Visit specialized nurse practitioners (SNPs) are playing an increasingly important role in Quebec’s healthcare system. Since their responsibilities were expanded under Act 19 in 2021, they have been able to diagnose several diseases, prescribe treatments and to do a self-directed clinical monitoring in their field [1]. However, many patients are still unaware of what they have to offer. This article explains what an IPS is, what it can do, when to consult one, and how to sign up for its services.
On this page
- What is an IPS
- What an IPS can do
- When to See a Physical Therapist Instead of a Doctor
- Register a patient with a nurse practitioner's table
- A collaborative approach in the clinic
- The Evolution of the Role Since Act 19
- Myths and Misconceptions
- Frequently asked questions
- Sources
What is an IPS
A IPS is a nurse who has completed a Graduate university education (master's degree) and holds a specialist certificate of the’Ordre des infirmières et infirmiers du Québec (OIIQ) [2]. Their practice falls between that of a clinical nurse and that of a physician, within specific areas defined by law.
The training path
- High School Diploma in nursing (3 to 4 years)
- Clinical Experience As a clinical nurse
- Master's Degree University-level nurse with a specialization in Nurse Practitioner
- Stages Advanced supervised clinics
- Review from the OIIQ to obtain the specialist certificate
- Continuing education mandatory throughout the career
The Five Specialties in Quebec
- Primary Care (IPSPL) Global health monitoring, common diseases, prevention
- Mental Health (IPSSM) Evaluation and monitoring of anxiety disorders, depression, and other mental health conditions
- Pediatric Care (IPSP) child monitoring, vaccination, common pediatric problems
- Adult Care (IPSSA) Management of complex chronic diseases in hospital or specialized settings
- Neonatology (IPSNéo) Newborn follow-up, often in a hospital or specialized setting
Key Takeaways
- A IPS is a nurse with a master's degree and a specialist certification from the OIIQ [2]
- She can diagnose, prescribe, and follow up in his field of practice
- Visit Law 19 (2021) expanded its scope of practice, notably diagnostic power [1]
- Five specialties exist in Quebec, the most visible of which to the general public is the Primary Care IPS (IPSPL)
- Several IPs follow their own patients Autonomously, like a family doctor
- Visit Front-Line Access Desk (GAP) allows you to request assignment to a physician or an IPS [3]
What an IPS can do
Visit driving range An IPS has a broad scope within its specialty. It has been expanded with the Law 19 in 2021 and continues to evolve toward greater clinical autonomy [1].
Main Clinical Activities
- Diagnose several common diseases (hypertension, diabetes, infections, anxiety and depressive disorders, asthma, for example)
- Prescribe medications within their scope of practice
- Prescribe laboratory and imaging tests
- Perform follow-up of chronic diseases (diabetes, hypertension, dyslipidemia, stable COPD)
- Do comprehensive clinical examinations
- Refer as a specialty if needed
- To practice Certain techniques (skin biopsy, sutures, infiltrations depending on the specialty)
- Ensure Prenatal and postnatal care, vaccination, infant and child monitoring (depending on specialty)
- Perform Monitoring anxiety or depressive disorders in mental health
- To practice health prevention and promotion
Concrete examples of IPSPL support
- Renewal a prescription for an antihypertensive medication, with dosage adjustments based on blood pressure
- Diagnosis and treatment of an uncomplicated urinary tract infection
- Tracking type 2 diabetes, with medication adjustments
- Evaluation and treatment of eczema or dermatitis
- Annual report, routine gynecological exam, request for preventive screenings
- Tracking a low-risk pregnancy, in consultation with a doctor if necessary
- Support for smoking cessation, prescription of varenicline or bupropion
- Diagnosis and initial treatment of mild to moderate depression
- Suture a simple wound
- Update From vaccination according to the IPQ
When to See a Physical Therapist Instead of a Doctor
Many situations common clinics can be supported by an NP, with equivalent quality of care. Physicians intervene for more complex cases or out of scope of practice.
