Nurses seek wider authority to streamline healthcare services

Rules, procedures and computer systems can prevent nurses from putting their own names to work they already perform, mbl.is reports. In some cases, a doctor must become involved even when the nurse has carried out the work, which can delay services.

Helga Rósa Másdóttir, chair of the Icelandic Nurses Association, said broader professional responsibilities for nurses are a priority for the association. She believes the healthcare system could make better use of nurses’ knowledge and education.

The issue includes whether nurses should be authorised to refer patients for imaging, such as X-rays, without a doctor first issuing a request. This could speed up the process in emergency departments when patients currently have to wait for a doctor to become involved before an examination can take place.

However, Helga Rósa said the matter was much broader and concerned a range of tasks nurses already perform, including requests for tests and assistive devices, referrals and possibly certain certificates.

In various cases, nurses carry out the work but the request must still be submitted in the name of another profession.

“So you always need a doctor, you always need the doctor’s registration number. But it is not necessarily the doctor who has the knowledge or who has been in contact with the person who needs the service,” Helga Rósa said.

She said this could delay services and that it was necessary to examine where the current arrangements could be changed. The aim would include allowing nurses to put their names to work they are already carrying out.

The obstacles are not all of the same kind, she said. Some cases may require changes to laws or regulations, while others may involve old customs, procedures or technical barriers.

For example, nothing in the law necessarily prevents a nurse from requesting a particular test, but systems operated by Iceland Health Insurance or other information systems may be designed to accept only a doctor’s request.

“Some of it is tradition and culture. There is nothing in the law that says nurses may not order a urine test, for example,” Helga Rósa said.

Imaging such as X-rays can be more complicated because special rules govern the use of ionising radiation. However, international studies have shown that nurses can follow clear procedures when assessing the need for imaging by using recognised diagnostic tools such as the Ottawa rules, for example in cases involving ankle and wrist injuries.

Such methods are recognised and used in many countries and can shorten the service process and improve efficiency.