The journey: Legislative autonomy for nurse practitioners in Jamaica

Introduction Over the past decades, an exponential increase in the incidence of noncommunicable diseases coupled with an increase in life expectancy was observed. With these paradigm shifts, it is paramount that the strengthening of health systems be realized to meet the needs of the population. With this in mind, the role of the advanced practice nurse (APN) echoes the call. This response is timely to close the gaps in achieving universal health coverage. Scope of practice The advanced practice role was developed in Jamaica in the 1970s (Cumper, 1986). Nurse practitioners (NPs) have been an asset to the public health system delivering comprehensive quality care to all ages across the life cycle (Waugh-Brown, 2022). Although members of the health team and clients alike were satisfied with the quality care NPs offer, the regulatory framework for them to practice remained a challenge (Jones et al., 2014). Numerous Ministers of Health had tried to close this gap, but their efforts were futile. The majority of NPs in Jamaica are employed in the primary health care setting (Seivwright, 1982). Their scope of practice is aligned to the Nurses and Midwives Act of 1964. The regulations specify that NPs perform their duties in accordance with the recommended standards established by the Nursing Council of Jamaica (Linton, 2023). Although adequately trained to provide quality care, registration and licensure as APNs were not included within the Nurses and Midwives Act (Linton, 2023). Prescriptions written by NPs required the signature of the physician. There are circumstances whereby the physician did not show up for their assignment. This meant the clients would have to return another day to receive their treatment (personal experience). This situation fuels frustration among clients and retards quality care. Legislative autonomy Members of the medical fraternity had made several attempts to retard the efforts of the Ministry of Health and Wellness to provide legislative coverage for NPs. In their opinion, the NPs were not adequately trained and, hence, were not eligible to receive prescriptive rights (Lai, 2018). Despite the odds, the Ministry of Health and Wellness continued their quest. The Jamaica Association of Nurse Practitioners, an affiliate member of the American Association of Nurse Practitioners (AANP), has made several attempts to create platforms by which the work and worth of NPs can be showcased. This included an interview on a national television station to provide the Jamaican populace with the required information. For the past four decades, the Nurses Association of Jamaica had played an integral role in advocacy. In 2021, a Committee was set up by the Ministry of Health and Wellness to review the scope of practice and competencies for NPs. Prescriptive rights and registration details were also included in this mandate. Members of the Committee included the chair (physician), APN (H.M.), President of the Nurses Association of Jamaica, the Chief Nursing Officer and registrars for the medical, nursing, and pharmacy councils (Allen, 2022). Members of the Committee facilitated several consultations with stakeholders. The terms of reference included legislative autonomy outlined by the AANP. A Focus Group Discussion was an integral component of the mandate. Physicians who were employed in the primary health care setting along with clients who NPs served were offered the opportunity to share their insights regarding granting of prescriptive rights to NPs (personal experience). From the client's perspective, the care provided by the NPs was superb compared with that of the physician. Following discussions with the physicians, a resolution in support of the advanced practice role was drafted (Linton, 2023). This document ignited the signatures of over 70 physicians in the primary health care setting across the country. Members of the Committee generated a report. This facilitated a discussion among Government officials. In November 2023, the Minister of Health and Wellness provided insights regarding granting of prescriptive rights to NPs (Linton, 2023). This discussion yielded the following changes: (1) the Nurses and Midwives Act of 1964 would be amended to facilitate registration and licensure as APNs, (2) revision of the Pharmacy Act to include NPs, and (3) NPs would be granted prescriptive rights based on specific conditions (Linton, 2023). These amendments were garnered to improve access to health care delivery especially in the rural and underserved areas. The amendment of the Nurses and Midwives Act will facilitate the registration and licensure of APNs. Nurse anesthetist will be included in this group. In addition, the revision will regulate the training of APNs and focus on their professional conduct. The NPs will be registered by the Nursing Council of Jamaica and meet the specific training requirements and continuing education hours determined by the Council (Linton, 2023). The granting of prescriptive rights to NPs was multifaceted. The NPs will be allowed to practice only in the government setting and the University Hospital of the West Indies. A physician will assess all new clients. In addition, if the client's clinical status has changed, the NPs will be expected to refer to the physician. All patients discharged at the University Hospital of the West Indies will be assessed by a senior physician or consultant (Linton, 2023). A revision of the Pharmacy Act would be undertaken. This revision will allow NPs employed by the Ministry of Health and Wellness and the University Hospital of the West Indies to prescribe a selected list of drugs as outlined by their scope of practice (Linton, 2023). The draft of the revision of the Nurses and Midwives Act of 1964, the Pharmacy Act, and the advanced practice bill was completed in August 2024. In a few days, a meeting will be convened to discuss this document. The completed document will be forwarded to the Parliamentary Council for ratification. Conclusion Over the past 40 years, NPs have significantly contributed to the Jamaican public health system. Recent efforts to amend the Nurses and Midwives Act of 1964 aim to enhance access to health care services. Nurse practitioners practicing in Jamaica continue to advocate for and collaborate on initiatives, both nationally and internationally, to improve the health of the Jamaican citizens.