Extension of nurses' competencies: new provisions still raise objections from doctors

The Presidium of the Supreme Medical Council has published a position paper on the revised draft of advanced practice nurse competencies in primary care. The document was submitted to the medical council on November 18 by the Nursing and Midwifery Education Department of the Ministry of Health. The doctors stress that although some of the comments made in October have been taken into account, the new version of the draft contains provisions that define the scope of nurses' powers too broadly.

The NRL welcomes the withdrawal of provisions regarding the ability of nurses to determine death and issue death cards, and the repeal of the proposal authorizing them to refer for CT scans. However, as the local government points out, the new version of the document contains many new objectionable changes.

Expansion of patient groups and diagnostic privileges

According to the NRL, it is unjustified to expand the scope of patients whose health status would be assessed by an advanced practice nurse - from adults to children, along with the implementation of health balances and preventive programs.

The provision on "assessing the patient's health problems, establishing the diagnosis of the disease and implementing diagnostic and therapeutic procedures" also raises objections. The doctors' self-government stresses that diagnosing diseases is a statutory competence of doctors, and the draft does not provide for performing these activities under medical supervision.

The NRL also notes a contradiction between this provision and another section of the document, which refers only to diagnosis of "selected conditions."

Ordinance on psychotropic and narcotic drugs

Further objections relate to the proposal to allow nurses to write prescriptions for Group III N narcotics and Group IVP psychotropic substances as part of the continuation of treatment. The Presidium of the NRL considers this change "too far-reaching" and recalls that the prescription of such drugs should remain the exclusive competence of the physician.

Diagnosis of chronic diseases

The draft significantly expands the catalog of conditions for which an advanced practice nurse could provide diagnostics. It includes, among others, type 2 diabetes, heart failure, chronic respiratory diseases, thyroid disease, kidney disease, urinary tract disease, allergies, gastrointestinal disease and other chronic conditions. Such a broad scope is strongly opposed by the medical association.

Declarations of inability to work

The local government also took a negative view of the proposal to give nurses the authority to issue certificates of incapacity for up to 5 days. As the NRL points out, this would in practice entail granting the right to diagnose diseases on their own. Moreover, current regulations grant such powers only to physicians, dentists and feldspersons.

Scope of commissioned research

Regarding the appendices on diagnostic tests, the NRL reiterates its earlier negative opinion, especially regarding referral for endoscopic tests. The self-government also notes that the draft does not specify that the ordering of tests should apply only to patients who have already been diagnosed, and not to first-time applicants.

Source: NIL