Although the first nurse practitioner program in Canada began in 1967, advanced practice nursing remains in a near-constant state of change as legislative and regulatory bodies, universities, and professional nursing organizations work towards a uniform definition of the advanced practice nursing role and strive to build a framework that supports the full integration and sustainability of advanced practice nursing. It is innovative healthcare collaborators, such as advanced practice nurses, who are poised to meet the challenges of an evolving healthcare system.
In order to optimize the contribution that nursing has made to healthcare and address the issues of rising healthcare costs, shortages of medical professionals, and limited access to care, the role of the advanced practice nurse is now being expanded and clearly defined. According to the Canadian Nurses Association (CNA), the advanced practice nursing professional has clearly defined professional roles, which include direct patient care, research, education, consultation, collaboration, and leadership activities.
Canada currently recognizes two advanced practice nursing roles: Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS). The International Council of Nurses defines individuals in both of these roles as registered nurses who have an expert knowledge base, complex decision-making skills, and clinical competencies for expanded practice. As advance practice nurses build upon expertise in specialty areas by applying the theoretical, empirical, ethical, and experimental foundations of nursing, they are equipped to provide effective and efficient care to an identified population; demonstrate leadership to improve client, organization, and system outcomes; and integrate in-depth nursing knowledge, research, and discipline to improve access to quality care.
The Canadian Nurses Association (CNA) notes that the advanced practice nurse is an umbrella term for a nursing professional who has achieved a graduate-level education, and who has the in-depth nursing knowledge and expertise to meet the health care needs of individuals, families, communities, and specific patient populations.
The Nurse Practitioner (NP) is a registered nurse with a graduate degree in nursing who provides direct care for health promotion and the treatment and management of health conditions. Canada recognizes the nurse practitioner (NP) in the following specialties: primary healthcare NPs (PHCNP) and acute care NPs (ACNP).
Nurse practitioners diagnose illnesses, order and interpret diagnostic tests, prescribe pharmaceuticals, and perform specific procedures within their scope of practice. PHCNPs work in such locales as community healthcare centers, primary healthcare settings and long-term care institutions. The focus of the PHCNP is on health promotion, preventative care, treating and diagnosing acute illnesses and injuries, and overseeing and managing stable chronic diseases. ANCPs are specialty NPs who may serve a specific patient population. They provide care to individuals who are acutely, critically or chronically ill, often working in in-patient settings, such as neonatology, nephrology, and cardiology units.
Clinical Nurse Specialist
A Clinical Nurse Specialist (CNS) is a registered nurse with a graduate degree in nursing and expertise in a clinical nursing specialty. The CNA notes that CNSs contribute to the development of nursing knowledge and evidence-based practice while addressing complex healthcare issues for patients, families, administrators and policy makers. In particular, CNSs are essential for the development of clinical guidelines and protocols and the facilitation of system change.
The CNS specializes in a specific nursing practice that is often defined by patient population, setting, or medical subspecialty, such as family, adult, community and mental health.
The educational standard for NPs and CNSs in Canada is a graduate degree in nursing. It is the graduate education that allows advance practice nurses to analyze and synthesize knowledge and understand, interpret, and apply nursing theory and research.
The CNA notes, however, that advanced practice nurses cannot assume their practice is at the advanced level based on education alone. Instead, it is the graduate education and clinical experience that prepare nurses to practice at an advanced level. Because advanced practice nursing is dependent upon clinical practice, nursing professionals must assume that clinical practice is a significant part of their advanced practice role.
Two national consensus frameworks have been developed: The CNA’s Advanced Nursing Practice: A National Framework and the Canadian Nurse Practitioner Core Competency Framework to provide further guidance for the development of educational courses and requirements, research concepts, and government position statements regarding advanced practice nurses.
Because the NP is considered a separately legislated role in Canada, all educational programs for NPs must achieve formal approval by provincial and territorial regulating nursing agencies. As such, it is quite common to find disparities among approved educational programs between territories or provinces. In particular, there are inconsistencies among core graduate theoretical courses, clinical experiences, and length of programs.
