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Nurse Practitioners

Page modified November 11, 2008

Practice Resources


Introduction

This section of the website provides an overview of legislation and provincial policy governing Nurse Practitioner (NP) practice in Ontario, as well as additional practice resources for NPs. This information complements the Nurse Practitioners practice standard. The College is not responsible for information provided by external organizations.


Ontario Drug Programs

Ontario Drug Benefit (ODB) Program

ODB provides drug benefits for eligible Ontarians. Prescriptions written by NPs and dispensed in Ontario are ODB-eligible. Prescriptions must include the NP’s College registration number.

The ODB formulary is regularly updated and published. Information about ODB and other Ontario public drug programs is available on the Ontario Ministry of Health and Long-Term Care website..

Limited Use Drugs

NPs may prescribe a limited use drug if the drug is on the NP drug list, the client satisfies ODB listed limited use criteria, and the NP writes the limited use code on the prescription. Limited use prescriptions must include a Limited Use/Nutrition Product Form that indicates the reason for use.

Information about limited use drugs is available here.

Individual Clinical Review (ICR)

ODB cannot accept an NP prescription under the ICR mechanism,1 even if the medication is on the NP drug list. However, ODB will reimburse clients when an NP renews the prescription if a physician provided the initial prescription under the ICR mechanism.

Information about ICR is available on the Ministry website.

1 The Ontario Drug Benefit Act limits this authority to physicians only.

Non-Prescription Drugs

Over-the-counter drugs are not included in the NP drug list. However, NPs can, in compliance with College practice standards, prescribe over-the-counter drugs covered through ODB or other insurance plans2 so the client can claim reimbursement.

2 Subject to insurer policies. Some drugs may require a physician’s prescription.


Ordering Laboratory and Diagnostic Tests

Provider Services Number

When ordering tests, NPs must include their provider services identification number on the requisition. This number authorizes the lab or diagnostic facility to bill the Ontario Health Insurance Plan (OHIP) for the tests. For more information or to obtain a provider services identification number, contact the Ministry at 1 800 268-1154 (416 314-5518 in Toronto) or visit OHIP’s website to download and complete the Registration for Regulated Health Professions form (No. 3384-83).

Following Up on Tests

NPs or employers should have protocols so that labs and diagnostic facilities can advise them of urgent client findings that may require immediate follow-up or urgent care.

Electrocardiograms

NPs can order electrocardiograms for clients in non-urgent or non-acute circumstances and have the tests interpreted by a qualified professional.

Assistive Devices Program (ADP)

The ADP helps eligible Ontarians with long-term physical disabilities access and pay for personalized assistive devices. The Ministry accepts NP authorization forms for enteric feeding and ostomy supplies. For more information, call the Ministry at 1 800 268-6021 (416-327-8804 in Toronto) or visit the Ministry website.

Home Equipment

When the equipment and supplies are available in a hospital and prescribed for a client by an NP employed by the hospital, OHIP covers the costs of:

  • home renal dialysis equipment/supplies;
  • home hyperalimentation equipment and supplies; and
  • haemophilia-related equipment/supplies

Ontario Disability Support Program (ODSP)

ODSP provides income and employment support to eligible Ontarians. When assessing an individual’s eligibility for income support, ODSP accepts an NP’s assessment of a client’s physical or mental impairment and the expected duration of that impairment. As well, NPs can complete an application for a special diet allowance for eligible recipients. For more information about ODSP, visit the Ministry website.

Hospital Privileges

NPs who are hospital employees can order laboratory and diagnostic tests and procedures, and prescribe medications for hospital outpatients only.3 NPs who are not hospital employees may be permitted to send their clients to a local hospital for outpatient diagnostic procedures and laboratory tests.4 Regulation 965 under the Public Hospitals Act specifies that the hospital’s Medical Advisory Committee (MAC) can make recommendations to the board regarding appointing and granting privileges to NPs who are not hospital employees.

The hospital’s MAC is responsible for making recommendations to the hospital board related to the overall supervision and quality of the practice of NPs who are not hospital employees, but have been granted hospital privileges.

