Dr Michal Boyd, an aged care NP and nurse leader who last week was celebrating at last being able to issue death certificates for her patients’ families said it was a “terrible blow” to discover that NPs were still blocked from signing cremation certificates.
More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made only come into effect on January 31.
The complex Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), and other health practitioners like pharmacists, registered nurses and physiotherapists are now qualified to carry out those roles – but did not amend the related Cremation Regulations. This means cremation certificates still have to be signed by a medical practitioner, which is a particular frustration for NPs working in aged care.
Ministry of Health chief nursing officer Jane O’Malley said the Ministry was aware of the oversight of not amending the Cremation Regulations to allow NPs to complete cremation certificates and was “working as quickly as possible to remedy this”. She said the Ministry was currently in the process of informing stakeholders of its plan and timeline.
“In essence, not being able to do cremation certificates basically keeps in place the barrier to completing death certificates for over 80% of those I serve,” Michal Boyd said in a Facebook post to fellow Nurse Practitioners of New Zealand (NPNZ) members. “This development is so disappointing and frustrating. To feel that one of the last barriers to my practice in aged care was gone and to see it back again is very disheartening.”
She said apparently the cremation referee, who overseas cremation certificates, had let the Ministry of Health know of his concerns late last year about the regulations around cremation certificates being missed out.
NPNZ members shared Boyd’s frustration about the ongoing major barrier to NP practice, with one reporting that it cost her practice $90 every time it had to ask an outside GP to sign a death or cremation certificate for her patients. There was a call for action on the issue and concerns were expressed whether NPs would again to have wait years for this barrier to be removed.
Nursing Review sought comment on the NPs concerns from the Health Minister Dr David Clark and Ministry of Health. A spokesperson for the minister’s office said the Minister was aware of the issue and had asked the Ministry for a solution to the problem “which was inherited from the previous government”.
NB this article was updated on February 12 to include additional comment supplied in a revised response from the Ministry of Health and to clarify that it was the cremation regulations needed to be amended not the related legislation.
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More than a decade in the making, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was passed in late 2016 but the changes made will only come into effect on 31 January. The Bill amended eight Acts to replace references to ‘doctors’ or ‘medical practitioners’ where nurse practitioners (NPs), nurses and other health practitioners are now qualified to carry out those roles.
“One of the things I’m most excited about is overseeing the enactment of this legislation that is coming in at the end of the month,” said Clark.
“This means that nurses will be able to issue sick notes for work and NPs can issue death certificates,” he said.
The amended Acts also remove the current anomaly where NPs can sign ACC forms and sickness benefit forms but cannot sign a certificate for ordinary sick leave from work.
Roles changing under the new legislation (see full details at end of story) include:
Outgoing chief nursing officer Jane O’Malley described the passing of the bill in 2016 as the “culmination of years of work” from the nursing sector, the Ministry of Health and other agencies.
“We’ve got to make the most of particularly the nursing workforce, with its 53,000 nurses who oversee the largest unregistered workforce in the sector,” said Clark. “If we have these people active and practising at top of scope, there’s a huge opportunity for our health system to deliver more care within the fiscal restraints that we have.”
The Minister talked about the legislative changes in an interview with Nursing Review this week in which he also discussed pay expectations and briefly touched on pay relativity for nurses working in sectors such as aged care and Māori and iwi health providers.
Clark said pay relativity was something that needed to be looked as part of the primary health care review. It is understood that the terms of reference are currently being worked on for the review of the primary care funding system promised by the incoming government within its first 18 months.
“I do want to see different models of care looked at,” said Clark. “I think that is required if we’re going to have a sustainable sector that actually delivers better access to quality care for New Zealanders.
“We need to recognise that in many areas, particularly those that are rural or underserved, they have workforces – and nursing workforces – that are actually practising at the top of their scope.” Clark said he believed that was where the opportunities were – ensuring that people were supported to practise at the top of their scope.
Clark added that his job as Minister of Health was to defend the interests of the patient.
“I’m not there to represent any particular workforce but to ensure the best outcomes for the public patient, and that involves ensuring that the workforce is sustainably funded and we have healthy workforces and safe staffing levels.
“I think the only reason our health system is in the good shape that it is, is because of the good grace of the workforces that have been subject to underfunding over the last nine years,” Clark told Nursing Review.
He said the new Government was committed to putting that money back into the sector, but it would take time. It would also take time to build a sustainable health workforce and the capacity to employ more new graduate nurses, he said.
LEGISLATION CHANGES FOR 2018
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury.
Burial and Cremation Act 1964: Nurse practitioners will be able to issue certificates for the cause of death for patients in their care.
Medicines Act 1981: Nurse practitioners will be able to supervise designated prescribers (such as authorised registered nurse prescribers or RN prescriber candidates).
Mental Health (Compulsory Assessment and Treatment) Act 1992: Nurse practitioners, or registered nurses working in mental health, will be allowed to complete a health practitioner certificate for applications for assessment under the Act. An NP will also be able to conduct an assessment examination if approved by the Director of Mental Health. The Director can delegate this approval to the Director of Area Mental Health Service.
Accident Compensation Act 2001: Health practitioners providing treatment to a client will be given the opportunity to participate in preparing clients’ individual rehabilitation plans. Suitably qualified health practitioners will also be able to prescribe aids and appliances.
Oranga Tamariki Act 1989 (formerly the Children, Young Persons, and Their Families Act 1989): Health practitioners will be able to carry out medical examinations ordered by the court when considering whether children or young people have been abused, if the court considers that these health practitioners are qualified for that purpose. In addition, a social worker will be able to ask for medical examinations to be completed by health practitioners qualified for that purpose.
Misuse of Drugs Act 1975: Nurse practitioners, registered nurses working in addiction services and pharmacist prescribers will be allowed to prescribe controlled drugs for the purposes of treating addiction.
Land Transport Act 1998: Health practitioners will be able to request blood tests from drivers and assess and report on their fitness to drive. It will be illegal for someone to refuse a blood test from a health practitioner. Other amendments enable health practitioners to take blood, handle evidential specimens and appear in court to give evidence.
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