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The impetus for the introduction of CNS roles arose after World War II, when the shortage of skilled nurses and progressive developments in healthcare science and technology led to the need for more advanced and specialized nursing roles and nurses with the knowledge and skills to support nursing practice at the bedside. An educator interview participant from Quebec comments:
Nursing mentorship essay - Osprey Observer
They [NPs] were part of solutions for other problems, for example, if there were times of shortages in primary care physicians and those sorts of things. When we got to the '90s, we recognized through a number of reports that there needed to be revitalization of primary care and that advanced practice roles may well be an important part of increasing access to primary care. Then the nurse practitioner program was reintroduced.
Supporting students to learn is an important function for both educators and practitioners and thus teaching, assessing and mentoring are fundamental aspects of nurses' roles and responsibilities.
Nursing mentorship essay - Selfguidedlife
The first wave that the government allowed was in neonatal ICU, cardiology/cardiovascular and nephrology, and the reason why those were chosen versus let's say something like primary care was because politically it was a specialist in the university teaching hospitals who wanted, who really backed the support of advanced practice nurses and lobbied within their associations and at a larger collective with the government to say, we absolutely need these people… on the other hand, the group of family practice professionals here in Quebec opposed the NPs.
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I think there's absolutely no question that the nurse practitioner role, and particularly in NICU, has been very positive. I mean it's only enhanced the quality of the care that the infants receive; it's enhanced the continuity of care that the infants receive; it's enhanced the linkages and support, education and emotional support with families; and it's assisted in developing probably better collaboration among the teams and all of the disciplines that work [there].
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Prior to 1998, all acute and primary care NPs working in Canada utilized medical directives or care protocols, under the delegation of physicians, to perform the competencies of their training that were beyond the scope of a registered nurse. In 1998, the first legal recognition for NP scope of practice began with legislated authority for primary care NPs in Ontario (CIHI and CNA 2006). Many jurisdictions implemented regulations for both PHCNPs and specialty/ACNPs at the same time (i.e., Alberta, British Columbia, Manitoba, Newfoundland, and Nova Scotia). Each jurisdiction provided the authority whereby the ACNP's professional scope of practice was defined (CIHI and CNA 2006). However, there were many barriers to practice. For example, the Public Hospitals Act in Ontario prohibited NPs from admitting or discharging a patient. Because of the Act, ACNPs in Ontario require medical directives even with regulation of their role. Jurisdictions where ACNPs have not been regulated require medical directives, negotiated at the institutional level, for ACNPs to carry out extended controlled acts. In most provinces and territories, successful completion of a national (or in some cases provincial) examination is a requirement for NP licensing. Currently the CNA offers examinations for family/all-ages (PHCNPs), adult NPs and pediatric NPs (for more information see ). Eligibility of candidates and permission to take these exams are determined by provincial/territory regulatory bodies. In Quebec, NPs must have a specialty certification in order to practise.
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The introduction of the ACNP role in neonatology in Ontario was based on a comprehensive research program (DiCenso 1998) that began with a needs assessment (Paes et al. 1989). This was followed by surveys to delineate the role (Hunsberger et al. 1992), evaluations of the graduate-level education program (Mitchell et al. 1991, 1995), a randomized controlled trial to evaluate the effectiveness of the role (Mitchell-DiCenso et al. 1996a) and assessments of team satisfaction with the role (Mitchell-DiCenso et al. 1996b). A healthcare administrator interview participant adds,