‘Super nurses’ gain powers, but look for more autonomy
Quebec is gradually increasing the scope of practice for nurse practitioners, but the issue of their ability to practise autonomously without the supervision of a doctor remains unresolved.
Health Minister Gaétan Barrette announced the adoption of two regulations Wednesday that will formalize the ability of specialized nurse practitioners, or “super nurses,” to do things that previously could be done only by doctors.
They will now be able to, for example, treat suspected cases of hypertension, asthma or diabetes before a doctor has seen the patient and made a diagnosis.
There will be no longer be limits on their ability to prescribe medicine.
However, the announcement did not dispel some of the vagueness surrounding the extent and limits of their powers with doctors and nurses having different interpretations.
According to one understanding, patients will have to see a doctor quickly to obtain a diagnosis confirming the initial analysis of the super nurse.
However, Barrette said the second appointment was not mandatory, but “it is mandatory that the doctor be informed” of the file.
One of the two regulations adopted formalizes the authority exercised by the doctor, who will have to ensure quality control over the medical activities performed.
The president of the Association des infirmières praticiennes spécialisées, Christine Laliberté, welcomed the progress announced by the minister, but said Quebec is behind other parts of the country, where nurse practitioners can make diagnoses.
She lamented that under the Quebec plan a patient cannot just see a super nurse once to receive a diagnosis and the appropriate treatment.
“If we stop here today, it’s clear that we will stay behind” colleagues in other provinces, Laliberté said, adding there’s nothing to justify such a situation.
She said the masters-level university training received by Quebec nurse practitioners compares favourably with that required elsewhere in Canada.
“We are the only ones in Canada who cannot diagnose,” Laliberté said.
Under the current legal framework, nurse practitioners will only be able to give “diagnostic hypotheses.”
For years, super nurses have fought to acquire greater professional autonomy, but they ’ve faced resistance from doctors, who say they’re open to super nurses, but want to preserve their progressives and privileges. At a news conference, Barrette said he didn’t see doctors providing a form of supervision over nurse practitioners. Rather, he spoke about the necessity of constructing a “partnership” with a sharing of responsibilities that will be defined and clarified over the years.
“We’re doing a reform that breaks silos, we are not going to create others,” Barrette said.
The new rules were negotiated for years by the government, the Ordre des infirmières and the Collège des médecins.
The president of the Collège des médecins, Dr. Charles Bernard, said the way he understands it, the super nurse will “identify the problem” and will work with their partner doctor to confirm a more complicated diagnosis.
A followup committee has been created to continue discussions between the professional orders and the government.
Barrette said he had delivered on super nurses’ concrete requests, adding the larger issue of their professional autonomy is another debate.
“We have responded fully to the demands of the nurses,” he said.
Quebec currently has 475 super nurses.
Presse Canadienne