Likewise, the CNA notes that the responsibility for developing CNS roles lies with the universities, and it is up to them to provide curricula based on the competencies of advanced nursing practice. Although many universities have graduate programs to prepare for advance practice nursing, none have specific CNS programs. There is no certification or protective titling for CNSs in Canada; therefore, it is often challenging to find common threads in educational and clinical experiences.
These challenges have highlighted the need for national curriculum standards and one, consistent core curriculum for both NP and CNS programs in Canada. The CNA notes in their Advanced Nursing Practice: A National Framework that a “coordinated national approach [would] permit flexibility among provinces and territories and allow new roles to develop.” In short, a well-defined national approach to advanced practice nursing is necessary to ensuring that high-quality nursing services are available and consistent across the country.
CNA Nurse Practitioner Exam Program
The Canadian Nurses Association, through the CNA Nurse Practitioner Exam Program, offers the following exams that are administered by most provincial and territorial regulatory authorities:
Canadian Nurse Practitioner Examination: Family/All Ages
The Canadian Nurse Practitioner Examination: Family/All Ages (CNPE: F/AA) is administered by provincial and territorial nursing regulatory authorities through the CNA.
The CNPE: F/AA, which is offered twice a year, includes a framework of 42 competencies within four categories:
- Professional role, responsibility and accountability
- Health assessment and diagnosis
- Therapeutic management
- Health promotion and the prevention of illness and injury
American Nurses Credentialing Center (ANCC): Adult and Pediatric Nurse Practitioner Exam
The ANCC Adult NP Exam and the Pediatric NP Exam are not taken for credentialing or certification purposes in Canada. Instead, they provide a comparable exam to the CNPE: F/AA that NPs can take electively.
Entry Requirements for Advanced Practice Nurses
Because Canada does not currently have a national curriculum or consistent standards regarding advanced practice nursing, all advanced practice nurses must meet the individual requirements set forth by the provincial or territorial regulatory nursing body where they are practicing. In general, a graduate education, as well as writing and passing an exam through the CNA Nurse Practitioner Exam Program and registering with the appropriate territory or province is required to practice as an advanced practice nurse in Canada.
Find Your Province
- British Columbia –The College of Registered Nurses of British Columbia (CRNBC) recognizes the nurse practitioner.
- Alberta – The College and Association of Registered Nurses of Alberta recognizes the nurse practitioner in one of three categories (streams): Family/All Ages, Adult, and Child/Neonatal.
- Saskatchewan – The Saskatchewan Registered Nurses Association recognizes the nurse practitioner in four categories: Adult, Neonatal, Pediatric and Primary Care.
- Manitoba – The College of Registered Nurses of Manitoba recognizes the nurse practitioner, which is synonymous with the title of Registered Nurse Extended Practice.
- Ontario – The College of Nurses of Ontario recognizes the nurse practitioner.
- Quebec- Ordre des infirmières et infirmiers du Québec recognizes the nurse practitioner in the following specializations: neonatology, nephrology, cardiology, and first-line care.
- New Brunswick – The Nurses Association of New Brunswick recognizes the primary healthcare nurse practitioner.
- Nova Scotia – The Colleges of Registered Nurses of Nova Scotia recognizes the nurse practitioner in the following four categories: Family/All Ages, Adult, Pediatrics and Neonatal.
- Prince Edward Island – The Association of Registered Nurses of Prince Edward Island recognizes the nurse practitioner.
- Newfoundland and Labrador – The Association of Registered Nurses of Newfoundland and Labrador recognizes the clinical nurse specialist and the nurse practitioner in three categories: Primary Healthcare, Adult and Pediatric.
- Northwest Territories and Nunavut – The Registered Nurses Association of Northwest Territories and Nunavut recognizes the nurse practitioner.
- Yukon – The Yukon Registered Nurses Association recognizes the nurse practitioner.