BC Nurses Allowed To Admit, Discharge Patients

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NURSES
B.C. nurses have been given the authority to admit and discharge patients. (AP/Ted S. Warren) | AP: Ted S. Warren

VANCOUVER - The B.C. government is giving nurse practitioners more authority in a move that Health Minister Margaret MacDiarmid says will make the health-care system more efficient, especially in rural communities, saving doctors, nurses and patients time.

MacDiarmid announced Thursday that nurse practitioners will be able to admit and discharge patients, an expansion to their current roles that include diagnosing, prescribing and ordering diagnostic tests to treat common medical conditions.

But Dr. Shelley Ross, president of the BC Medical Association, which represents physicians, medical residents and students, said in a statement that doctors should remain the team leaders who oversee patients' care.

MacDiarmid said until now, nurse practitioners, who have more training than registered nurses, had to wait for somebody else to sign off on the admissions and discharges of patients.

"So what we're doing now is something that I think really makes sense: that for the patients that they're providing care for, they can now do that admission and discharge and make things more efficient," said MacDiarmid.

She said she could envision scenarios where patients were ready to be discharged but had to wait, sometimes for hours, for somebody, often a doctor, to sign off and let them go.

Small, rural hospitals are not always staffed by doctors, she added, noting there were times when she was working as a physician in Trail, B.C., and a doctor wouldn't be in the hospital.

The announcement earned praise from Opposition NDP Leader Adrian Dix, who called it a "good idea" that helps make the health care system more efficient and builds on professional strengths of nurse practitioners.

He said gaps in the health-care system are much bigger in rural areas of the province, noting, for example, that about 15,000 people in the region surrounding Kamloops, B.C., are currently without a family physician.

Dix said nurse practitioners can help fill those gaps and also assist patients who are dealing with chronic diseases, like Type 1 diabetes.

"This is a real opportunity to improve care and also make the health-care system more efficient, and I think we've got to take advantage of them in this day and age," he said.

Dix said while nurse practitioner numbers have grown, the province has also lost many in recent years to Ontario and the United States, jurisdictions that "used them better."

MacDiarmid said nurse practitioners will help fulfil the health-care needs of small rural communities that are struggling to find doctors.

"I think we will see, you know, a blend. I think we will see a blend of the two kinds of providers out there in rural communities working together as a team," she said.

"That's going to be good. So that will be a positive thing for the health care system and for patients."

However, Ross said while the association supports collaboration and team care, doctors have the most comprehensive understanding of patients' conditions.

Physicians also have the training to make key health-care decisions, she added, and the medical association has concerns about accountability.

"Where does accountability lie if a patient experiences adverse consequences if someone other than the physician discharges a patient," asked Ross.

"Who will follow through with the coordination of care once a nurse practitioner has admitted a patient? This is especially important today when so many patients present with complex and chronic conditions."

B.C. is now the second province in Canada, behind Ontario, to give nurse practitioners admitting and discharging privileges.

The ministry said the provincial government introduced nurse practitioners in 2005, as a way to improve primary health-care services, and this past May announced $22.5 million in funding to pay for 190 nurse practitioners over the next three years.

According to the College of Registered Nurses of British Columbia, the number of nurse practitioners in B.C. has grown from 156 in 2009 to 246 this year.

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