Slowly, nurse practitioners in this province are getting some respect. Too slowly.
The province is ready to expand the prescribing authority of nurse practitioners, who do many of the things a family doctor is licensed to do. Instead of having a physician sign off on prescribing a wheel chair or a cast, NPs will be able to order it themselves. Talks are beginning on expanding their authority to prescribe drugs on a list now reserved for physicians only, drugs that are newer and more expensive. There is little reason for the restrictions other than expense and bureaucratic blind spots.
The Nurse Practitioner Association of Manitoba believes it is, in part, a matter of policy catching up with practicalities.
Medical practice is heavily regulated and one by one the restrictions are falling to the logic of letting patients make fuller use of the medical expertise of nurse practitioners.
The health system, straining to keep up with demand and to contain costs, is changing to accommodate nurse practitioners and their clients, but numerous barriers to full employment continue to exist.
Some graduates from the University of Manitoba have been unable to find full or permanent employment and some have even fallen off the roster as registered practitioners after failing to get the minimum 600 practice hours required annually to meet competency standards.
There is no valid reason why nurse practitioners should not be able to set up private practice and hang out their own shingle, as do physicians, but for the fact Manitoba Health does not want to open another route of fee-for-service billing.
This keeps nurse practitioners captive to a health system that tells them where they fit best and deprives citizens of broader access to primary health care.
While the Manitoba association believes that nurse practitioners ought to be able to bill fee-for-service if they choose, it, as with sister associations across Canada, is frustrated with the dearth of innovative funding arrangements. Putting nurse practitioners on publicly paid salary within physicians' private practices, for example, would free doctors for more complex care, reducing the cost to them and the system.
Many nurse practitioners who were educated, or who migrated, to Manitoba are underemployed and underused. Health Minister Theresa Oswald must look more broadly at opening the health system fully to the value and skills of nurse practitioners.