3 To provide those services for hospital in-patients, NPs must use an authorizing mechanism such as a medical directive.

4 For a list of approved diagnostic procedures and laboratory tests, see www.cno.org/for/rnec/index.htm.

Rehabilitative Services

When NPs refer eligible Ontarians to hospital outpatient clinics, OHIP covers the costs of occupational, physiotherapy and speech therapy services. NPs can also refer clients to community rehabilitation clinics, but financial coverage for the client is subject to third-party insurance policies.

Parking Permits

NPs and other recognized health practitioners can complete the Application for Accessible Parking Permit form (SRLV-129 07-08) for clients. The form is available on the Ministry of Transportation website and at any ServiceOntario driver and vehicle licence issuing office.

Medical Certificates of Death

The provincial Vital Statistics Act gives NPs the authority to complete a Medical Certificate of Death (Form 16) in specific circumstances. This certificate is part of the death registration form and is an important legal document detailing the fact of and circumstances of death. NPs can complete a Medical Certificate of Death of the deceased when:

  • the NP had primary responsibility for the deceased’s care;
  • the death was expected;
  • a documented medical diagnosis of a terminal disease had been made by a medical practitioner;
  • there was a predictable pattern of decline; and
  • no unexpected events or complications arose.

An NP had primary responsibility for the deceased’s care when she or he had an established therapeutic nurse-client relationship with the client and provided care to the client either independently or as a member of a team of health care providers. NPs should not sign the Medical Certificate of Death for clients they did not care for, did not have contact with or did not know.

Unexpected events or complications that arose during the last illness of the deceased include death caused by an accident such as a fall or an unanticipated adverse drug reaction.

When NPs are unsure if the circumstances surrounding the death of the client were unexpected, they must consult with a physician.

Prior to signing a Medical Certificate of Death, NPs must read and follow the instructions in the Handbook on Medical Certification of Death from the Office of the Registrar General.

Consulting Physicians with Restricted Licences

It is common for NPs to work with a physician who has a restricted licence. For example, international medical graduates or physicians in the process of obtaining certification may have a restricted licence. The terms and conditions of the restrictions are specific to each physician.

Physicians with a restricted licence are fully qualified to practise medicine, but are responsible for practising within any terms, conditions and limitations that the College of Physicians and Surgeons of Ontario has placed on their practice. They are also responsible for determining any individual liability issues that may arise.

NPs can consult with a physician whose licence is restricted and are not responsible for interpreting any terms, conditions or limitations on a physician’s practice.

Workplace Safety and Insurance Board

The Workplace Safety and Insurance Board (WSIB) recognizes NPs as service providers. To bill WSIB, NPs must obtain a WSIB provider identification number, available by calling WSIB at 416 344-4526 or 1 800 569-7919, or by completing this on-line form. For further information, please contact WSIB.

Immunization of School Pupils

Under the Immunization of School Pupils Act, NPs are authorized to complete a statement of medical exemption that exempts a child from a childhood immunization required for school attendance in Ontario. The conditions under which an exemption may be provided are:

  1. the immunization may be detrimental to the health of the client (i.e., the child is known to be allergic to a substance in the vaccine); and
  2. the immunization is unnecessary because the client is already immune (i.e., there is laboratory evidence of immunity).

Click here for the provincial schedule of childhood immunizations and the medical exemption form (form 1).

Emergency Infection Kits for NPs

As part of its pandemic planning initiative, the Ontario Ministry of Health and Long-Term Care is offering eligible Nurse Practitioners (NPs) an emergency infection control kit.

The kits can be used to provide the first line of defence during a large-scale infectious disease outbreak, such as an influenza pandemic. It’s designed particularly for settings that do not have everyday access to infection control supplies and equipment.

Each kit comes in a sealed box and contains 10 days of infection control equipment such as gowns, gloves and masks that can be used in an outbreak of a droplet-spread disease. The ministry recommends that all health care facilities and services maintain a one-month supply of personal protective equipment.

To receive a kit, an NP must:

  • be in good standing with the College;
  • practise in a setting that is not directly affiliated with or located in a hospital, long-term care facility, family health clinic or correctional facility; and
  • practise in a setting that is not located in the same office with a physician who previously received a kit.

To view the order form, visit www.health.gov.on.ca/login and enter the password regeick08 for English, and regeickf08 for French. You do not have to be a member of the NPAO to access this information.

 

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