When an IPS Is Definitely Recommended
- For the regular monitoring your overall health or a stable chronic condition
- For the renewal prescriptions
- For acute problems current conditions (infections, pain, wounds, allergies, for example)
- For a prenatal care or pediatric routine according to the specialty
- For a mental health follow-up with anxiety or depressive disorders
- For the prevention and screening according to recommendations
- For clinical examinations routine and annual checkups
When a doctor (general practitioner or specialist) is the better choice
- Complex Cases You rare
- Situations that fall outside the scope of IPS practice
- Pathologies requiring specialized expertise (cardiology, oncology, neurology, surgery, for example)
- Cast involving multiple comorbidities that are difficult to balance
- Reviews forensic-specific
- Tables conditions requiring hospitalization
Quick Orientation Table
| Situation | IPS | Family doctor | Specialist |
|---|---|---|---|
| Stable prescription renewal | Yes | Yes | If assigned to a specialist |
| Common infection | Yes | Yes | Rarely |
| Annual report | Yes | Yes | No, generally speaking |
| Low-Risk Prenatal Care | Yes (IPSPL) | Yes | Special cases |
| Anxiety disorder or mild depression | Yes (IPSPL or IPSSM) | Yes | More complex cases |
| Stable chronic disease | Yes | Yes | As needed |
| Complex or rare pathology | Reference | Often | Reference |
| Acute Emergency | Triage and Referral | Evaluation | As the case may be |
Nurses work in close collaboration with doctors. They know when to refer patients and when to continue providing care on their own. This coordination is one of the cornerstones of quality primary care.
Register a patient with a nurse practitioner's table
In Quebec, the Front-Line Access Desk (GAP) allows to request an attribution to a doctor or to a IPS. Several NPs follow their own patients autonomously, like a family doctor [3].
The Front-Line Access Desk (GAP)
- Service Department public network québécois
- Help with orient patients to the right professional according to their situation
- Allows you to ask for the’attribution to a family doctor or an NP
- Women access for one-time consultations pending registration
- Includes the 811 Option 3 and the government's web portal
Steps to Register on an IPS Roster
- Check Registration with Quebec’s First-Line Access Portal (GAP)
- Specify in the request for admission, to be followed by an IPS
- Prepare List of medications, medical history, and diagnoses
- Wait the assignment or check it from time to time in the meantime
- Complete if needed with follow-up via teleconsultation for urgent reasons
- Update Information in case of a status change
No family doctor, or looking for care from a primary care nurse? Clinique Omicron integrates doctors and healthcare professionals in a collaborative approach at our service points in Quebec, with teleconsultation for eligible reasons. Make an appointment or opt for the teleconsultation.
A collaborative approach in the clinic
In practice, the’IPS is not a substitute for a doctor : It expands the team's capacity to treat more patients, more quickly, in the right situations. This complementarity is one of the most promising models for improving primary care access [4].
What interprofessional collaboration changes
- Increased access at primary care
- Better-coordinated monitoring chronic diseases
- Decrease unnecessary visits to the emergency room
- Best Integration of prevention and therapeutic education
- Support enhanced support for vulnerable patients (seniors, people with reduced independence, and those with mental health issues)
- Continuity between the medical consultation, nursing follow-up, and home care
What Happens During a Consultation with an IPS?
- Medical History complete (history, medications, lifestyle, reason for consultation)
- Clinical examination situationally targeted
- Discussion from diagnosis and treatment plan
- Specifications as needed (medications, tests, imaging)
- Tracking scheduled at defined intervals
- Reference to a specialist physician, to a family physician, or to another professional if required
- Documentation in the medical record, accessible to the treating team
The Evolution of the Role Since Act 19
The adoption of Law 19 In 2021 marked a major turning point for the practice of NPs in Quebec. They can now diagnose formally several conditions, without always going through a «shared» activity with a doctor [1].
