Garth Rattray | Prescriptive rights for nurse practitioners?
In general, nurses are the hands-on caregivers and day-to-day monitors for patients. Doctors are there to make management decisions and carry out interventions using data/ reports from, and in association with, the nursing staff. In a hospital and clinic setting, doctors cannot function independently of nurses.
Although they work for the common good, certain tasks have always remained separate and distinct, according to each individual's training, qualification, expertise and experience.
However, some nurses have undergone specialist training as family nurse practitioners (NPs). These are qualified nurses who go on to study for the MScN programme - a two-year, 45-credit course. They form an essential part of our health-delivery system. A resurgent petition is in the works to grant these specialist nurses prescriptive rights. They would be able to write prescriptions and request investigations on a limited basis.
FEW PRESCRIPTIVE RIGHTS
Family NPs are currently in 50 countries with several others mulling over using them to enhance patient care. Not all countries allow them prescriptive rights and, even within the United States, only some states extend them very limited prescriptive rights. In a few states, their prescriptive rights allow some autonomy, while others require them to work only under the direct supervision of a physician.
In Georgia, in preparation for his day off, a physician pre-signed blank prescriptions and left them for the nurse practitioner to use (for writing controlled meds). This illegal act earned the doc seven months in a federal prison. I understand that we may be having a similar problem here in Jamaica, and this is one of the factors fuelling the nurses' request for prescriptive rights.
It goes without saying that no nurse can replace a physician; we all have our roles to play. However, globally, we are not unique in the need to broaden the base and efficacy of primary-care service, but prescriptive rights, including investigations, need to be thoroughly thought through.
The Ministry of Health's legal department is looking at the restricted list of meds that NPs may prescribe, but it cites sensitivity and won't disclose it. This secrecy baffles me.
The concern within the broader medical community is that doctors must undergo vastly more training, are put under far more scrutiny, stress and repeated clinical assessments for much longer than NPs, all to safeguard the health of patients. The conclusion, therefore, is that NPs cannot function on par with their physician colleagues.
The fear is that some NPs might get it into their heads that they are capable of functioning as well as their physician colleagues and might set up their own, private (surreptitious) medical practices. Since NP training can't eclipse that of the physicians, patients would be in jeopardy
- Governments often make decisions based on the opinions and agendas of selected individuals who may not be au fait with relevant principles and practices. So, if they go ahead with this proposal, several safeguards should be put in place
- The NPs should always work under supervision. This may be direct or indirect (by electronic consultation and oversight). This should be no problem, because we graduate three times the number of doctors annually than we did when I graduated.
- Prescriptions written by NPs should only be written on official government clinic prescription pads and only accepted by government pharmacies.
- Similarly, investigations requested by NPs must be confined to government labs/imaging centres.
- Referrals for therapies must also be restricted to government centres.
- Since swiping the National Health Fund (NHF) cards triggers access to any health insurance that patients may have, the insurance companies are also stakeholders. They have their own methods of vetting health-care providers. Each NP must be subjected to health insurance scrutiny, just like medical doctors/dentists, physical therapists, laboratories, and imaging establishments.
- With this added privilege comes added responsibility and an increased need for surveillance. Therefore, these nurses should perhaps be overseen by the Council for Professions Supplementary to Medicine.
- The Government needs to involve the Medical Association of Jamaica, the Association of General Practitioners of Jamaica and the Caribbean College of Family Physicians (Jamaica Chapter) for ideas, suggestions and guidance. They are major stakeholders because they have many years of experience in optimising patient care.