Policy and Political Action

Policy & Political Action

Pre-Budget Consultation 2016 - Aric Rankin (Hamilton)

Good Afternoon:

My name is Aric Rankin. I am a nurse practitioner and I’m representing the Board of Directors of the Registered Nurses’ Association of Ontario (RNAO). We are the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. The region I represent includes Brant-Haldimand Norfolk, Hamilton and Niagara. I thank you for the opportunity to offer RNAO’s recommendations on two important issues facing nurse practitioners: 1) unfreeze NP compensation, and 2) implement immediate regulatory changes to authorize NPs to prescribe all controlled drugs and substances, including methadone, testosterone and suboxone.

Let me provide some background. The NP role was officially legislated in 1998, however, it was in existence for several decades before that. Nurse practitioners have an expanded scope of practice and hold either a Masters degree or postgraduate certificate. Before becoming an NP, one must have at least two years of clinical practice experience as an RN. In truth, the average NP has at least 16 years of clinical experience.

Thanks to RNAO’s evidence-based advocacy efforts, Ontario has established 26 NP-led clinics that are delivering comprehensive primary care to more than 40,000 Ontarians. At these clinics, NPs are the lead clinical providers and work in collaborative teams with registered nurses, pharmacists, social workers, dieticians and others. A physician is associated with the clinic for consultation. Physicians are on-site for a couple of hours every two weeks.

NPs also work in home care, hospitals, and nursing homes. I'm proud to say that Ontario was the first jurisdiction in North America to authorize NPs to admit, treat, discharge and transfer hospitalized in-patients; another achievement of RNAO working with policy makers and all political parties.

Indeed, the knowledge and skills of NPs have contributed substantively to improve timely access to quality care for Ontarians. But, we are not done yet.

Minister Hoskins has made his commitment to community care clear. He aims to advance person-centred care, home health care and primary care. However, there is a persistent challenge that is destabilizing the primary care workforce. Primary care NPs have had their salaries frozen for the past nine years at $90,000. When you take inflation into account, our salaries have actually dropped by 16 per cent. This makes retention and recruitment in primary care a huge challenge as we are not only competing with other jurisdictions like Alberta, where NPs have an average salary of approximately $120,000, but we are in competition for NP-expertise right locally with hospitals and CCACs paying much higher salaries and comprehensive benefits.

While primary care NPs have seen their compensation frozen, the Canadian Institute for Health Information reports that the gross pay of physicians in Ontario has actually gone up. In fact, between 2003 and 2013, physicians' wages jumped 61 per cent. How is that fair, I ask you?

Health Minister Eric Hoskins has promised to put patients first by improving access to care, connecting services, informing people and protecting our universal publicly funded health-care system. This plan sets the wheels in motion to make a complex health system easier to navigate and to help people get the care they need. RNs, NPs and nursing students are on-board. However, it is critical that we do justice for NPs, especially given that our role and accountability has grown exponentially and we are caring for Ontarians with the most complex health and social needs.

RNAO asks in the strongest possible terms, that this provincial budget include funding to eliminate salary and benefit inequities for primary care NPs. This recommendation is important as a standalone, and also given that the NP workforce is predominantly female and the government is currently conducting a review of the gender wage gap in Ontario and promising action. The time is now.

Our second ask relates to an outstanding gap in the care that NPs are able to provide to the people of Ontario. Since 2009, we’ve seen our scope of practice grow with the passage of Bill 179, enabling us to prescribe most medications. However, we are prohibited from prescribing controlled substances and this challenges our ability to deliver timely and appropriate pain management, especially for palliative clients. It limits our ability to lead harm reduction programs for those battling addictions. And, it prevents us from helping transgendered persons who need hormonal therapies. All of this conflicts with our evolving role and the expectations that come from being the most responsible provider for thousands of Ontarians. It also contradicts government agendas in areas such as harm reduction, gender identity justice, and palliative care.

In 2012, federal amendments authorized NPs to prescribe controlled substances. This was a big step forward and we anticipated regulatory amendments would follow suit in Ontario. In 2013 we were thrilled when, at RNAO’s Annual General Meeting, Premier Wynne committed to look at having NPs prescribe controlled substances. However, two years have gone by and we have seen no action.

Historically, Ontario has led the way through significant expansions to the scope of practice of NPs. But, we now lag behind other jurisdictions such as Alberta, Manitoba, Saskatchewan, and Nova Scotia, where NPs have that authority.

With enabling regulation to authorize prescribing controlled substances, NPs will contribute to decreasing health costs by reducing duplication and unnecessary referrals. It will also improve continuity of care and timely access to necessary treatment. Studies from the U.S. show that increasing NP prescriptive authority to include controlled substances results in positive outcomes including improved access to care and decreased costs.

Given the demonstrated positive impact of NPs on improving access to health services for Ontarians, RNAO calls for immediate regulatory changes to authorize NPs to prescribe all controlled drugs and substances, including methadone, testosterone and suboxone. It is time to bring the regulations up-to-date to reflect the comprehensive, safe and evidence-informed care that NPs consistently provide.

I thank you on behalf of RNAO for this opportunity to present our views to the Standing Committee, and I am happy to answer any questions you may have.

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Speaking Notes