Support a Mission-Driven Team as a Nurse Practitioner!

CANES Community Care is a not-for-profit organization committed to providing outstanding support and care services that enhance the lives of seniors, enabling them to remain in their homes and communities. Guided by our vision — Live well, age well – with CANES Community Care — we foster a workplace culture rooted in our core values: Reliable, Reputable, Responsive, and Reaching .

Permanent Part-Time (approximately 14 hours/week)

Hours: Approximately 14 hours/week (2 days/week)

POSITION SUMMARY:

The Nurse Practitioner will be the primary care provider to Transition Care and community clients and works within his/her legislative scope of practice as described by the College of Nurses of Ontario (CNO). This individual will collaborate with the clients, caregivers and families, and the circle of care in the development, implementation and evaluation of the client’s care plan.

The Nurse Practitioner (NP) delivers comprehensive, person-centred care to older adults, including those transitioning from hospital to community settings and supports patients with complex health needs to maintain safety, independence, and optimal health outcomes while living at home.

This role is primarily clinical and client-facing, with a focus on assessment, diagnosis, treatment, and care coordination. The NP plays a key role in stabilizing clients and proactively mitigate avoidable emergency department visits and hospitalizations through timely clinical intervention, ongoing monitoring, and coordinated care planning. He/She will also lead and provide mentorship to the Transition Care staff to ensure quality care for clients are in place.

WORK SCHEDULE & COVERAGE MODEL

The NP role is structured as a fixed part-time position of approximately 14 hours per week

Weekly hours are distributed across:

On-site clinical care and rounds at assigned locations

Documentation, care coordination, and interdisciplinary collaboration

Scheduled availability/on‑call coverage periods to support clinical decision‑making and urgent client needs

On‑call/availability expectations:

Defined weekly availability windows (to be scheduled in advance)

Focus on timely clinical guidance and escalation support

Flexibility required based on client acuity and program needs

ROLES AND RESPONSIBILITIES

Key Responsibilities

Advanced Clinical Practice

Perform comprehensive health assessments, including physical, mental,



and functional evaluations

Diagnose and manage acute and chronic conditions in older adults

Provide pharmacological and non‑pharmacological treatment within NP scope of practice

Order and interpret laboratory tests, diagnostic imaging, and other investigations

Complete medication reconciliation in collaboration with pharmacy partners

Monitor client progress and adjust care plans as needed

Transitional Care & Coordination

Support safe and effective transitions from hospital to community-based care

Liaise with hospital discharge teams where necessary to ensure continuity of care

Develop, implement, and evaluate individualized care plans with clients and families

Participate in care conferences with clients, caregivers, and care team members

Identify and mitigate risks for hospital readmission or clinical deterioration

Documentation & Communication

Document all clinical assessments, interventions, and outcomes in a timely and accurate manner as per CNO standards

Maintain clear communication with clients, families, and the interprofessional team

Support completion of required documentation such as LTC application assessments where applicable

Client & Family Support

Provide education on health conditions, medications, and self‑management strategies

Promote health maintenance, disease prevention, and functional independence

Engage clients and families in shared decision‑making and care planning

On Call/ Clinical Coverage Expectations:

Provide remote clinical support (phone/virtual) and guidance to nursing staff and care teams during assigned coverage periods

Respond to clinical concerns within established response time expectations

Support appropriate escalation pathways, including in‑person assessment when required

Quality & Safety

Contribute to a culture of client safety and continuous quality improvement

Adhere to all organizational policies related to infection prevention, health and safety

Report adverse events and support safe clinical practices

Report to CANES Community Care senior management, as well as relevant stakeholders





Demonstrate a positive and professional attitude when representing CANES

Support Accreditation

Member of the medication safety committee

Provide clinical education to clinical teams as required

Other duties as assigned

QUALIFICATIONS

Registered Nurse (Extended Class) in good standing with the College of Nurses of Ontario

Completion of an accredited Nurse Practitioner program

Master’s degree in nursing

Minimum 2–3 years’ recent clinical experience as a Nurse Practitioner (or ≥3 years in a relevant healthcare setting)

Experience in geriatric care, chronic disease management, or transitional care preferred

Community, post‑acute, primary care, or rural health experience considered an asset

Mental health and public health experience (including health promotion) an asset

Coursework in program planning, evaluation, data management/analysis, and health promotion

Experience working with infectious diseases

BCLS/ACLS and valid First Aid & CPR certification

Ability to work independently and across multiple sites

Robust problem‑solving, teamwork, interpersonal, and organizational skills

Ability to manage a dynamic caseload

Knowledge of community health resources and system navigation

Experience developing policies/procedures and understanding relevant legislation/regulatory bodies

Familiarity with CQI frameworks (e.g., PDSA, Lean, Six Sigma, Baldrige)

Experience in client relations and collaboration with internal/external stakeholders

Technical & Other Requirements

Proficiency in interRAI tools, Alayacare, and Microsoft Office (Word, Excel, PowerPoint, Outlook)

Fluent in English (French or additional languages an asset)

Valid Class G driver’s license and access to a reliable vehicle

Clear Police Reference Check with Vulnerable Sector Screening

CANES Community Care is an equal opportunity employer committed to fostering a diverse, inclusive, and barrier‑free workplace. We welcome applications from all qualified individuals and strive to attract, develop, and retain talent from a wide range of backgrounds, experiences, and perspectives.

In accordance with the Accessibility for Ontarians with Disabilities Act (AODA), accommodations are available upon request throughout the recruitment and selection process. If you require any accommodations, please let us know and we will work with you to meet your needs.

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📌 Nurse Practitioner (Ontario)
🏢 CANES Community Care
📍 Ontario