Expanded prescribing powers for nurses makes sense

Posted on March 12, 2024 in Health Debates

Source: — Authors:

TVO.org – Opinion/Health
Mar 11, 2024.   Written by Matt Gurney

OPINION: In a perfect world, everyone with any ailment would see a GP. But Ontario is far from perfect 

Nurses are getting expanded prescribing powers in Ontario. Good.

That’s kind of it? Is there much more to say? The CBC has a news report about it that’s online now; it indicates that nurses who pass training offered by the College of Nurses of Ontario will be able to prescribe basic medications for a limited range of conditions and needs. Most forms of birth control, travel-related medications, standard immunizations, and topical wound care will be covered by the new regulations. The CBC story profiles the first nurse in Ontario to be given the new expanded powers and notes that this particular nurse, Cyril Lee Turley, works at a clinic in Little Current, not far from Sudbury. There is a real shortage of doctors in northern Ontario — we don’t have enough in practice anywhere, as recently noted here, but it’s particularly bad in the north. Expanding nurse powers will be hugely helpful to many who might otherwise go without.

I confess to some curiosity as to how controversial this will prove. In recent years, I have been fascinated by the outright hostility that can exist between family doctors and pharmacists (and their respective associations) in this province. On several occasions over the past few years, Ontario first created and then expanded the ability of pharmacists to prescribe medications for a limited number of relatively minor medical ailments. This moved Ontario into lockstep with the other provinces, where this had been done long ago, but it was still met — officially and unofficially — with hostility by family doctors in Ontario.

I’vewritten about this for TVO Today before and recapped some of the concerns doctors had with the expanded powers. The main one? Simply that pharmacists may rush to assume that an ailment is one of the minor conditions they are allowed to prescribe for and fail to realize that it is a more serious issue with similar symptoms (the assumption being, of course, that a doctor would not make the same error). Doctors have also told me they worry about a lack of privacy for sensitive medical discussions in some pharmacy settings and that there may be a financial conflict of interest on the part of pharmacists, who may benefit from the sale of medications they prescribe.

Fair enough, but that wasn’t, to me, a slam-dunk argument against matching the other provinces and allowing pharmacists to prescribe. Your dentist can upsell you, too, and despite recent federal efforts to establish some kind of national dental-care program, the existence of dentists and their clinics is not itself held up as some kind of failure or threat to the integrity of medicine. Concerns about privacy in older, smaller pharmacies, which may lack private consultation rooms and rely instead on the more generous standard of “acoustical privacy,” are again valid, but the drawbacks must be balanced against the fundamental reality: in many cases, given congestion in emergencies rooms and the lack of family doctors, a pharmacist may be the only realistic way someone can access treatment for a minor but irritating condition.

I do not dismiss the concerns of doctors. I do view them with some skepticism because doctors are only human, and gatekeeping is part of the human condition. But even if we approach the concerns of doctors with maximum charity for their motives, we’re still left with the facts on the ground. More than 2 million Ontarians don’t have access to a family doctor. If they’re afflicted with a minor ailment, their options are to go without care, go to an ER (where they will either not be seen, due to overcrowding, or be treated at enormous cost to the health-care system), or go to a pharmacist who can likely treat their condition — rapidly and at minimal cost.

I have no problem granting that, in a perfect world, we’d have so many family doctors available that our system would insist that everyone with any medical ailment or concern be seen by a family doctor, given a full and comprehensive exam, and then treated accordingly. Since this isn’t our world, I am a realist. This is the very essence of a “don’t let the perfect be the enemy of the good” scenario. I vote for the good!

Expanding prescribing powers to nurses will not present the same kinds of concerns as expanding to pharmacists did. Nurses work in clinics that have privacy, and they lack potential financial conflicts of interest. Plus, they’re currently limited to very routine prescriptions, so the danger of a blown diagnosis is minimal. On that basis, the risk of blowback seems low.

And that’s good! As discussed often here, there seems to be a growing consensus even among health professionals that our system is already in some kind of state of collapse. We will not — do not — have the luxury of perfectionism. Millions of Ontarians lack routine access to basic cures and treatments already. It’s going to get worse for a long time — probably much worse — before it gets better.

This is a crisis. I hope more people remember to act like it. The priority is treating patients; the goal is not leaving any to suffer for lack of access to a safe, proven treatment. And that is absolutely the status quo that already exists today for millions. It will soon be the status quo for millions more. This is a tragedy and an outrage. Let us hope it does not also become further fodder for sniping among the health-care professionals the rest of us are counting on, sometimes quite literally over matters of life and death.

Matt Gurney – Matt Gurney is a journalist in Toronto.


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