Neglecting legal status in health planning: nurse practitioners in Jamaica

ABSTRACT

The nurse practitioner (NP) was introduced as a member of the primary health care team in Jamaica in 1978 when it became evident that the demand for health centers which provided both curative and preventive care could not be met by medically-trained personnel alone. Despite the responsibilities taken on by NPs in practice, they have not been given legal recognition of or protection in their expanded role with the result that their relationships with others in the field have not been defined. This has led to pharmacists challenging the right of NPs to prescribe. This challenge has threatened the usefulness of NPs in the field. To facilitate understanding of how this situation arose, some background to the establishment of the program is presented, followed by a discussion of the current status of NPs and resolving the problems. The elements that have an important bearing on the appropriate legal status for NPs are qualifications for recruitment to the course of training; the length and content of the course; the question of supervision as it relates to their deployment in the field; and the arrangements, if any, for their discipline in the performance of their expanded duties. The problems about prescribing, the uncertainties related to status, and in some instances relationships with other health workers have caused considerable problems for the NPs. The question of the legal status of the NP was raised as soon as difficulties about their practice began to be perceived. The issue crystallized around their right to prescribe. While discussions about a legal status for and formal recognition of the practice of NPs dragged on, the uncertainties and frustrations began to have an effect on the program. Applications from suitably qualified individuals began to drop markedly. Recruitment of nurses dropped to 9 in 1982 and to 7 in 1985 from 22 in 1978 and 21 in 1979. Since most of the problems encountered in the acceptance of NPs arose out of uncertainties and misunderstandings about their training and scope of practice, it was decided that protocols should be prepared for each of the common disorders which they would be likely to encounter in health centers. Eventually practice protocols directing the practice of NPs were prepared and accepted by all professional groups involved. Standing orders which define the relationship of NPs to other health workers also have been prepared with a view toward moving on to legislation as soon as possible. (AU)