1. Quality of NP Education
1.1. Varying programs with different licensure exams - lack of standardization
1.1.1. Neonatal
1.1.2. Adult
1.1.3. Family/All-Ages
1.1.4. Pediatric
1.2. Transition shock from RN to NP
1.2.1. Educational curriculum
1.2.1.1. Not enough pathophysiology and pharmacology courses
1.2.2. Self-learning
1.2.3. Surface-level
1.3. Competition with MD students for clinical placements
2. Government
2.1. Provincial & Territorial
2.1.1. Funding to health authorities
2.1.1.1. Salaried NP positions vary widely between provinces and territories
2.1.1.1.1. Unable to bill government directly
2.1.1.1.2. Remuneration does not reflect responsibility
2.1.1.1.3. Disincentivizes NPs to take on additional patients
2.1.2. Alternate funding model example: Alberta's NP Primary Care program
2.2. Federal
2.2.1. Canada Health Act (CHA) Services Policy will come into effect April 1, 2026
2.2.1.1. How will each jurisdiction implement new interpretation of CHA?
2.2.1.2. Will a new government reverse this policy?
2.2.1.3. Global News
2.2.2. Provides healthcare funding to provinces & territories
2.2.3. Canada Student Loan Forgiveness for Family MDs and nurses (including NPs)
2.3. International
2.3.1. USA: Highest number of NPs per capita
2.3.1.1. Online "degree mills"
2.3.1.2. Minimal entrance requirements for many NP schools (e.g., no RN experience required)
3. Nursing Organizations
3.1. Regulators
3.1.1. National
3.1.1.1. Canadian Council of Registered Nurse Regulators
3.1.1.1.1. In 2020: Nurse Practitioner Regulation Framework Implementation Plan Project (NPR-FIPP)
3.1.2. Provincial & territorial colleges
3.1.2.1. Varying scopes of practice across the country continue to persist
3.2. Unions
3.2.1. Difficulty advocating for fair salary through contracts
3.2.2. Provincial & territorial nursing unions
3.2.3. National
3.2.3.1. Canadian Federation of Nurses Unions
3.3. Associations
3.3.1. Individual provinces & territories
3.3.1.1. NP Associations of Individual provinces and territories
3.3.1.2. Provincial & territorial associations for all regulated nurses
3.3.2. National
3.3.2.1. NPAC
3.3.2.1.1. Responds to CHA interpretation letter
3.3.2.2. CNA for all regulated nurses
3.3.2.2.1. In response to the CHA interpretation letter, CNA requesting the federal government to fund a refresh of the CNPI for 2025
3.3.2.3. CASN
3.3.2.3.1. National accrediting body for nursing education
3.3.3. International
3.3.3.1. International Council of Nurses (ICN)
3.3.3.1.1. NP/APNN Network
3.4. Foundations
3.4.1. CNF
3.4.1.1. Invests in advanced nursing education and research initiatives (e.g., CNF Scholarship Program)
4. Gender
4.1. 90% of NPs are female
4.2. "When nurses and doctors are female, traditional power imbalances in their relationship diminish, suggesting that these imbalances are based as much on gender as on professional hierarchy" (Phillips & Zelek, 2003, p. 1)
4.3. "Nursing has long faced barriers to effective advocacy, based on the gendered identity of the profession and its status as a second class or 'softer' profession" (Madigan et al., 2023, p. 1)
5. Mentorship programs for new grad NPs
5.1. Supported by NPAC
5.2. Peer-review study published by CASN
5.2.1. Increase in confidence, skills, and satisfaction of new grad NPs
5.2.2. "As of 2022, over 200 residency programs were available [in the United States]... only one documented fellowship program in Canada" (Audet et al., 2023, p. 2).
6. Lack of primary care providers
6.1. The NP profession is growing at a faster rate than RNs and MDs
6.2. 6 million Canadians without a primary care provider
6.3. Downstream effects: CBC News
6.3.1. Overcrowded ERs
6.3.1.1. ER staff burnout
6.3.1.2. Less paramedics on the streets
6.3.1.3. Decreased patient outcomes due to lack of management of chronic conditions
6.4. NPs can improve this gap, especially in rural and underserved communities
7. Public Perception
7.1. Media - negative views from physicians often amplified by news outlets (CBC)
7.2. Personal experiences - high satisfaction after receiving NP care
7.3. Role ambiguity between RNs, MDs & NPs
8. Interprofessional Tension with Physicians
8.1. Scope creep
8.1.1. American Medical Association
8.1.2. Calgary Herald
8.2. Financial competition
8.3. Physicians only financially supported to precept MD residents (e.g., Doctors Nova Scotia)
8.4. Mistrust of the NP profession (Reddit group, 62K members)
9. Proposed solution = mentorship programs
10. History
10.1. Role first established in Canada in the early 1970s
10.2. RNs with additional graduate education and clinical practice experience
10.3. Interpret medical results, diagnose, and prescribe treatments autonomously
11. Nurse financial burden
11.1. Opportunity cost of MN-NP program
11.2. Salary for a general duty RN at the top level of the pay scale, including premiums such as shift differential and overtime, would likely be higher than the minimum NP starting salary
11.2.1. Discourages experienced RNs from pursuing NP education