The nurse practitioner role in other jurisdictions

Nurse practitioners around the world

A role comparable to that of  NPs in Ontario exists in several countries, each of which have varying strategies to regulate the NP scope of practice [1]. Internationally, it can be difficult to define advanced practice nursing across jurisdictions due to the  variety of roles that an advanced practice nurse may play [2].

The International Council of Nurses (ICN) has proposed the following definition:

“A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master’s degree is recommended for entry level”[2, 3].

Guiding documents from international jurisdictions have been included in this toolkit to broaden our perspective and consider innovative NP roles not yet conceived or enabled by legislation and regulation in Canada. This brief jurisdictional review provides a useful backdrop for considering what is being achieved in other countries with NP utilization in hospitals.


British Columbia

As in Ontario, NPs are registered nurses with advanced education and expanded scope of practice; they have a protected title, and practise in one of three streams: family, adult or pediatric [4].  Nurse practitioners have been authorized in BC only since 2005 and are much fewer in number than in Ontario (318 practising NPs) [5]; however, significant regulatory barriers have already been tackled to move towards full utilization of NPs.

NPs order diagnostic tests from a list of authorized tests and prescribe medications with some limitations [4].  At this time NPs cannot prescribe controlled substances. However, in April 2015, the provincial government proposed regulatory revisions (not yet proclaimed) to include this in their scope of practice [6].

In 2012, legislation was enacted to allow NPs to admit and discharge hospital patients [7]. In 2014, further legislative changes removed a number of barriers to NP practice, allowing NPs to provide legal and administrative documentation [8].



As of May 30, 2014, nurse practitioners have the authority to admit and treat patients in Manitoba [9]. Regional Health Authorities will still need to amend their by-laws to recognize NPs as admitting health-care providers.

Nova Scotia

On March 23, 2015 the Nova Scotia government announced changes to authorize nurse practitioners to discharge patients from hospital. These changes are being piloted at two hospitals beginning summer 2015 [10].

Prince Edward Island

Admitting privileges were granted to NPs as of 2011 through changes Health PEI Medical Staff Bylaws [9].


The NP role was initially established in 1990. The NP role began in emergency departments and has now expanded into a variety of practice settings [11]. A graduate degree in nursing is required [2]and NPs have a protected title and standardized competency standards [1, 11]. Australia is considering adding specialist frameworks to further define scope of practice [1].

State and Commonwealth (federal) regulations impact NP practice and scope of practice varies slightly across individual states [1]. Some states may not using NPs to their full effect [12]due to regulatory barriers. The Australian College of Nurse Practitioner (ACNP) has had evidence compiled to support NP utilization [12]. There are noted gaps in health-care delivery in Australia that NPs could fill, including chronic disease management, mental health addictions and care of older adults [12].


United Kingdom (UK)

The Advanced Nurse Practitioners (ANP) role is well established, although ANP is not a protected title [13].  The introduction of ANPs dates back to the 1970s and was initially used in primary care, and now also in hospitals [2]. ANPs function under a competency-based framework [1]that is country-specific and ANPs and endorsed by the Royal College of Nurses [13]. Some ANPs work in a number of roles and some function in a role similar to NPs in Canada, both in primary care and in hospitals [13].


United States of America (US)

The NP role originated in the United States in the 1960s and was initially developed to improve access to primary care for remote populations [2]. The role is well established in many settings, including hospitals. Similar to Ontario, NPs have a protected title and are accredited by a state-wide regulatory body after they have met educational requirements and written an exam [1]. There are different legislative and regulatory frameworks for NPs in different states and thus scope of practice varies between states [14].


 Organisation for Economic Co-operation and Development (OECD)

Please see the link below for a 2010 working paper: "Nurses in Advanced Roles in 12 developed countries" [2].

OECD: "Nurses in Advanced Roles in 12 developed countries" 2010



1.            Kilpatrick, K., et al., How are acute care nurse practitioners enacting their roles in healthcare teams? A descriptive multiple-case study. International Journal of Nursing Studies, 2012. 49(7): p. 850-862.

2.            Organisation for Economic Development. OECD Health Working Paper No. 54 Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries. 2010.

3.            International Council of Nurses. Nurse Practitioner/Advanced Practice Nurse: Definition and Characteristics. 2009  [cited 2015 July 8]; Available from:

4.            College of Registered Nurses of British Columbia. Scope of Practice For Nurse Practitioners. 2015: Vancouver, BC.

5.            College of Registered Nurses of British Columbia. At the Forefront Leading as a Relational Regulator, in 2014-2015 Annual Report. 2015, College of Registered Nurses of British Columbia.

6.            College of Registered Nurses of British Columbia. Controlled drugs and substances (CDS) prescribing: NP prescribing of controlled drugs and substances. 2015  [cited 2015 July 8]; Available from:

7.            News, B.C. Nurse practitioners to admit, discharge patients. 2012  [cited 2015 July 8]; Available from:

8.            College of Registered Nurses of British Columbia. Bill 17 update Some legislative barriers to NP practice removed. 2014  [cited 2015 July 8]; Available from:

9.            Brown, S., Bill 28: The Health Services Insurance Amendment and Hospitals Amendment Act (Admitting Privileges) Manitoba Law Journal, 2014. 37(2): p. 109-134.

10.          College of Registered Nurses of Nova Scotia. New Authority for NP Discharge and RN Release. 2015  [cited 2015 July 13]; Available from:

11.          Masso, M. and C. Thompson, Nurse practitioners in NSW ‘Gaining Momentum’:rapid review of the nurse practitioner literature. . 2014, Centre for Health Service Development, University of Wollongong.: New South Wales, Australia.

12.          The Centre for International Economics. Responsive patient centred care: The economic value and potential of Nurse Practitioners in Australia. 2013, Prepared for the Australian College of Nurse Practitioners.

13.          Royal College of Nursing. Advanced Nurse Practitioners—An RCN Guide to the Advanced Nurse Practitioner Role, Competences and Programme Accreditation. 2012.

14.          American Association of Nurse Practitioners. State Practice Environment. 2015  [cited 2015 July 6]; Available from: