The PharmaBrands Podcast

Dr. Michelle Acorn, CEO of the Nurse Practitioner Association of Ontario on the Growing Role of NPs in the health System.

• Propeller Events • Season 2 • Episode 6

Share episode

Dr. Michelle Acorn, CEO of the Nurse Practitioners' Association of Ontario on the growing role of NPs in the health system.

Nurse Practitioners are a growing, and increasingly funded part of the care system in Ontario. In this episode Michelle shares her views on the evolving role of NPs as both clinicians and clinical leaders, and gives some sage advice to industry on how best to engage with this important community.

Our Producer is Darryl Webster with Chess Originals

Speaker 1:

I am Dr Michelle Acorn. I'm a doctor of nurse practitioner and I am the chief executive officer for the Nurse Practitioner Association of Ontario, celebrating my one-year anniversary with you Well happy anniversary. Is it actually?

Speaker 2:

today Like is this the celebration?

Speaker 1:

It's pretty close. It's this week, yes.

Speaker 2:

We've had an odd run of guests who are recording an episode with us very, very close to an anniversary, so I'm happy to keep that run going.

Speaker 1:

Congratulations on your anniversary.

Speaker 2:

I'm going to use that as my jumping off point, because I'd love to know a little bit more about your background. I know that before this you were actually doing something similar overseas, so maybe give us a bit of your background and orient us to what you've been up to in your career.

Speaker 1:

I have had such a career trajectory. I have been a nurse for over 35 years, so prior to coming to become the CEO for the Nurse Practitioner of Association, I was the inaugural international council of nurses chief nurse. So what that means is I've represented, with over 135 national nursing associations and the 29 million nurses across the world, high, middle and low income countries. Working with the international council of nurses on socioeconomic conditions, regulation, scope of practice, working with the World Health Organization, the United Nations, to improve health equity, access to care and the professional recognition and respect and safety and protection for nurses.

Speaker 2:

Wow, and that was in Zurich, the International Council of Nurses right.

Speaker 1:

The headquarters was in Geneva, switzerland, and I did that for almost three years, neil, and then, actually prior to that, for nearly three years, I was the provincial chief nursing officer for the government, for the ministries of health and long-term care, and are you still practicing? So I still practice. Prior to that, I should say, actually, I was with Lake Ridge Health and I was a nurse practitioner for over 30 years, including the clinical lead, professional practice leader and the most responsible provider. It's interesting when you say, do you still practice, neil, because it comes down to a value proposition. Nurse practitioners are clinicians, but they're also leaders, educators, researchers and quality improvers. If your question is do I still practice clinically on top of my executive leadership role? Yes, I do.

Speaker 2:

I have to imagine that moving from being in a clinical setting and being a clinician moving into the boardroom was a pretty big shift. Tell me a little bit about what that transition was like.

Speaker 1:

Great question, neil. It's interesting when we reflect. It's from the bedside to the classroom, to the boardroom and beyond locally, nationally, provincially and globally as well. It was a huge transition for me because I identify as a clinician and I still do. I had a history of implementing the first nurse practitioner roles in my hospital as an emergency nurse practitioner, as a hospitalist, punting into geriatrics and also starting the first nurse practitioner-led hospital from a mission to discharge by a nurse practitioner as well, celebrating almost 30 years of improving access to care and innovating models of care delivery as well. So to transition over to executive leadership, you feel like a bit of an imposter. However, we do have the competencies, the knowledge, skill and judgment, the expertise and thought leadership and the on-the-ground boots-on-the-ground experience, as well as how to navigate the healthcare system that's very complex and represent our patients, our residents and our citizens' needs to improve access to care and to have nurse practitioners to be able to be enabled and empowered to offer full scope of services.

Speaker 2:

It feels like a shockingly small number of nurse practitioners in the province of Ontario. I think there's around 5,400, if I'm not mistaken, and I think there's 132,000 nurses, so a small portion there's talk of nurse practitioners can be an absolutely key lever in addressing a whole bunch of issues, including access to care. Give me a sense of what your key priorities are, maybe as the president or the executive of the Nurse Practitioners Association of Ontario. What are the biggest jobs to be done? Do you feel in the world of leadership in nurse practitioners?

Speaker 1:

Thanks for the question, neil. I'm going to ask. Answer the question specifically on the nurse practitioner in numbers. I think that's some first of importance and then punt over to the priorities. You did identify correctly there's over 5,400 nurse practitioners in Ontario, but did you know, for example, it has had exponential growth, more investments by the government as well, and we have more than 50% of nurse practitioners across Canada from Ontario as well. According to the Canadian Institute of Health Information, we have a 10% annual increase of nurse practitioners, as well as nurses in the most trusted profession as well.

Speaker 1:

So for the priorities of the Nurse Practitioners Association of Ontario we represent we're a nurse practitioner association with over 50 years of experience, since 1973. And it's nurse practitioners representing nurse practitioners who work in primary, secondary and tertiary care. We were founded to actually function and our mandate is ensuring that we're integrated across the entire healthcare system. I think that's important. We think about primary care, where you have 28 nurse practitioner-led clinics and hopefully more coming. They're in family health teams, they're in Aboriginal health centres, community health centres, hospitals, long-term care and corrections.

Speaker 1:

So the first priority is full integration across the entire health care system. The second one is actually flexible funding mechanisms and ways of working and maybe we can talk about the exciting announcements that are coming up that have just been announced the last week on the Canada Health Act interpretation letter. The third thing is actually equitable compensation and funding. It's not harmonized across sectors and it really impacts health workforce recruitment and retention, respect and recognition for the bucket of services that nurse practitioners deliver, recognized as clinical leaders, not just as clinicians. We have that value add. We can inform and build on team capacity and system capacity. And the last one would be enhancing data collections for health outcomes. Specifically, as a good example, you have 2.5 million people Statistics are showing that do not have access to a primary care physician. However, the language should be, respectfully, that they do have access to a family physician or a nurse practitioner, but they do not capture data that they are attached to a nurse practitioner when many are.

Speaker 2:

Oh, interesting. Ok, because I saw that stat and that that number is predicted to double in the next two years.

Speaker 1:

Yeah, so we have nurse practitioner that are actually the most responsible provider, that work within healthcare teams that are delivering care, but they're not captured in the data that show that patients are attached, or residents or Ontarians are attached, or Canadians to that matter as well.

Speaker 2:

Is that simply a system issue, where systems need to be updated so that data can be connected, or is there something bigger, more complicated, in being able to track and connect back that an Ontarian is being serviced and supported by a nurse practitioner?

Speaker 1:

It's a bit of a complex question, as you're aware. I think this is shifting from traditional models of care and traditional data collection. Are we capable of capturing this Absolutely? Is the information there? It can be. However, traditional methods of collecting have been physician-centric and focused in this area. Collecting have been physician-centric and focused in this area. As we know, we can actually track information out for prescribing of pharmacists quite equally. So I think it's based on the value, the priorities and alignment with the priorities across the system as well.

Speaker 2:

Is it partly a hangover from a time when it was really considered that physicians were the only sort of primary care practitioner?

Speaker 1:

And part of it and you can track it back on how physicians are remunerated and why that flexible funding mechanisms for nurse practitioners is sentinel right now, so that we could collect that information as well.

Speaker 2:

You primed me with my next question, which is let's talk about some of the exciting announcements that have just happened in our upcoming oh, I'm just.

Speaker 1:

I'm so ecstatic, to be honest with you. We're celebrating that nurse practitioners have been included in the Canada Health Act interpretationpretation Letter. This is a significant win for Ontarians, canadians, nurse practitioners and access to universal health care, and it represents a culmination of years of leadership and advocacy by the Nurse Practitioner Association and nurse practitioners and patients and citizens across the landscape as well. This is huge. Right now, we really welcome the release of the Canada Health Act Interpretation Letter that clarifies that nurse practitioners must be included, and the letter also underscores the importance of provincial governments' immediate implementation of robust, sustainable funding mechanisms to support nurse practitioners as key members of the healthcare workforce.

Speaker 2:

And practically for those of us, including your friendly host who may not be intimately familiar with the Canada Health Act, is the biggest practical implication of that inclusion being funding.

Speaker 1:

Absolutely funding so by April 1st 2026, and that's not April Fool's, this is about health, this is no joke that they do need access and services that are delivered, that are deemed medically necessarily and are publicly covered in. That funding will encapsulate nurse practitioner service delivery and must be remunerated so that patients do not pay out of pocket. There's no user charges for them if they're medically necessary and there's some teeth behind this policy. It doesn't amend the Canada Health Act, it modernizes it and it shows that provinces and territories need to expedite reimbursement measures and funding measures for nurse practitioners to be able to deliver these services.

Speaker 2:

How are we doing in Ontario with respect to supporting, promoting, increasing the numbers of nurse practitioners compared to other provinces? And then, when you sat on the ICN, are there other countries that you look to where you say, well, they're really, really doing it well and we need to catch up.

