NPAO: The Voice of Nurse Practitioners in Ontario
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I think it’s important we stop to reflect on how we got to where we are as nurse practitioner – who advocated for us? Who continues to advocate? And how can we contribute as individuals to leading that path for more NPs to bolster the health care system and take care of our patients? To understand where we’re headed, it helps to look back at how far we’ve come — from the early days of NP advocacy to the expanded scope we now have in Ontario.
How the NP Role Evolved in Canada
It wasn’t very long ago that NPs in Ontario (and Canada) had limited scope of practice – but thanks to advocacy efforts from national and provincial organizations, this has changed for the better.
The NP journey in Canada (in a nutshell): The evolution of nurse practitioners (NPs) in Canada began in the 1800s, with outpost nurses providing primary care in remote communities. By the 1960s, the NP role began to formalize in response to physician shortages and growing primary care needs. Historically, there was a struggle for standardization of the NP role and scope – lack of consistent NP education and unclear role definitions slowed down national integration. The Regulated Health Professions Act (1991) encouraged broader NP use, with Ontario granting legal authority for NPs to practice independently in 1998 (1). NP scope was historically limited. For example, physicians needed to “sign off” on various diagnostic test orders and NPs could only order a specific list of medications autonomously. Despite these advances, NPs faced persistent barriers to practicing to their full potential — many of which advocacy groups continue to challenge today.
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Breaking Barriers and Building Recognition for NPs
I think sometimes we take for granted the expanded scope we have today in 2025 – but this didn’t happen overnight, and like any advocacy work, it took a lot of work from national and provincial advocacy groups to make this happen for us. Barriers for NPs in Canada still exist – for example inconsistent salaries and limited role recognition in some settings.
The Canadian Nurse Practitioner Initiative worked towards standardizing education, regulation, and practice nationwide (2). Other national advocacy efforts have been made by liaising with government and education campaigns for public awareness of the NP role. These advocacy efforts laid the groundwork for the strong NP workforce we see today.
The Rapid Growth of the NP Workforce
NPs are working everywhere — in family practices, community health centres, hospital units, emergency departments, and long-term care facilities. The biggest jump in 2024? Private nursing agencies and self-employed NPs, which grew by roughly 12% (3). As of 2024 in Ontario, 2,115 NPs were employed in hospital, 285 in long term care, and 2,955 in community settings – all of which has increased in numbers since 2019 (4). As NP numbers rise, so does the importance of having a unified provincial voice — and that’s where NPAO comes in.
Why NPAO Matters More Than Ever
Today, the Nurse Practitioners’ Association of Ontario (NPAO) stands as the collective voice for Ontario NPs — leading advocacy efforts, influencing policy, and shaping the future of our profession. Within Ontario, the NPAO has engaged in countless advocacy efforts to reduce barriers for NPs. NPs in Ontario have tripled since 2010 — a testament to the power of advocacy (5).
Over the past year, NPAO has amplified the NP voice through strong advocacy at Queen’s Park, national conferences, and media outreach. Highlights include the expanded NP scope of practice announcement, ongoing collaboration with Dr. Jane Philpott’s Primary Care Action Team, and continued efforts toward equitable compensation, full integration, and barrier removal. NPAO remains dedicated to ensuring NPs are recognized as essential leaders in Ontario’s healthcare system. Given the current situation with the Canada Health Act interpretation letter, NPAO’s advocacy efforts are now focused on representing all Nurse Practitioners across Ontario in negotiations to establish multiple, flexible funding models that reflect the diversity of NP practice settings and patient needs.
It was only since 2022 that NPs could order CTs and MRIs – essential diagnostic tests to work up several medication conditions. Effective July 1, 2025, Ontario expanded the scope for NPs with authorization to perform new procedures — including defibrillation, cardiac pacemaker therapy, transcutaneous pacing, and electrocoagulation — and may now complete medical certificates of death in more circumstances (6).
Significant pay disparities persist for NPs across the healthcare sector in Ontario. The NPAO recommends aligning NP salaries across sectors at a minimum rate of $180,000 to address compensation inequities within the profession (5). Professional and pay equity are essential to retention and sustainability of the NP profession. However, NPAO simultaneously continues to advocate for equal pay for equal work in situations where NPs are mirroring the roles of physicians (5). Expanding nurse practitioner led clinics – led by NPs – will strengthen access, improve patient outcomes, and help meet the growing demand for comprehensive primary care. These advocacy efforts are working – NPLCs have been expanding since 2005, with now 27 NPLCs across Ontario (7). NPAO’s advocacy is creating real change — but continued progress depends on all of us standing together as a profession.
As NPs, our scope, recognition, and impact have come a long way — but our work isn’t done. NPAO will always be needed to advocate for the issues that impact Nurse Practitioners across Ontario — whether in advancing scope of practice, improving working conditions, strengthening professional standards, achieving fair compensation, or addressing the many emerging and unforeseen challenges that lie ahead. Joining NPAO means more than simply adding your voice to a movement; it means actively shaping the evolving landscape of healthcare in Canada. Although membership in NPAO is voluntary, every NP should consider becoming a member to ensure their professional voice is represented — because NPAO is about NPs speaking for NPs. If NPs don’t speak for themselves, others might speak for them.
The future of NP practice is being shaped right now — will you be part of that change?
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Disclaimer - The views expressed in this post are my own and do not represent the official position of any organization. This is not a sponsored post.
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References
Government of Ontario. Regulated Health Professions Act, 1991. 2024. Available from https://www.ontario.ca/laws/statute/91r18Government of Canada Publications. The Regulation and Supply of Nurse Practitioners in Canada. 2006. Available from https://publications.gc.ca/collections/Collection/H115-34-2006E.pdfCanadian Institute for Health Information. Nurse Practitioners. 2025. Available from https://www.cihi.ca/en/nurse-practitionersCollege of Nurses of Ontario. Nursing Statistics Report. 2024. Available from https://www.cno.org/Assets/CNO/Documents/Statistics/latest-reports/nursing-statistics-report-2024.pdfNurse Practitioners Association of Ontario. NPAO Annual Report. 2025. Available from https://npao.org/2025-npao-annual-report/College of Nurses of Ontario. New scope of practice changes coming into effect for nurse practitioners and registered nurses. 2024. Available from https://www.cno.org/news/new-scope-of-practice-changes-coming-into-effect-for-np-and-rn#:~:text=Starting%20Tuesday%2C%20July%201%2C%202025,resources%20include%20updated%20information%20aboutAlliance for Healthier Communities. Nurse practitioner-led clinics. N.d. Available from https://www.allianceon.org/nurse-practitioner-led-clinics