Nurses seek authority to sign work they already perform

Rules, procedures and computer systems can prevent nurses from putting their own names to work they already carry out, mbl.is reports. In some cases, a doctor must be involved even when the nurse has completed the task, delaying care.

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

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

Helga Rósa said the issue was broader and involved a range of tasks nurses already perform, including requests for examinations and assistive devices, referrals and possibly certain certificates. In many cases, nurses do the work but the request must still be submitted in the name of another professional group.

“You always need a doctor and you always need the doctor’s 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,” she said.

She said this could delay care and that it was necessary to examine where the system could be changed. The aim was partly to allow nurses to put their names to work they already perform.

The obstacles vary, she said. Some cases may require changes to laws or regulations, while others may involve old practices, procedures or technical barriers. A health insurance system or information system may be designed to accept only a doctor’s name even when the law does not necessarily prevent a nurse from requesting a particular examination.

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

X-rays and other forms of diagnostic imaging can be more complicated because special rules apply to the use of ionising radiation. International research has nevertheless shown that nurses can follow clear procedures when assessing the need for imaging, including for ankle and wrist injuries, using recognised diagnostic processes such as the Ottowa rules.

Such methods are recognised and used in many countries and can shorten care processes and improve efficiency.