AMA Rejects Independent Nurse Practitioners As Medical Workforce Solution
Following debate at its Federal Council meeting last weekend, the AMA has released a Position Statement on Independent Nurse Practitioners, which states categorically that nurses are no substitute for doctors.
AMA President, Dr Mukesh Haikerwal, said today that at a time when Australians expect and deserve higher quality health care it would be irresponsible for governments to pursue medical workforce solutions that offer patients less than the best possible care.
"All Australians have the right to a medical diagnosis and medical treatment by a registered medical practitioner based on scientific and clinical training," Dr Haikerwal said.
"You cannot substitute independent nurse practitioners for doctors. You cannot invent the expert skills and experience and years of study and training that are needed to become a GP.
"While nurses are an essential part of the primary care team, they should use their skills in a way that complements the work of the doctor - under the guidance of the doctor who provides the overarching care and who takes ultimate responsibility for the patients' medical care.
"The AMA supports improved career paths for nurses and greater recognition of specialist training by nurses, but we totally oppose any moves to supplant the GP as the pivotal member of the primary care team.
"Governments must train more medical professionals locally in sufficient numbers to fill the medical workforce gaps.
"Retaining doctors in the health workforce is vital. Investing in healthcare facilities, training and research is part of the way to underpin the current workforce and increase participation of doctors in clinical roles.
"Inappropriate short term solutions with lay workers or health professionals with different skills and training to a doctor is not desirable, sensible or safe. Australian patients deserve the best, and there is no substitute for a doctor in providing quality primary care," Dr Haikerwal said.
The AMA Position Statement on Independent Nurse Practitioners 2005 states that the role of a nurse in the primary care setting does NOT include:
- Formulating medical diagnosis
- Referring patients to specialists
- Independent ordering of pathology or radiology
- Prescribing medication and issuing repeat prescriptions
- Deciding on the admission of patients to, and discharge from, hospital.
The Position Statement is available on the AMA website at
Independent Nurse Practitioners
2005
The AMA does not support a role for the independent nurse practitioner.
The AMA's support for the role of General Practice Nurses (GPN) is outlined in a separate AMA position statement and policy resolution.
The Australian community wants and deserves the best quality medical care regardless of their geographical location or economic circumstances. The AMA supports a model of primary care that places the general practitioner as pivotal in the primary care team.
Nurses are an essential part of the primary care team adding value and enabling the primary health care providers to deliver more services to patients. In the primary care setting the role of nurses is complementary to that of the general practitioners. Nurses do not substitute for general practitioners.
The role of a nurse in the primary care setting does not include:
- Formulating medical diagnosis
- Referring patients to specialists
- Independent ordering of pathology or radiology
- Prescribing medication and issuing repeat prescriptions
- Deciding on the admission of patients to, and discharge from, hospital.
A debate on the issue of nursing career paths and recognition of nurses' specialist training is valid. It is not, however, a valid argument for models of legislated roles for independent nurse practitioners where levels of independence remove the general practitioner as central to delivery of primary care.
Governments throughout Australia are looking to reduce costs and providing the opportunity for substitution of medical care with independent nurse practitioners is one strategy. There is no evidence that this will improve outcomes particularly when such a strategy is pursued outside a collaborative model of primary health care delivery.
The demands of the Australian community have to be met by strategies that combine recognition for the need for an injection of more funding balanced with collaborative approaches to primary care delivery that do not compromise quality of care. The legislated capacity to substitute independent nurse practitioners represents unwillingness or inability of Governments to address the underlying issues related to general practitioner workforce shortages.
The AMA does not accept that medical practitioners should be legally responsible when errors of omission or commission by medically unsupervised independent nurse practitioners warrant subsequent medical intervention. Medical practitioners are not responsible for professional acts over which they have no control.