Let nurses bill for care

THE provincial government announced this week it will give regional health authorities $1.2 million to hire 12 more nurse practitioners. This essentially guarantees work for next spring's graduating class, which is good for the nurses because they don't have a lot of choice as to where they can work. That is because the province does not permit nurse practitioners to bill it directly for the work they do, the way physicians do.

This controls costs to the public treasury, but it does not well serve the community where the skills of nurse practitioners are in high demand. Nurse practitioners have many of the same skills as family doctors and can attend to many of the routine issues that patients present to their physicians, such as high blood pressure, cholesterol, diabetes, vaccinations and full physical exams. They were expected to be key to relieving the pressures created by a shortage of family doctors. But without the ability to bill their fees for service to the province, nurse practitioners are essentially restricted to working for the regional health authorities. To date, nurse practitioners have been hired by health authorities to work on salary in community clinics and hospital emergency rooms, where those who cannot get family doctors often seek medical care.

Many family doctors would jump at the chance to hire nurse practitioners, but without a billing mechanism, they would become an expensive addition to overhead costs. One pilot project funded by Manitoba Health with physicians at the Manitoba Clinic in Winnipeg has wrapped up and with the funding having run out, the nurse practitioner is no longer employed there.

To date, 42 nurse practitioners have completed the U of M's nursing graduate program, which prepares them for jobs in the primary health field. But practitioners come from other education institutions as well. Forty-nine nurse practitioners are registered in Manitoba, although some are working in RN roles rather than in the extended practice field. The rest are working for regional health authorities. Meanwhile, the U of M accepts eight nurses into its program each year, about a third of those who apply to get in.

Manitoba could use many more highly skilled nurses in community clinics, doctors' offices or in stand-alone practice. Manitoba Health's tight hold on where nurse practitioners can work and how they will be paid controls cost to the treasury, but also leaves many Manitobans without the primary care they need. Nurse practitioners should be able to choose where in the community their skills are best used. Manitoba Health should give them the power to bill their fees for service in the same way physicians now do to allow that to happen.