Responsive, Affordable Health Care
Jones, Esyllt, Canadian Dimension
Now that our health care system is in "crisis," politicians and policy makers are starting to pay closer attention to the arguments made by nursing's professional and union leaders that nurses can help make health care more responsive, accessible, and affordable. The skills and abilities of nurses in providing "primary" health care have long been ineffectively utilized.
Studies done in the United States, where nurses provide basic health care to a greater extent than they do here, show that patients think nurses do just as good a job of delivering basic care as do physicians. Recent media reports of over-prescribing to elderly patients should make the public appreciative of one study which found that nurse-practitioners prescribed medication for elderly patients suffering from insomnia in 17 per cent of cases, compared with the physicians' rate of 46 per cent. Other studies show that nurses spend more time with their patients, take better case histories, and have better communication skills, important in improving self-care and compliance with treatment. Nurses, of course, are paid less than doctors, so cost-savings are a factor too.
The Manitoba government, along with other provincial health departments, has obviously heard these arguments. Premier Gary Filmon announced to the annual meeting of the Manitoba Association of Registered Nurses (MARN) in May that the provincial government is planning to open a number of community nurse resource centres (CNRCs). It was difficult to be anything but "delighted," as the MARN executive director put it, by this news. But what will the government do to pacify physicians, threatened by the prospect of nurses being allowed out from under their thumbs? Historical alarm bells are probably ringing in the minds of those involved in the nurse practitioner movement of the 1970s and early 1980s. There was a "crisis" then, too, only the crisis involved a shortage of general practitioners to provide health care, both in rural and remote areas, and large urban centres. Studies were commissioned, articles written, and education programs developed, in support of giving nurses increased responsibility in the provision of basic health care. All was going well, until the numbers of family physicians increased (solving the problem of shortage) and the organized medical profession decided to oppose broad usage of nurse practitioners in the system.
Provincial governments did little to support nurses' expanded role -- while the federal government changed the Canada Health Act to accommodate nurse practitioners as health care providers, the provinces did not follow suit to integrate nurse practitioners into provincial health care systems. It was never clear exactly where the nurses were to fit. There was no public education. By the mid-1980s, all the training programs were gone. Manitoba now employs a handful of nurse practitioners, mostly in community health centres.
medical association inflexible
In response to the Manitoba Nurses' Union's call for nurses to be made first points of access to health care, former Manitoba Medical Association (MMA) president Ian Goldstein wrote to the president of the union last fall: "public funds can be put to much better use than merely adding a layer of nursing services that the public neither wants nor needs." So it would appear that the MMA is as inflexible as ever on this issue. Since Filmon made his commitment to CNRCs, Goldstein has continued in this vein, stating in a letter to the executive director of the Manitoba Health Organizations, "Given a choice, who would most patients likely prefer to diagnose their health problems: a nurse or physicians? …