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Shelley Ross, president of the B.C. Medical Association, which represents physicians, medical residents and students, says that doctors should remain the team leaders who oversee patients’ care.


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.

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

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

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Ms. MacDiarmid said that until now, nurse practitioners, who have more training than registered nurses, had to wait for somebody else to approve 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," Ms. MacDiarmid said.

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

Small rural hospitals do not always have a doctor on site, she added, noting that when she worked as a physician in Trail, there were times a doctor would not be in the hospital.

Opposition NDP Leader Adrian Dix called the announcement a good idea that makes 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, noting, for example, that about 15,000 people in the region surrounding Kamloops, are without a family physician.

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

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"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.

Mr. Dix said that 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."

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

"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, Dr. Ross said that 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.

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

"Who will follow through with the co-ordination 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, after Ontario, to give nurse practitioners admitting and discharging privileges.

The ministry said the provincial government introduced nurse practitioners in 2005 to improve primary health-care services, and this past May announced $22.5-million 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 to 246 this year from 156 in 2009.

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