Christopher Tufton | Embracing prescriptive rights for nurses
There is a new development in public health in Jamaica – one that has been years in the making and which augurs well for improved access to healthcare, particularly for those persons from rural and underserved areas. It is that our nurses are to be provided with prescriptive rights, that is, the authority to write prescriptions.
In 2021, I announced in Parliament the formation of a committee chaired by Professor Denise Eldemire-Shearer to examine the issue of granting prescriptive authority to advanced practice registered nurses (APRNs). Since then, this committee has engaged extensively with stakeholders, resulting in a report that has paved the way for a unique model of prescriptive authority for APRNs, tailored to our Jamaican context.
Under this model, family nurse practitioners and mental health psychiatric nurse practitioners in government health facilities and the University Hospital of the West Indies will be granted prescriptive authority under specific conditions.
The conditions include that there are no private practice privileges; that medical practitioners must assess all new patients, as well as review the patient when a new problem emerges or when the patient becomes unstable. Also, mental health psychiatric nurse practitioners and family nurse practitioners should be registered by the Nursing Council of Jamaica as APRNs and meet the specific training requirements and continuing education hours, as determined by the Nursing Council of Jamaica. Further, at the University Hospital of the West Indies, a senior resident or consultant at the hospital must see all patients discharged.
The amendments are aimed at further streamlining patient care, as all patients should be assessed and diagnosed by a medical officer and ongoing follow-on care provided by the family nurse practitioner and mental health psychiatric nurse practitioner, according to established clinical protocols. This is once the patient’s condition is within the scope of practice and clinical management level of the family nurse practitioner and mental health psychiatric nurse practitioner. If signs and symptoms do not respond to treatment as expected, the patient is to be referred to a medical officer.
As the minister of health and wellness, I am elated by Cabinet’s recent decision to give its stamp of approval for the issuance of drafting instructions to the Chief Parliamentary Counsel for amendments to the Nurses and Midwives Act and the Pharmacy Act to accommodate the registration and licensure of APRNs encompassing family nurse practitioners, mental health psychiatric nurse practitioners, and nurse anaesthetists.
Of note is that the Ministry of Health and Wellness is not pursuing prescriptive authority for nurse anaesthetists at this time. Instead, the focus is on accommodating their licensure and registration under a legal framework, recognising the advanced training and critical role they play in patient care.
Meanwhile, this milestone concerning the acquisition of prescriptive rights for our nurses underscores the Government’s commitment to healthcare excellence. Despite the success of the Nurse Practitioner Programme initiated in 1977, these professionals have not been recognised under the Nurses and Midwives Act.
The legal amendments, therefore, go beyond mere adjustments to acts. They signify the evolution of our healthcare system to meet the diverse new and emergent needs of our population. As such, the amendments to the Nurses and Midwives Act are multifaceted, seeking to not only accommodate the licensure and registration of APRNs, but also to regulate the registration, licensure, and training of APRNs, and uphold proper standards of professional conduct among individuals registered under the Nurses and Midwives Act.
An important element of the proposed changes pertains to the Pharmacy Act. Currently, certain provisions restrict prescriptive authority to specific categories of healthcare professionals, excluding APRNs. The amendments to the Pharmacy Act will address this limitation, allowing family nurse practitioners and mental health psychiatric nurse practitioners in government health centres and at the University Hospital of the West Indies to prescribe approved pharmaceuticals.
These changes are vital in addressing the pressing issue of non-communicable diseases (NCDs) in Jamaica, where more than 70 per cent of deaths each year are caused by one or more of the four major NCDs: cancer, cardiovascular disease, diabetes, and chronic lower respiratory disease. We are also seeing where Jamaicans are dying prematurely, that is, before the age of 70 years, also because of the NCDs scourge. This alarming reality underscores the urgency for our healthcare system to adapt to meet the needs of our population.
The proposed legislative amendments are therefore not only timely but also essential. Empowering APRNs with the ability to prescribe, especially in rural areas, is a significant step towards improving patient outcomes and delivering more comprehensive care.
It is, to my mind, impatient of debate that these amendments represent a progressive step towards a more effective and inclusive healthcare system. By acknowledging the expertise of our APRNs and granting them the necessary authority, we are not only enhancing their roles as invaluable to people’s health outcomes but also helping to ensure a healthier future for all Jamaicans.
As we embark on these reforms, Jamaica not only becomes the place of choice to live, work, raise families, and do business, but also sets the course to become a beacon of excellence in healthcare delivery. I urge the support of the public and health teams as we pursue this course.