Organization exhorted the public to refuse treatment from nurses; doctors, specialists welcome decision.
By JUDY SIEGEL-ITZKOVICHPublished: MAY 2, 2007 23:32Advertisement
The Israel Medical Association, "shocked" by the Health Ministry's decision to allow specially trained nurses to perform numerous medical interventions allowed until now only to physicians, has exhorted the public to "refuse to accept medical treatment from nurses."
However, leading physicians and specialist societies said they welcomed the decision, as such treatments are a "burden" on time-pressed doctors and added that "studies abroad have shown that nurses trained to do these procedures perform them as skillfully as doctors."
The IMA said Wednesday that nurses "who want the authority of doctors should go and study medicine for seven years and then study a specialty for four to six. Only then will they have the understanding that doctors have, which ensures safe treatment."
The IMA added that countries that recognized nurse practitioners did so because of a shortage of doctors, "and we are not yet in this situation." It accused the ministry of taking a "rash" decision and of a "lack of judgement."
Ministry director-general Prof. Avi Yisraeli issued a detailed circular this week that will take effect on June 1.
According to the instructions to hospitals and clinics around the country, registered nurses with an academic degree who undergo special training will be allowed to help diabetics balance their insulin/sugar levels, adapt their prescription dosages and change times for taking of medications; decide to halt or reduce certain psychiatric drugs; decide to remove a stomach feeding tube from rehabilitation or geriatric patients; take blood for typing, treat wounds and inject drugs to a major vein; prescribe antibiotics for throat and urinary infections; treat local allergic reactions and sores on the skin; change dosages for hypertension drugs; give inhalation treatment for asthma, and change painkiller dosages for cancer patients and those receiving anti-clotting drugs or treatment for hypothyroid conditions.
The ministry has not yet allowed nurses to deliver anesthesia, even though nurse anesthetists are a growing phenomenon in the US due to the shortage of physician anesthesiologists, who perform more complicated anesthesiology.
Dr. Shoshana Riba, head of the ministry's nursing division, told The Jerusalem Post that for 10 years, the idea of recognizing "nurse practitioners" has been under discussion. Pressure for giving more responsibility to registered nurses was initiated by former ministry director-general and Sheba Medical Center director-general Prof. Mordechai Shani.
The phenomenon of nurse practitioners - a profession that falls between nursing and doctoring - has become widespread in the US, Britain, Scandinavia, Australia and other Western shortages where there are shortages of doctors or doctors have inadequate time to give chronically ill patients - especially diabetics, geriatric and oncology patients - the attention they deserve.
"All studies have shown nurses give excellent treatment when they are trained for it. I won't say better than doctors, but no less good," Riba said. "There is no danger to patients. It is cheaper and more accessible, and nurses have more time to give than doctors. It is not all inclusive of all medical procedures but strictly limited."
The IMA is a professional union as well as a medical association, Riba explained, so it is "opposed to giving up doctors' authority in hospitals and in community clinics. But various associations, including the Israel Diabetes Society and the Israel Neonatology Society, have begged us to expand responsibility of nurses because the doctors cannot cope.
"Many nurses have been doing such things for years because there was no doctor around to do them, but now it is official. Now I will start supervision to make sure that only nurses trained properly by medical specialists will do these things. For the time being, nurse practitioners will not get higher salaries. I don't say they don't deserve more money. We hope they will eventually get it. But everyone wants more prestige and interesting things to do in their job, and the added medical dimension will attract more people to nursing," Riba said, adding that about a quarter of today's nurses had the potential to become nurse practitioners.
Prof. Itamar Raz, head of the Israel Diabetes Society and director of the diabetes unit at Hadassah-University Medical Center in Jerusalem's Ein Kerem, said he was one of the initiators and advocates of nurse practitioners in the field of diabetes.
"Many patients need close, almost daily monitoring, and there is a shortage of diabetologists. Nurses can learn about balancing insulin and drugs to stabilize sugar levels. Our society has set up a school for diabetes nurses, headed by Shoshi Goldberg. It's a year course, and we expect the ministry will allow them to get higher salaries. We've also established a school for dietitians who will teach diabetics how to cope with their condition.
"There are 400,000 diabetics around the country, and many of them do not get accessible care from doctors," Raz declared, "even though the health funds have invested a lot of money in treating diabetes."
Prof. Amnon Lahad of the Hebrew University Medical Faculty's family medicine department is another enthusiastic advocate of nurse practitioners for certain medical tasks. "I worked with them in the US and saw they can function excellently together with doctors.
"Many things doctors regard as a burden, such as screening patients during flu season, controlling cholesterol, hypertension or diabetes. Their roles must be defined, and they will have to fight for higher salaries between those of nurses and doctors. In any case, nurses in villages, kibbutzim and other rural settings have been doing these medical procedures for years in doctorsâ€š absences, and no one protested. Nurse practitioner roles in community clinicsâ€š primary care will be very important."
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