What Law 19 Changed
- Option to To make a diagnosis within the scope of IPS practice
- Enlargement Prescriptive authority (medications, tests, treatments)
- Increased reconnaissance on the clinical autonomy of IPSs
- Possibility to sign certain medical forms
- Bigger capacity to register and follow up on patients in the first line
- Adaptation the professional framework established by the OIIQ and the CMQ to support this evolution
What is still shared with the doctor
- Visit complex cases that exceed the scope of practice
- Visit decisions forensic-specific
- Visit support of very specialized conditions (interventional cardiology, oncology, surgery, for example)
- Some responsibilities hospitable
- Visit global clinical judgment in cases where the differential diagnosis is very broad
Myths and Misconceptions
«The IPS isn't as good as a doctor.»
False. An IPS has completed advanced university-level training (master’s degree) and holds a specialist certification. For conditions within their scope of practice, several studies show that the quality of care, patient satisfaction, and clinical outcomes are comparable to those of physicians [4]. The role is not inferior; it is different and complementary.
«An IPS cannot prescribe anything.»
False. A primary care nurse prescribes medications, laboratory tests, and imaging studies within their scope of practice. The list of permissible prescriptions is extensive and was expanded by Act 19. It covers most common situations in primary care.
«If I have an IPS, I no longer have a doctor»
False. The IPS works in collaboration with physicians on the team or at the clinic. When a case falls outside its scope of practice or requires specialized expertise, it refers the patient to the appropriate physician. The patient benefits from a team, not just a single professional.
«An IPS is only for simple cases.»
Nuanced. An IPS is indeed very effective at managing routine situations, as well as the long-term care of stable, complex chronic conditions (diabetes, hypertension, COPD, depression). It is precisely in long-term care that the added value of IPSs is most evident: continuity of care, therapeutic education, and gradual adjustment of treatments.
«An IPS costs the system more.»
Mostly fake. Economic analyses generally show that integrating primary care clinics improves access to care, reduces certain emergency department visits, and promotes a more efficient use of resources. The cost-benefit ratio is favorable, particularly in settings where there is a shortage of family physicians.
Frequently asked questions
Do you need to have a family doctor to see an IPS?
No. Many IPSs provide independent care for their own patients, much like a family doctor. Registration is done through the Primary Care Access Portal (GAP) or directly at certain clinics that offer IPS care. A one-time consultation is also possible without being registered on the patient list.
Can an IPS sign a medical form?
For many forms (insurance, employer-related, leave of absence, prescriptions, routine administrative requests), yes. For certain very specific forms (such as some forensic medical evaluations), a doctor is still required. The specific requirements for each form should be verified with the clinic or the entity requesting it.
Is the follow-up of an NP covered by the RAMQ?
In the public health care system, IPS services are available as part of primary care visits at no cost to the patient. In the private sector, the terms and conditions vary by clinic. Prescriptions for medications are then covered under the applicable prescription drug plans (RAMQ or private insurance).
Can you see an IPS via telemedicine?
Yes, in several situations. Telemedicine is useful for prescription renewals, follow-ups for stable chronic conditions, certain eligible acute conditions, and mental health follow-ups. For conditions that require a direct physical examination, an in-person visit is still preferable.
Can a primary care nurse provide care for me throughout my life, just like a family doctor?
Yes, many primary care IPSs provide long-term follow-up over several years, using an approach very similar to that of a family doctor. This follow-up includes prevention, annual checkups, screenings, management of chronic conditions, and referrals to other professionals as needed.
How can I tell if the IPS is registered with the OIIQ?
The OIIQ’s membership directory is available online. It lists registered nurses and IPSs, along with their specialties and status. Checking this directory is a useful way to verify that a professional is indeed licensed and that their practice is regulated by the professional association.
Sources
- Quebec National Assembly. Act 19 — Expansion of the Scope of Practice for IPSs (2021).
- OIIQ — Order of Nurses of Quebec. IPS Practice Area.
- Quebec Ministry of Health and Social Services. Front-Line Access Desk (GAP) and Front-Line Services.
- INESSS — National Institute for Excellence in Health and Social Services. Performance of Care Models Incorporating IPS.
- FMOQ — Federation of General Practitioners of Quebec. Collaboration Between Physicians and IPS Staff on the Front Lines.
- CMQ — Quebec College of Physicians. Interprofessional collaboration framework.
- Canadian Geriatrics Society. The Role of Nurse Practitioners in Elderly Care.
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