Nurse practitioners: Asset or liability to the health-care system?
SHOULD nurse practitioners be given legislative rights to offer medical care to vulnerable and underserved communities in Jamaica? This is a topical matter that has been deliberated for several decades.
To objectively respond to this concern, it is necessary to establish who is a nurse practitioner, the roles and functions that they play in the delivery of health care, and the level of training and experience that prepare them to undertake these roles.
The quality of the service rendered over the years must also be taken into consideration.
The nurse practitioners programme is not unique to Jamaica. Many countries across the globe utilise them to help meet the needs of its people in primary health-care settings. These countries are increasingly recognising the value of the contributions of nurse practitioners in the primary health-care delivery system. Subsequently, the scope of practice and degree of autonomy have increased over the years. In developed countries, such as the USA and Canada, nurse practitioners are given prescriptive rights and are allowed to practise independently or collaboratively with a medical practitioner.
In Jamaica, the nurse practitioners programme was introduced in 1977 at a time when there was a chronic shortage of medical doctors. People, especially those living in rural areas, were greatly disadvantaged in obtaining basic health care. Nurses rose to the challenge of meeting the growing health-care needs of citizens in underserved communities.
Experienced nurses were trained for the crisis to assume roles normally carried out by doctors in primary care. The expanded scope of practice empowered this group of specially trained nurses to provide preventive and curative services effectively and efficiently to clients at the primary health-care level (health centres).
Nurse practitioners are trained to conduct advanced health assessments, request and interpret diagnostic tests, make appropriate medical diagnoses, treat patients with common health conditions, as well as engage in health promotion and disease prevention management. For over 40 years nurse practitioners have demonstrated competence in providing quality care to the Jamaican populace.
After completing three to four years of being trained as a registered nurse, an additional year of training in midwifery or mental health, two years of training as
a nurse practitioner, plus years of experience working as a nurse, the Jamaican nurse practitioner is capable of providing excellent comprehensive primary healthcare services.
The stark reality, though, is that nurse practitioners in Jamaica are stymied by the absence of a regulatory framework for practice. Despite lobbying for legislative rights, consecutive governments have failed to fully recognise the real value and potential of nurse practitioners to primary health care.
Previous ministers of health made promises to address this matter but failed to follow through. It is hoped that this current minister of health will follow through on his recent promise to remedy this sore issue.
As it now stands, patients seen by nurse practitioners are still being disadvantaged. A simple example is that of a patient who is seen by the nurse practitioner and is eligible to receive benefits from the National Health Fund (NHF). Such a patient is forced to return to the health centre at a time when a doctor is available to have the NHF beneficiary form signed because this responsibility is not in the jurisdiction of the nurse practitioner.
As Jamaica seeks to strengthen its health-care delivery system and improve health outcomes, expanding the scope of practice of the nurse practitioner must be seriously explored.
We face the reality that Jamaicans are living longer and non-communicable diseases are burgeoning rapidly while resources for health care are dwindling. The limited financial resources allotted to the health sector and the changing demographic and epidemiologic profiles of the country are major threats to the nation’s health. These factors increase the burden on the health-care system.
Nurse practitioners are well positioned and equipped to help alleviate the negative impact of our changing health profile and advance the national agenda for health. This will enable the deployment of more doctors to critical areas in secondary care, thus helping to improve the doctor to patient ratio, decrease doctors’ long working hours, and improve patients’ satisfaction.
Nurse practitioners are valuable assets to the health-care system in Jamaica. They are positively impacting the outcome of health care in primary health-care settings across the island and with more autonomy, the health-care service could have a greater reach.