Speaker 1:

To country X Ontario has been a leader and needs to celebrate a few things for nurse practitioners. First of all, they were the first to implement the 25 nurse practitioner-led clinics that are publicly funded, led by nurse practitioners, the governance and representation on the board were more than 50% nurse practitioners that changed the traditional models of care and they looked after patients that are orphaned or unattached did not have access to a primary care provider. The Ontario government also should be applauded as they've increased the scope of practice for nurse practitioners in terms of access to controlled drugs and controlled acts. So it used to be list-based prescribing. Now it's full prescribing, including controlled drugs and substances such as opioids, narcotics, marijuana, for example, as well across all health promotion and prevention medications and chronic diseases. They're able to emit, treat and discharge from hospitals. They can be attending nurse practitioners in long-term care. You see the recent announcement that they are being considered and it's gone to second reading that they can be medical directors or clinical directors in long-term care as well, as a good example. So Ontario has been leading that and funding a lot of positions, but there's still an opportunity for more funding.

Speaker 1:

The thing about Ontario and nurse practitioners that people need to realize is their primary care providers, specialty care providers in primary, secondary and tertiary settings, and they're autonomous and independent. They can refer to physicians. They don't need to be supervised as well, so that is a big difference. If you compare to our cross-border colleagues in the United States, they have a lot more nurse practitioners specifically, but they do not all have full practice authority across all the states, so some need to be in collaborative practice environments or supervised as well, so that's a big difference. Globally, there's pockets of advanced practice nursing that are happening but, again, not a true delineation of nurse practitioners that are title protected. There's some great work that's being done in the United Kingdom as well as Australia and a few others, but many of our colleagues are actually connecting with us at the Nurse Practitioners Association of Ontario and we're helping to shape them. We had colleagues that just came from New Zealand, for example, to shadow with us as well, and they're doing some great work with nurse practitioners as well.

Speaker 2:

For a number of years I was on the marketing side on agencies and occasionally targeting nurse practitioners was part of the strategy, but often HCP was really synonymous with physician as opposed to physician and nurse practitioner. So how have you seen industry engage with the 5,400 nurse practitioners in Ontario and have you seen that change?

Speaker 1:

I'm happy to celebrate some change. I've had excellent relationship with industry over the years. However, I think it's sometimes culturally based and knowledge based and understanding what the full scope of practice is, what the model of care is and how you actually ensure you're using inclusive language. A good example is if you go to a nurse practitioner-led clinic and you're detailing and you ask to speak to the doctor and it's a nurse practitioner-led clinic. Or when you go to some of the family health teams and you ask to speak to the doctor and it's both nurse practitioners and physicians and interprofessional team. That can really affect the relationship as they don't feel included and respected as well, even in the detailing opportunities.

Speaker 1:

I was invited with PAB, p-a-b and I spoke in Toronto and Montreal to educate.

Speaker 1:

You know, talk to your healthcare provider versus talk to your doctor, and it's interesting because I know a lot of the pharmaceutical industry who are excellent at supporting education. They track the data on physician prescribing practices and many are not aware and we've been trying to work with the Nurse Practitioners Association. Is there access to nurse practitioner prescribing data or you could also for ordering of devices or things like that as well. There's that opportunity to do that and shape that notice as not best practice. I would recommend that when you're actually doing education webinars, you actually have a shared webinar presentation or also led by nurse practitioners as well. I think that really helps to know who your audience is and shift that mental model and know them as experts and ambassadors as well and show that you're really inclusive in that culture and know who your audience is. If you're going to detail or be industry partner and you're working with nurse practitioners, if you don't understand their scope of practice, that is a great opportunity to work towards and understand.

Speaker 2:

You mentioned, there's 5,400 nurse practitioners and it's growing by 10% a year. If that curve continues to go up, starting now if brands aren't already doing it having a higher degree of understanding as to how a nurse practitioner impacts their product, the scripting behavior on the product tracking that scripting behavior is you look a few years out and 5,400 very quickly becomes 6,000, becomes 8,000, and all of a sudden it's a really meaningful and material likely portion of some product's professional audience.

Speaker 1:

Absolutely, and it's other best practices that could really shift forward. Including them nurse practitioners in your advisory boards, for example, would be another one. Or some of the research studies are best practices. If you're updating new practice updates, for example, as well, including them in that being inclusive. When you actually address them, do you actually say, oh, hi, dr Acorn or hi, np Acorn versus? You know the doctor name goes first for physician colleagues and then nurse practitioners. They put our name or our protected title NP, after. It just shows you the value and respect and it's not intentional, I assure you.

