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.
]]>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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