the heart function program, started her nursing career in Ottawa as registered nurse in the cardiac renal floor in 2020. Three years later, she went into the nurse practitioner master’s degree program at the University of Toronto.
“I got into nursing with the goal of being a nurse practitioner,” says Krauter. “I was in the early wave of someone entering the practice with the goal of being a nurse practitioner.”
Throughout her nursing career Krauter has focused on cardiac care, from her bedside work as a registered nurse on the ward and then to the critical care ward.
Within that, she’s become particularly interested in the area of heart failure which is a mix of older people with end-stage heart disease and young people having had an acute event and looking at advanced therapies such as a heart pump or heart transplant.
“Those are the ones who tug onto the heart strings the most, patients who are admitted into the intensive care unit with a long-standing history of cardiac disease,” Krauter says, adding many of the interventions involved are uncomfortable for people.
She completed part of her cardiology and heart failure training at the University of Ottawa Heart Institute, followed by a placement at Southlake hospital in Newmarket where she found a healthy family of nurse practitioners who provided positive mentorship and coaching as well as cardiologists.
After working at the heart-failure program working with acutely ill people as well as palliative care, she took on the role to develop and help grow the nurse practitioner-led heart function program at RVH in Barrie, where she was living.
Three years ago, she started the Doctor of Nursing program at the University of Toronto and is on track to graduate this year. Her thesis involves integrating hospital-based heart-failure care into the community, helping to support people to live well at home receiving supports to reduce their need to go to hospital.
The program, she says, is the first of its kind in Canada and is an alternative academic route to the PhD program and is more oriented to knowledge translation or implementation science and how issues work in the real world in the local health-care system.
“I can’t imagine a situation that I was not looking after people day-to-day — that’s truly important to me,” says Krauter, adding she wants to build upon what she is doing now.
The recent announcement for expansion means that nurse practitioners can continue to provide independent and autonomous care, reducing the time it takes to access special interventions.
“I think it introduces a lot of opportunities … to address the lag times,” says Krauter.