Speaker 2:

For somebody who's interested and is listening and is thinking. Okay, I am going to start to explore either segmenting a little bit differently, being a little bit more inclusive. Who do they reach out to? Is it helping to shift this education? Is the NPAO a place for them to start in terms of engaging a little bit differently?

Speaker 1:

Absolutely. We have a lot of opportunities as well. So we have education events that you're able to engage with us. We almost have a virtual access to all our members through corporate sponsorships that are building that relationship. If there's special projects that you would like to consider implementing for shifting the professional paradigm, for example, to ensure that your priority health policy needs are met as well, or it's a win-win to partner together, we have communities that practice. So, whether it's primary care or older, adult or antimicrobial considerations, or wearable devices you name it we have nurse practitioners that work in those areas and are experts also at informing their peers and that are mentors for their peers as well their peers and that are mentors for their peers as well.

Speaker 2:

So without maybe naming names? Are you seeing anybody who's doing it really well and what does really well look like? I imagine it's a collection of those things that you just described, but have you seen opportunities or examples of really unique and creative ways to include, engage and learn from the nurse practitioner community that industry is putting out there?

Speaker 1:

Absolutely. We're doing a really good project. For an example right now, where we're doing micro-credentialing with nurse practitioners we're increasing prescriber confidence in prescribing cannabis, for example, would be one.

Speaker 2:

Interesting, and that's in partnership with.

Speaker 1:

The Nurse Practitioners Association of Ontario. Yes, we have many, many other things as well that are happening. It really kind of depends on what that looks like. Yeah, special projects right now, even the prescribing landscape we have some work in that area. There's just so many things, if you think about it right now, across across remember we deal with all ages and across the entire health system. So there's excellent projects and historically I've enjoyed partnering. I think that they there's a change in the wins right now before it's ensuring that we uphold, as professionals, our ethics and values. But I think things are modernized enough that professionals can partner with industry partners as well and to ensure that it's a win-win and needs are being met for mutual opportunities.

Speaker 2:

I think that those are the programs that work the best, you know, when they're not just purely promotional and there's, you know, an educational component and there's kind of a win on both sides right, and it's not just about investments of money.

Speaker 1:

It's that relational considerations, the relational partnerships, the strategic partnerships and, as a consequence for intended effect, is the relational care that happens.

Speaker 2:

So, as you look to 2025, obviously some big announcements you've got a growing population of nurse practitioners what are you most excited about in 2025? What are the things that are kind of getting you up in the morning and you're excited to tackle and what are the things that you're concerned about? What are you worried about? Making sure that you kind of stave off a little bit as you think about the upcoming year. Making sure that you kind of stave off a little bit as you think about the upcoming year.

Speaker 1:

I'm thrilled that nurse practitioners are starting to be more visible, vocal and vital and being recognized and respected across the health care system.

Speaker 1:

As a result of that, you can see, with the primary care action team led by Jane Philpott, that we ensure that all Ontarians are attached and are getting care by either a nurse practitioner or physician.

Speaker 1:

Changes the mental model, educates the public.

Speaker 1:

I'm very excited about that and I don't think geography should define where we practice and also how the models of care are going to evolve to ensure that we're being utilized to our top of our potential to improve access to care or provide that thought leadership and be at the decision-making tables, co-leading teams, co-designing teams or also just nurse practitioner-led teams.

Speaker 1:

Additionally as well, the Canada Health Act Interpretation Letter being inclusive to nurse practitioners is very exciting and how that will roll out across the provinces and territories and NPO has been a strong advocate and an advisor in that area as well for recruitment and retention purposes is the compensation of nurse practitioners and, frankly, the compensation of our other colleagues that are in primary care has not been harmonized or kept pace with respect, value or the competency and the care that's being delivered and if we're going to really invest in primary and secondary care, specialty care. We need to remunerate for the knowledge, skill, judgment and accountabilities and scope of practice and shift to equal work, equal pay and really work as teams and we have persons that are able to define what their care is and their care planning. You have a model of care that they can go and see their provider of choice and get that continuity of care and convenience of care as well. That is defined and planned together.

Speaker 2:

And that sort of continuity of care and choice also shouldn't have a cost burden on the individual. Right To your point Absolutely yes. Yeah Well, Michelle, that sounds like a long list and I feel like I should let you get at it. I appreciate the time today. Happy one-year work anniversary again, and this has been a really insightful conversation. I really appreciate it.

Speaker 1:

Thanks so much for the opportunity to be here, neil, and I hope you have a great day and, daryl, you can edit this. Thank you for meeting you as well, and I hope this met your needs. Take care.