|
|
|
|
|
Editorial |
April 2007
The last month has seen yet another flurry of activity around the long running issue of nurse prescribing. Currently the Therapeutic Products and Medicines Bill is at the Select Committee phase. This Bill, described as a flagship of Trans-Tasman legislation, is an omnibus bill with two parts. The first part proposes a joint Trans-Tasman regulatory scheme for the regulation of conventional medicines and complementary and alternative medicines. The second part of the Bill will replace the Medicines Act 1981 with new legislation for controls on medicine including prescribing. The second part of the Bill can support the transfer of Nurse Practitioners from designated prescribers to authorized prescribers. Currently only doctors, dentists and midwives are authorized prescribers and interestingly, their status is not up for debate. All nursing groups (Nursing Council of NZ, College of Nurses Aotearoa (NZ), NZ Nurses Organisation, Nurse Practitioner Advisory Committee of NZ, and Nurse Practitioners of NZ) have made submissions arguing for defining NPs as authorized prescribers based on:
Authorized prescribers may prescribe prescription medicine for patients under their care and designated prescribers may only prescribe a prescription medicine that is listed in the prescribing notice issued by their prescribing authority. The notices must list the medicines and the circumstances in which they can be prescribed and they must relate directly to the prescriber's scope of practice. In mid March the Ministry of Health issued a document and requested an extremely hasty consultation on collaborative prescribing - a proposal which would make all registered nurses who meet competency requirements designated prescribers. This is potentially a valuable development freeing up nurses in certain areas to provide a wider range of services. But at the same time, during a meeting with the Nurse Practitioner Advisory Committee, the Minister made it known that sector policy in the Ministry of Health had advised the Select Committee not to support the move of NPs to authorized prescribers. It seems this may be, or at least the overt reason is, that there is concern not to risk contention around the Bill being generated by those who may wish to see NPs confined as designated rather than authorized prescribers. Despite the fact that the select committee process is arguably the highest consultation process available, the view has been expressed that there has been inadequate consultation. The Ministry is adamant that this is only a temporary delay and that NPs will become authorized prescribers through a subsequent regulatory change by the Minister of Health. Many of us are very concerned that yet again this whole process is to be relitigated and that once more the fear of upsetting doctors takes precedence over the need to support a flexible and responsive workforce in a manner strongly supported by evidence. The issue of independent prescribing by NPs has been extensively and repeatedly consulted on and has been the topic of previous select committee deliberations, and changes in the Medicines Act have already been made. In addition nursing had previously understood that the change would be made in this Bill. The current government has invested a great deal of time, effort and resource to deliver on its policy of making effective utilisation of a highly educated nursing workforce and in particular to allow the public of New Zealand to have access to a Nurse Practitioner who can prescribe. This policy and direction is put at risk due to the current advice being provided by the Ministry of Health. There are potential consequences of a process which considers authorized prescribing and collaborative prescribing separately. The risk is that if collaborative prescribing is approved and there is a delay, or worst-case scenario a failure, to make NPs authorized prescribers we will have all nurses in effect prescribing under a degree of supervision by medical practitioners. This might seem attractive to many of our medical colleagues but it would defeat the major purpose - of nurse prescribing at any level - which is to improve access to services regardless of workforce shortages and poor availability of services. If all prescribing acts are dependant on the proximity of a medical practitioner then issues of access are not challenged. I think nurses are tired of the energy and time put into the submission process in good faith. The move to nurse prescribing is a move to benefit consumers of health care through improved access and flexibility and is based on extensive evidence of the safety and efficacy. Nurses are becoming disillusioned by the continued time-wasting prevarication. Most distressing has been the difficulty of determining an appropriate and strategic strategy shared by all nurse leaders for ensuring that the Ministry changes its advice to the Minister and to the Select Committee. Those present at the meeting with the Minister felt reassured that he was committed to NPs becoming authorized prescribers and that he had clearly challenged the Ministry staff to justify their advice. Others of us, admittedly not present, “smelt a rat” wondering if the power of medical lobbying had yet again infiltrated the decision making processes in the Ministry and if at this eleventh hour we are to be cheated of appropriate authority for NP prescribers. How to manage this difference presented significant professional leadership challenges. Even more distressing has been the confusion wrought by e-mail exchanges as we sought to share views and prepare a strategy. My personal experience was of being the recipient of e-mails requesting strong and diverse lobbying of all political parties and calls for rousing all nurses to action, and other e-mails suggesting that it was inappropriate to do anything other than trust the process the Minister had set in place by giving the Ministry four weeks to justify its advice. What is most complex about e-mail communication is that e-mails can be copied widely beyond their intended recipients and that people receive and read e-mails out of logical order as the forwarding-on process destroys any chronology. In addition documents intended as tentative drafts take on a much more formal status when they are circulated beyond those for whom they were drafted. A salient message for all of us is the importance of picking up the telephone and hearing it from “the horse's mouth”. In addition I believe “forwarding-on” to be a potentially dangerous process, which encourages misunderstandings and ill feeling as people read documents but do not understand the context or intent behind their production. E-mail can be a major convenience, enabling rapid and efficient transmission of volumes of information but it certainly needs to be used with caution and with agreed rules! All nursing groups attend a meeting, on the 19 th of April to strategise and attended a second meeting with the Ministry to discuss their advice. As a result we feel that a much more balanced paper has gone to the Minister. I am concerned that yet again this whole process is to be relitigated and that once more the fear of upsetting doctors takes precedence over the need to support a flexible and responsive workforce in a manner strongly supported by evidence and strongly championed by the Ministry itself. I note that no other group of existing authorized prescriber is to be reconsidered despite, in some instances, having considerably less educational preparation than NPs. I note that the issue of independent prescribing by NPs has been extensively and repeatedly consulted on and has been the topic of previous select committee deliberations, and changes in the Medicines Act have already been made. I note that the current government has invested a great deal of time, effort and resource to deliver on its policy of making effective utilisation of a highly educated nursing workforce and in particular to allow the public of New Zealand to have access to a Nurse Practitioner who can prescribe. This policy and direction is being put at risk due to the current advice being provided by the Ministry of Health. I think that by leaving the issue open yet again to consultation there will be significant risk of challenge from medical lobby groups whose interests are vested and not related to patient safety or improved consumer access. All possible evidence has already been presented and debated and there is no further evidence available to justify further wasting of tax-payer money through further consultation. Finally I think that nurses are tired of the energy and time put into the submission process in good faith when in fact there appears to be another process running concurrently. Nurses are in danger of becoming disillusioned by the continued time wasting prevarication. The overriding issue here is that evidence shows that nurse prescribing is a safe and effective addition to the nurses' “tool box” and the prime reason for its instigation is to ensure that more people have better access to comprehensive and affordable care. Given that this is the real agenda and should be the only agenda, it is a sad reflection on the health sector that we have had to fight so long and so hard to achieve it. Imagine if all of the energy invested over the last 10 years had been able to be directed more productively. Professor Jenny Carryer Executive Director |
Back to Top All rights reserved © College of Nurses Aotearoa (NZ) Inc. |
