Integration of Nurse Practitioners into the Alberta Healthcare System

Resolution Category Strategic Initiatives B10
Subject Social
Year 2020
Status Adopted - Expired
Sponsor - Mover
AUMA Board of Directors
Active Clauses

IT IS THEREFORE RESOLVED THAT the AUMA advocate for the Government of Alberta to remove the legislative and funding barriers that impede greater integration of nurse practitioners into the healthcare system.

Whereas Clauses

WHEREAS Nurse Practitioners are expert clinicians with advanced training, who are able to provide comprehensive primary, acute and specialty health care;

WHEREAS smaller municipalities in Alberta experience challenges accessing essential healthcare services and therefore need access to alternative options to a traditional physician-oriented service delivery model;

WHEREAS the Government of Alberta recognizes the potential of Nurse Practitioners in meeting the healthcare needs of Albertans and saving the healthcare system money;

WHEREAS current provincial grant funding programs for Nurse Practitioners are short term and do not address the broader funding models that create a barrier to greater integration of Nurse Practitioners into the healthcare system; and

WHEREAS provisions in the Mental Health, Vital Statistics and Nursing Home Acts, further prevent Nurse Practitioners from providing services they are qualified to conduct.

Resolution Background

The March 2015 Rural Health Services Review Final Report clearly stated that Albertans are struggling to obtain access to essential healthcare services. Feedback provided by Albertans, documented in the report, identified that Albertans support the implementation of Nurse Practitioners as an approach to improving access to essential healthcare services.

In Alberta, Nurse Practitioners are Master’s and PhD 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 health 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 a hospital, clinic, or primary care network.  As a result, about 60 percent of Alberta's approximately 500 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 support the longer-term integration of nurse practitioners throughout the province.

AUMA’s advocacy on Nurse Practitioners started with a resolution adopted in 2015, Promoting the Use of Nurse Practitioners within the Alberta Healthcare System, 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 a Primary Care Network Nurse Practitioner Support Program in March 2019 to provide $38.5 million over three years in Primary Care Networks to support Nurse Practitioners currently working within the networks, as well as to hire 50 more Nurse Practitioners over two years.

AUMA staff recently contacted Alberta Health and obtained confirmation that the PCN Nurse Practitioner Support Program continues under the current provincial government with the level of funding maintained for the 2019-2020 fiscal year. However, Alberta Health staff indicated that funding levels for future fiscal years are uncertain at this time, though continued funding is assured for any Nurse Practitioner positions already created under the program.

The programs that the province has implemented related to 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 provides a further barrier to the integration of nurse practitioners, which the province has started taking steps to address In June 2020, Alberta Transportation amended the Operator Licensing and Vehicle Control Regulation to authorize Nurse Practitioners to complete driver medical examinations. Allowing Nurse Practitioners to complete driver medical examinations is not a change in their responsibilities, as the tasks they complete when assessing a driver’s medical fitness are already within their regulated scope of practice under the Health Professions Act. There are more opportunities for the Government of Alberta to remove legislative  barriers as part of its ongoing Red Tape Reduction Initiative.

For more information on Nurse Practitioners, see the Nurse Practitioners Association of Alberta and Alberta Health Services websites.

Government Response

The resolution was sent the Minister of Health, and cc’d to the Ministers of Labour and Immigration and Municipal Affairs, on November 20, 2020.  The Minister of Health responded on June 14, 2021 highlighting the 2019 launch of the Primary Care Network Nurse Practitioner (NP) Support program and the more recent funding commitments made to sustain this program. The Minister indicated that Alberta Health would be reviewing the program and forming recommendations for future strategies, and the Provincial Primary Care Network Committee's Rural Sustainability Primary Care Task Force, established in 2020, would be providing recommendations by March 31, 2022 related to improving rural primary care, including the use of NPs.   

Alberta Municipalities notes

Intent partially met 

On October 8, 2023, the Minister of Health announced a new funding model that would allow Nurse Practitioners (NPs) to direct bill and give them the ability to open up their own clinics. The province promises a $2- million grant over the next three years to implement the compensation model and encourage NPs to open their own clinics. The Nurse Practitioners Association of Alberta (NPAA) is currently negotiating with the Provincial Government and gathering further specifics of how this plan is set to unfold. ABmunis will have a clearer understanding of these changes in the coming months.  

Although the Minister of Health's initial response did not address removing legislative barriers for NPs, the Government of Alberta did, in addition to the other actions the Minister noted, make some legislative changes that enable NPs to make their expertise more available to Albertans. These legislative changes 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.  

ABmunis sent a follow-up letter to the Minister of Health in October 2021 acknowledging the actions taken by province that align with the objective of the resolution and encouraged Alberta Health to continue to engage with stakeholders like ABmunis and the NPAA.  

ABmunis administration periodically connects with representatives of the NPAA to discuss our resolution, any remaining legislative barriers to integration, and steps that both organizations are taking to promote the greater integration of NPS into the health care system. Representatives of NPAA’s Board attend an ABmunis Small Communities Committee meeting annually to provide an update on their advocacy work.  

NPAA shared that they have been in ongoing discussions with Alberta Health about a sustainable compensation model that would not be grant-based and would enable NPs to work in independent practice. They also confirmed that many legislative barriers to fuller integration of NPs into the health care system have been removed and advised that the province has scanned all health care legislation to find language that would limit NPs authority to practice in a manner that is equivalent to physicians.  

While this resolution has expired.  A similar resolution was adopted at the 2023 convention.