06/27/2012 04:47 EDT | Updated 08/27/2012 05:12 EDT

CP Exclusive: Nurses should order tests, diagnose common ailments: report

TORONTO - Ontario should allow nurses to perform more tasks, from diagnosing common ailments like throat and ear infections to managing and prescribing drugs, such as birth control pills, says a new report obtained by The Canadian Press.

The 116-page report, to be released Thursday by the Registered Nurses' Association of Ontario, provides a step-by-step, three-year plan to expand the scope of practice for nurses.

Nurses should be able to order diagnostic and lab tests, as well as interpret and communicate the results of those tests to patients, the report said. That will ensure nurses have all the information they need in order to prescribe medication.

The report also recommends that nurses be able to manage chronic illnesses for patients with whom they've developed long-term therapeutic relationships.

Many registered nurses and registered practical nurses aren't performing all the tasks they're capable of doing, the report found.

"Clearly there is untapped potential in Ontario's primary care system with a significant nursing workforce waiting and eager to be fully utilized and take on expanded roles," it said.

Some nurses are already performing some of these duties — such as prescribing medication in remote northern communities and sexual health clinics, the report said.

But they can only do it under medical orders, when they should be able to do it independently within a health team, said Doris Grinspun, chief executive officer of the association.

In nurse practitioner-led clinics, nurses can order tests to diagnose ear infections. But if antibiotics are required, the nurse must go to the nurse practitioner or doctor.

Following through on the recommendations will make the health-care system more efficient and contain health costs for a province that's facing a $15-billion deficit this year, said Grinspun.

If the proposed plan is fully implemented by 2015, patients would be able to receive same-day access anywhere in the province within six months, she said. But legislative changes are needed to make it a reality.

Registered nurses cost about four to five times less than a family doctor, Grinspun said. They would still work in teams with doctors and nurse practitioners, but simply have the ability to perform more work for patients.

"Nurses today can already do full physical assessments, they can do counselling, they can do education," she said. "They can do so much more."

But most registered nurses in primary care aren't doing that work because there are barriers in the system, she said.

Nurses in the United Kingdom have been prescribing medication for 15 years, Grinspun said. Alberta, Manitoba and British Columbia are also looking at having registered nurses prescribe drugs.

The province passed legislation two years ago to give more powers to some health-care professionals like nurse practitioners and pharmacists, but the government is moving slower than molasses, said NDP health critic France Gelinas.

"It's as if they know where they want to go, but they don't seem to be able to find a road to get there," she said.

"Well, this report is basically what the NDP has been saying for a long time, and it's a road to get there."

In his February report on reducing costs, economist Don Drummond recommended that the government train more nurses and let nurse practitioners perform more work currently done by doctors, including annual physical exams.

Health Minister Deb Matthews said she agrees with Grinspun that nurses play an important role in Ontario's health-care system, but could do even more.

Ontario has added more categories of nurses and 24 nurse practitioner-led clinics are up and running across the province, she added.

"They are a model that other health ministers from across the country are asking me about, so they are filling a very important need," she said.

"And those other nursing roles are being expanded across the province."