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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From today for the first time nurse practitioners can issue the death certificate for patients in their care. Suitably qualified nurses can also write sick leave certificates.
Dr Michal Boyd, a long-standing NP, says being unable up until today to complete death certificates for patients in her care meant the risk of unnecessary delays and distress for a grieving family.
“As the primary healthcare provider I know the person’s medical conditions and have often led their care over months or even years,” said Boyd. “Now I am able to provide all the care needed for the older person and their family.”
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 today (January 31).
The 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.
Lobbying began early in the millennium by nurse leaders to identify and remove a range of legislative barriers to nurse practitioners’ practice and formal work began back in 2005 to go through legislation with a fine tooth comb to find references to “doctors” or “medical practitioners” in roles that now could be done by other suitably qualified health practitioners. The acts remove the anomaly where NPs could sign ACC forms and sickness benefit forms but could not sign an ordinary sick leave certificate for work under the Holiday’s Act.
Boyd, a former chair of Nurse Practitioners New Zealand (NPNZ), said today’s enacting of the new laws represented to her the removal of some of the last barriers to being able to practice at the top of her scope as a nurse practitioner.
The Ministry of Health’s 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.
Memo Musa, the chief executive of the New Zealand Nurses Organisation congratulated all those involved in the watershed changes particularly the Nursing Council and the Office of the Chief Nurse.
Musa said the amended Acts meant more nurses could improve public access to some medicines and also enable them to work to the full breadth and scope of their practice. “It is often easier and quicker to see a nurse than a doctor so this change means more people in the community can benefit by accessing health care sooner.”
2018 LEGISLATION CHANGES SUMMARY
AMENDED ACTS
Holidays Act 2003: Health practitioners will be able to certify proof of sickness or injury including suitably qualified registered nurses, if their employer and the Nursing Council of New Zealand recognise that they are competent and safe to do so
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.
]]>The Minister for Workplace Relations and Safety Iain Lees-Galloway and the Minister for Women Julie Anne Genter today put out a statement reaffirmed the new Government’s pre-election commitment to halting the Employment (Pay Equity and Equal Pay) Bill currently before parliament.
“While both sides of the House seemed united in lauding the TerraNova decision in favour of care and support workers and Kristine Bartlett, the previous Government immediately introduced legislation that fundamentally changed the ability of anyone else to achieve the same result,” said Lees-Galloway.
Cee Payne, industrial services manager for the New Zealand Nurses Organisation said the flawed bill had put the onus on women to prove inequity and introduced extra barriers for women to be paid fairly.
“The Bill gave no opportunity for outstanding pay equity claims to be assessed the same way as Kristine Bartlett’s was,” she said. “Nurses haven’t established the best pay equity comparison for them yet but this Bill is off the mark as nurses deserve to establish this without having to jump through hoops.”
NZNO lodged a pay equity claim for district health board nurses and other NZNO members in the recent MECA negotiations (see previous story) and it is understood that alongside a new pay deal – to be voted on later this month – a possible pathway for pursuing the claim had also been progressed.
Glenn Barclay, national secretary of the Public Service Association, agreed the bill was flawed said there was much to celebrate in the decision to “dump” it. “It was a short-sighted and unfair bill, and congratulations to this government for recognising that,” said Barclay.
He said unions, women’s groups and their allies had campaigned for equal pay for more than a century – and forty-five years after the Equal Pay Act, it was time to finish the job.
Lees-Galloway said while both sides of the House had seemed united in lauding the TerraNova decision in favour of care and support workers and Kristine Bartlett, the previous Government immediately introduced the bill that fundamentally changed the ability of anyone else to achieve the same result. He said the new Government would start work on new legislation built on the principles of the Joint Working Group on Pay Equity.
Genter, who is also an associate minister for health said women in New Zealand should know the new Government was committed to valuing women in the workplace and valuing vocations that that have traditionally been women’s work; “the work that provides for others” and “cares for people who need care”.
“The existing Bill aimed to apply retrospectively, which would have been unfair to the up to eight groups of women currently making pay equity claims. We will do better by all women,” said Genter.
The government press release did not mention the fate of community mental health workers who were excluded from the $2 Billion care and support care workers pay equity settlement last year. Labour election policy was to make mental health workers a priority in pay equity negotiations.
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