Collaboration confusion

Misinformation surrounds the prescribing rights of nurse practitioners and midwives.

A month has passed since nurse practitioners and eligible midwives gained access to PBS and MBS, but the dust has far from settled.

The new legislation – which has been long fought for – continues to attract criticism from certain groups. And it is still surrounded by “misinformation”, particularly when it comes to collaborative agreements, says College of Nursing chief executive, Tracey Osmond.

“Misinformation being broadcast by certain groups with vested interests in the health sector strongly suggests nurse practitioners and eligible midwives act autonomously and independently of other health professionals,” said Osmond.

“That is wrong. Nurse practitioners act, and have always acted, within a defined scope of practice that involves a collaborative team of, often, more than one doctor and other health professionals. Collaboration is integral to their practice and a requirement of the legislation.”

That arrangement, Osmond said, has not changed. Moreover, because nurse practitioners specialise, the scope of practice determines what they can do.

“A nurse practitioner in paediatrics, for example, cannot prescribe drugs for a patient under the care of a nurse practitioner specialising in women’s sexual health.”

However, doctors claim regulations for collaborative care are not transparent, calling on the government to “urgently clarify” the intent and coverage for such arrangements.

AMA President Dr Andrew Pesce said that claims in the media by some groups that their models of care – staffed by independent nurse practitioners, not doctors - were eligible for access to Medicare and the PBS was throwing the new arrangements into disarray and confusion.

“The AMA supports collaborative arrangements where a doctor is in a position to provide advice and medical support when required for patients being seen by nurse practitioners,” Pesce said.

“We also believe this arrangement must be agreed and formalised before a patient is seen by a nurse practitioner. This is in keeping with the spirit and intent of the legislation.  It is the best model of care for patients.

The AMA does not support “contrived arrangements” that may involve correspondence with a remote or distant doctor who signs off on a written protocol but who “cannot provide advice and direct medical support when required”, Pesce said.

“While we recognise that special arrangements with doctors will be necessary for some nurse practitioners working in remote locations, these must be exceptions, not the norm.
Media headlines of “Nurses replacing doctors” and “NPs filling the gaps” isn’t assisting in encouraging doctors to embrace the changes, a nurse practitioner told Nursing Review.

“This is a simplified understanding by some of what the legislation means, but it is wrong and in my view not the view of the majority of NPs,” the nurse, who asked to be unnamed, said.

“But it does do us a disservice, as that is what some doctors fear will happen, and that most, in my experience, will fight against.

“Some doctors will be dead against these changes no matter what, but I believe they are in the minority. For the majority of doctors and nurses, what is best for our patients come first and that means working alongside each other. For this to happen we have to make sure we don’t prioritise our profession over patients.”

Providing the public with accurate information is also essential if the new legislation is to benefit the public, said Osmond.

“Not just anyone can practise as a nurse practitioner or eligible midwife,” said Osmond.
Nurse practitioners and eligible midwives are registered to practise only after they have completed a Bachelor degree, a graduate certificate in a specialty, a Master degree and five years of advanced practice in their specialty.

“For some GPs to suggest that nurse practitioners are not professionally equipped and collaboration between nurse practitioners and doctors does not already occur is simply scare-mongering.

“The legislation is perfectly clear on these matters.”

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