US-trained physician assistants are to be triaLled in Auckland later this year as one potential means of boosting the elective surgery workforce. But nursing organisations say greater energy and resources should be put into expanding nursing roles first. FIONA CASSIE reports on the background
With a push to find about 800 additional health workers to boost elective surgery it is not surprising physician assistants are a buzzword at the moment. And after taking a decade to produce 60 nurse practitioners it is also not surprising that other new health practitioner roles are being mooted.
The Medical Council last year issued a discussion paper seeking feedback on how physician assistants (PAs) could be used in New Zealand and how (or whether) they should be trained or regulated. And in August the new chair of the Clinical Training Agency Board (also known as Health Workforce NZ) promoted the idea of trialling PAs as a possible way of helping staff the government’s target of 20 new operating theatres.
Nursing organisations NZNO and the College of Nurses were not surprised, but they were also not convinced.
In their recent submissions on the Medical Council paper, they argue that no hasty decisions should be made on this new role without fully exploring and investing in new roles for the biggest health professional workforce – nursing.
In a press release in December, CTA board chair Des Gorman says PAs have the potential to grow the health workforce or provide new opportunities for those wishing to join it, including those who miss out on medical school places or who have biomedical degrees.
The statement goes on to say that PAs could help meet the urgent need to look at new types of health workers for elective surgery and that in the USA 25 per cent of PAs work in general surgery and surgery subspecialities.
It also says PAs are not about replacing NPs, as physician assistants have different training and work in a different way to nurse practitioners. “Overseas experience suggests that there is a role for both physician assistants and nurse practitioners in the health services and the pilot will help to answer this question for New Zealand,” believes the board.
Both the college and NZNO submissions to the Medical Council point out that internationally about half of PAs are registered nurses and many others are drawn from other health professions, so it could be argued that the PA role “reshuffled” the available workforce rather than enlarging it. They also argued it would be more timely and cost effective to build on nursing roles than to set up a new regulatory and training framework for PAs.
College of Nurses executive director Jenny Carryer argues in the college’s submission that any formal introduction of the PA roles would “direct focus, energy and resourcing away from development and implementation of the nurse practitioner role”.
She argues that if the NP role was properly established it could “quickly transform many of New Zealand’s health workforce challenges”. This could be done through developing and refining the role’s education pathway and giving it greater attention and resourcing.
Carryer also argues that PAs should not be viewed >> as an alternate model to a nurse practitioner as they have different strengths, education pathways and come from different health models. “Their (NP) education and model of care are far more applicable to all areas and especially those where doctor shortage is acute or levels of chronicity or unmet need are high.”
“The role of NP remains totally underutilised due to failure of the health sector to adopt this strongly evidence-based innovation,” she concludes in the college’s submission.
The New Zealand Nurses Organisation submission takes a similar stand while noting the pressure to introduce the PA role in the local workforce.
It calls for a “considered national debate” on the possible place, cost and “fit” of a PA role. But it says first the potential for nursing initiatives and registered nurses to fill a “skill gap” needs to be “comprehensively considered”.
NZNO’s submission points out that the RN scope “abuts” onto the scope of all health professions, RNs were the most flexible health professional workforce, and nurses’ ability to use post-registration training to fulfil the functions of a PA needed to be considered.
“RNs have risen to this challenge in multiple ways, but their full potential has to date not been fully realised across all sectors of health nationally,” it argues.
“There are a number of initiatives that show nurses do have the ability to take on these roles e.g. PRIME Nurses, the orthopaedic electives project with nurses running pre-admit clinics, nurse colposcopists, nurse endoscopists project, etc.”
NZNO said it would only support the introduction of a PA training programme for international medical graduates unable to register as doctors in New Zealand. Also, that New Zealand client safety was the benchmark and must not be overlooked at the expense of rushing in a new role. “Especially when there is already a nurse practitioner role which has credible, established recognition and stringent regulation pathways.”
