As nurse practitioners (NPs) who have worked across diverse settings and within a variety of interprofessional models to support the health of individuals and communities, we are deeply concerned about the current threats to Medicare. Canadians are anxious about the future of our health-care system, and so are we.
NPs are key contributors to the delivery of safe and equitable care across the Canadian health-care system. A role developed in the 1960s, NPs are licenced professionals who work in hospital and community settings, integrating advanced practice clinical skills to assess, diagnose and independently manage patient care. The NP role has been increasingly recognized as part of a solution to Canada’s long-standing shortage of primary-care providers to improve access and wait times, particularly in underserved populations and communities.
Despite these promising outcomes, only 3 million Canadians receive care from an NP, and the NP role remains poorly understood by the public at large.
Evidence demonstrates that NPs provide high quality, efficient and cost-effective care valued by patients, families and other health-care providers, yet the role remains vulnerable to shifting political contexts related to health-care reform. One example is the consistent lack of provincial funding for increased NP roles, particularly in rural and underserved communities. For example, the impact of Ontario’s 25 NP-led clinics has proven to be significant, creating greater access to primary health-care teams for tens of thousands. Increasing the number of NP-led clinics would help solve the primary-care crisis in Ontario.
NPs offer unique value within the health-care system and bring a perspective that unabashedly honours a 360-degree view of health, with patients and their social contexts at the centre. The core national values of the nursing profession remain steadfast in our daily work: honouring dignity; promoting justice, health and well-being; and providing safe, ethical and accountable care.
We argue that the development and sustainability of the NP role is a crucial component of a strategy to protect Canadian Medicare. Looking through a critical social justice lens, we believe Canadians are entitled to a health-care system that has the capacity to keep people well by linking collaborative care to social justice, equity and the determinants of health. We view health as a human right based on need and not the ability to pay, as harmonized nationally through federal law in 1984 through the Canadian Health Act.
Many are barely able to afford food, housing and medications let alone private health care.
In Ontario, many of us practice in provincially funded, salaried team models of care focused on achieving health equity for all Ontarians, including those who face high health risks because of poverty, housing and food insecurity, racism and the legacy of colonialism. Many of our patients are among those least likely to be rostered to dominant fee-for-service physician models because of their medical and social complexity. Many are barely able to afford food, housing and medications let alone private health care.
Medicare can provide access to equitable care regardless of the model of team-based care NPs work within. In August 2022, the Canadian Medical Association outlined solutions to address the current health-care crisis, including expanding team-based care and investing in training and education infrastructure to increase the supply of registered nurses, nurse practitioners and physicians. We believe these strategies can be effective if done collaboratively to bolster the responsiveness of our health-care system.
In Ontario, where we practice, the provincial government’s deconstruction of publicly funded health care has demonstrated its plan to make two-tier, private-pay care appealing to those who can afford it. We categorically reject any notion that health-system solutions are to be found in what the Ontario Health Coalition calls the “create-a-crisis-and-privatize” strategy the Ford government has used. To those concerned about emergency department wait times and even outright closures, any shift in our already scant health human resources toward privatization will exacerbate these problems and further erode public Medicare.
We call on NPs and the organizations that represent them to join with national and provincial allies demanding investment in a strong publicly funded health-care system that explicitly calls for equity-focused, primary-care models. NPs have excelled in these settings for decades and ought to be leading the fightback to save public health care and hold provincial governments to account for eroding it, consigning millions to second-class care.