Patient's choice: Doctor or nurse practitioner?

For the first time, Nova Scotia is to begin using nurse practitioners outside the tertiary care setting. The nurses are the cornerstone of new primary care projects about to begin in 4 rural communities.

Health Minister Jamie Muir stresses that nurse practitioners will work closely with doctors and will not be allowed to prescribe experimental or controlled drugs. "The pilot projects are going to be an integrated system. There will be a physician or a nurse practitioner, and other people as well. So it won't be like the nurse practitioner is in an office at one end of town and the physician is way down at the other end of town. The nurse practitioners are not going to be making profound diagnoses and then acting as though they were fully qualified medical doctors."

As well, patients who are uncomfortable with NPs can choose to see a physician instead, says Harriet McCready, director of primary care in the provincial Department of Health. "Nobody is going to force a patient to do one thing or another."

In addition, she notes, doctors and nurse practitioners can refer patients to each other, with problems beyond the scope of the nurse practitioner being addressed by a physician. Likewise, if there is a procedure that needs to be done and could be done easily by a nurse practitioner, the doctor might suggest this to a patient.

In order to allow for the use of NPs in Nova Scotia, the Pharmacy Act was amended to allow nurses to prescribe certain drugs, including birth control pills and blood pressure medication. The new legislation will remain in force for 3 years while the primary care pilot projects are running. If the projects prove successful, the Pharmacy Act could be amended to allow for the ongoing use of NPs in the province, the health minister says.

In addition to nurse practitioners, the four primary care projects, funded primarily by Health Canada at a cost of $2.85 million, involve developing new computerized information systems and new payment options for physicians.