Transforming and Supporting Patient Care - Health Professions ...

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290Chapter 12 – Profession of NursingThe CNO and the NPAO have requested that no limitations on prescribingauthorities, including designating drugs by classes or categories or lists, beincluded in the legislation or regulation for NPs.Proponents’ Rationale for ChangeProponents have requested this change as a result of concerns relating tothe regulation-making process and experiences with attempts to amend thedrug regulation. The CNO argues that “regulating by lists, categories orclasses is inconsistent with the philosophy of self-regulation, does notpromote safe practice and will not provide NPs with the flexibility or theauthority they require to prescribe for the diverse client populations andsettings they serve.” 44NPs provide care to a full range of patient populations and seek an enablingprocess rather than one that can limit effective care. The CNO told HPRACthat drug categories do not address the depth and breadth of practice ofNPs. The diversity in practice, along with managing patients with multipleco-morbidities, makes the use of limitations in regulation an unworkableoption.An approach that includes drug categories with specific conditions andlimitations is also not practical for NPs given that “keeping categories up todate for each of the four specialty certificates and the multiplesubspecialties subsumed under these certificates will be difficult and likelyimpractical, if not impossible to achieve”. 45NPs believe that limits and conditions are more appropriately managed instandards of practice rather than legislation because they can more quicklybe amended according to emerging best practices. 46Limits on scope of practice caused by these lists have delayed the deliveryof appropriate patient care in addition to placing burdens on other membersof the health care team who are pulled away from their own responsibilitiesto enact a function NPs are capable of performing on their own.The amount of time spent developing, reviewing and updating medicaldirectives, as well as taking them through the physician and administrativeapproval process, is labour-intensive and time-consuming. Furthermore,removing the necessity of medical directives will reduce the risk of blurredaccountability and related liabilities, decrease duplication, increase publicsafety and increase efficiencies and cost-effectiveness within the system.What HPRAC FoundSystem IssuesHPRAC heard that there are numerous benefits to NP prescribing. Nurseprescribing is cost- and time-effective for service providers, rates of44CNO. Submission to HPRAC. 1.45Nurse Practitioners Association of Ontario, Submission to HPRAC. 5.46Ibid: 6.HPRAC Critical Links January 2009
291Chapter 12 – Profession of Nursingpatients’ compliance with nurse prescriptions are high, and nurses takedetailed medical histories before making a decision about an interventionand may be more likely to prescribe a non-pharmacological intervention. 47During the scope of practice review, HPRAC heard from stakeholders thatNPs prescribing in specialist roles is useful in hospitals, provided there is acomplete record of prescribing activity documented through centralizedhospital records. A number of professionals came forward and noted NPs’expertise and contribution to care and supported their right to prescribe.What Other Leading Jurisdictions DoIn Alberta, NPs have been authorized to prescribe Schedule I drugs since1994. In British Columbia, the CRNBC sets strict standards outlining whatcan be prescribed and under what circumstances. These standards are setin consultation with physicians and pharmacists.In Great Britain, nurse prescribing, introduced in May 2006, is well receivedand understood by the public and other health practitioners. HPRAC heardin consultations with authorities from Great Britain that nurse prescribing isboth time- and cost-effective and results in higher patient compliance.Among the challenges and barriers identified in the implementation ofnurse prescribing in Great Britain were the limitations of the formulary,which impacts the effectiveness of patient care; the bureaucracy associatedwith writing Clinical Management Plans; the degree of closeness of theworking relationship with the physician; a perception by some physiciansthat their role is being eroded; physicians’ concerns about patient safety;the lack of institutional strategy for implementing nurse prescribing; accessto computerized prescribing; and a number of education and practiceissues that warrant ongoing attention. 48,49,50Managing the Risk of HarmPhysicians told HPRAC in key informant interviews they are concernedabout the implications of bypassing the traditional gate-keeping role of MDsand pharmacists if open prescribing by NPs were to become a reality. Theyraised concerns about the CNO oversight and about the drugs the CNO hasrecommended for inclusion in the designated drug lists for nurses.47HPRAC. Prescribing and Administration of Drugs by Non-Physician Health Professionals: LiteratureReview. 19.48Evaluation of non-medical prescribing within the Essex Health Economy. 2005-2006.49Latter, S., Maben, J., Myall, M., Courtnay, M., Young, A, Dunn, N. (2005) An Evaluation of ExtendedFormulary Independent Nurse Prescribing. Executive Summary of Final Report. Policy ResearchProgram at the Department of Health and University of Southampton.50Latter, S., Maben, J., Myall, M., Young, A. Evaluating Nurse Prescribers’ Education and ContinuingProfessional Development for IndependentPrescribing Practice: Findings from a National Survey in England (2007) Nurse Education Today. 27:685-696.HPRAC Critical Links January 2009
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186Chapter 8 - Profession of Dental
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398Chapter 18 - Summary of Proposal
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