Visit Specialized nurse practitioners (SNPs) are playing an increasingly important role in the Quebec healthcare system. Since the expansion of their powers with Law 19 in 2021, they can diagnose several diseases, prescribe treatments and to do a self-directed clinical monitoring in their field [1]. Yet, many patients are still unaware of what they can offer them. This article explains what an NP is, what they can do, in what contexts to consult them, and how to register with their board.
On this page
- What is an IPS
- What an IPS can do
- When to see an NP 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 the 19 law
- 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 from the’Ordre des infirmières et infirmiers du Québec (OIIQ) [2]. Their practice lies between that of a clinical nurse and a physician, in specific fields defined by law.
The training path
- High school diploma in nursing (3 to 4 years)
- Clinical experience As a clinical nurse
- Mastery 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
- First-line 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
To remember
- A IPS is a master's level nurse with an OIIQ specialist certificate [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 existing in Quebec, the most visible of which to the general public is the Nurse Practitioner in Primary Care (NPPC)
- Several IPs follow their own patients Autonomously, like a family doctor
- Visit First Line Access Service allows you to request assignment to a physician or an NP [3]
What an IPS can do
Visit driving range of an IPS is broad in its specialty. It has been expanded with the Law 19 in 2021 and continues to evolve towards greater clinical autonomy [1].
The 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 analyses
- 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 of a prescription for an antihypertensive medication, with adjustment based on blood pressure
- Diagnosis and treatment of uncomplicated urinary tract infection
- Tracking of type 2 diabetes with medication adjustment
- Evaluation and treatment of eczema or dermatitis
- Annual report, routine gynecological exam, request for preventive screenings
- Tracking of a low-risk pregnancy, in consultation with a doctor if necessary
- Support At the smoking cessation stop, prescription of varenicline or bupropion
- Diagnosis and first treatment for mild to moderate depression
- Suture a simple wound
- Update From vaccination according to the IPQ
When to see an NP 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 fully indicated
- For the regular monitoring of your general health or a stable chronic illness
- 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 monitoring 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 more indicated
- Complex Cases You rare
- Situations that exceed the nurse practitioner's scope of practice
- Pathologies requiring specialized expertise (cardiology, oncology, neurology, surgery, for example)
- Cast involving multiple comorbidities that are difficult to balance
- Evaluations forensic-specific
- Tables conditions requiring hospitalization
Quick Orientation Table
| Situation | IPS | Family doctor | Specialist |
|---|---|---|---|
| Stable prescription renewal | Yes | Yes | If attached to the specialist. |
| Common infection | Yes | Yes | Rarely |
| Annual report | Yes | Yes | Not in general |
| Low-risk pregnancy monitoring | 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 and when to continue autonomous follow-up. This collaboration is one of the cornerstones of quality primary care.
Register a patient with a nurse practitioner's table
In Quebec, the First Line Access Service allows to request an attribution to a doctor or to a IPS. Several NPs follow their own patients autonomously, like a family doctor [3].
Front-line Access Desk (GAP)
- Service Department public network québécois
- Help 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 occasional consultations while waiting for registration
- Includes the 811 Option 3 and the government's web portal
Steps to register with an IP board
- Check Registration for Quebec's First Line Access Point (GAP)
- Clarify in the request, the opening to be followed by an IPS
- Prepare List of medications, medical history, and diagnoses
- Wait the assignment or to consult on a case-by-case basis while waiting
- 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 an NP? 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 do not replace the doctor it expands the team's capacity to handle more patients, faster, 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 follow-up chronic diseases
- Decrease Avoidable emergency room visits
- Best Integration of prevention and therapeutic education
- Support Strengthened support for vulnerable patients (seniors, people with loss of autonomy, mental health)
- Continuity between the medical consultation, nursing follow-up, and home care
How does an appointment with an NP work?
- Anamnesis 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 to the medical record, accessible to the treating team
The evolution of the role since the 19 law
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
- Possibility of To make a diagnosis in the IPS practice field
- Expansion Prescriptive authority (medications, tests, treatments)
- Increased reconnaissance of the clinical autonomy of NPs
- Possibility to sign certain medical forms
- Bigger capacity to register and follow up on patients in the first line
- Adaptation of the professional framework by the OIIQ and the CMQ to support this evolution
What remains 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
«A nurse practitioner is not as good as a doctor.»
False. An NP is trained at an advanced university level (master's degree) and holds a specialist certificate. For situations within their scope of practice, multiple 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 NP cannot prescribe anything.»
False. An IPS prescribes medications, laboratory tests, and imaging within their scope of practice. The list of possible prescriptions is broad and has been expanded with Law 19. This covers the essentials of common primary care situations.
«If I have an IPS, I no longer have a doctor.»
False. The IPS works in collaboration with physicians on the team or in the clinic. When a case falls outside her scope of practice or requires specialized expertise, she refers the patient to the appropriate physician. The patient benefits from a team, not an isolated professional.
«An IPS is just for simple cases.»
Nuanced. An IPS effectively manages common situations very well, as well as stable complex chronic disease follow-up (diabetes, hypertension, COPD, depression). It is precisely in longitudinal follow-up that the added value of IPS is clearest: continuity, therapeutic education, gradual adjustment of treatments.
«An IPS costs the system more.»
Mostly fake. Economic analyses generally show that the integration of NPs improves access to care, reduces certain emergency room visits, and supports more rational use of resources. The cost-benefit is favorable, particularly in contexts of family physician shortages.
Frequently asked questions
Do you need a family doctor to see an NP?
No. Several NPs follow their own patients autonomously, like a family doctor. Registration is done through the First Line Access Gateway (GAP) or directly at certain clinics offering NP follow-up. A one-time consultation is also possible without registration.
Can an IPS sign a medical form?
For many forms (insurance, employer, leave, prescriptions, common administrative requests), yes. For certain very specific forms (e.g., some forensic medical examinations), a doctor is still required. The specific case of each form must be verified with the clinic or the body requesting it.
Is the follow-up of an NP covered by the RAMQ?
In the public network, IPS services are accessible as part of first-line consultations, free of charge to the user. In the private sector, the terms vary by clinic. Medication prescriptions remain covered according to the current drug insurance plans (RAMQ or private insurance).
Can one consult an NP via telehealth?
Yes, in several contexts. Teleconsultation is useful for prescription renewals, stable chronic disease follow-ups, certain eligible acute conditions, and mental health follow-ups. For reasons that require a direct physical examination, an in-person consultation remains preferable.
Can an IP be with me my whole life like a family doctor?
Yes, several nurse practitioners in primary care provide longitudinal follow-up over several years, with an approach very similar to that of a family physician. Follow-up includes prevention, annual check-ups, screening, management of chronic diseases, and referrals to other professionals as needed.
How to know if the IPS is registered with the OIIQ?
The OIIQ member directory is available online. It lists the registrations of nurses and nurse practitioners, their specialties, and their status. This verification is useful to ensure that the professional holds the correct title and that their practice is regulated by the professional order.
Sources
- National Assembly of Quebec. Law 19 — Expansion of Nurse Practitioner Scope of Practice (2021).
- OIIQ — Order of Nurses of Quebec. IPS Practice Area.
- Ministry of Health and Social Services of Quebec. First-line Access Service (GAP) and First-line Services.
- INESSS — National Institute of Excellence in Health and Social Services. Performance of care models integrating NPs.
- FMOQ — Federation of General Practitioners of Quebec. Physician-NP collaboration in primary care.
- CMQ — College of Physicians of Quebec. Interprofessional collaboration framework.
- Canadian Geriatrics Society. Role of Nurse Practitioners with Seniors.
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