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Good News - Rn Can Soon Prescribe And Diagnose In Ontario!


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#21 MountainAmoeba

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Posted 20 May 2017 - 01:01 AM

Haha caught me....phallacy.....whoops.

#22 MountainAmoeba

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Posted 20 May 2017 - 01:14 AM

I definitely can understand having concern...but I have reservations about including the slippery slope as a counter augment. Rather we should identify the actual concerns and the limits that need to be met.

Example
Concerns RN's gain too much scope for their four year degrees.
Concerns that unregulated healthcare providers take on prescribing privileges.
Concerns that RN wages snowball and limit resources.
Concerns that these lead to poor patient outcomes.

People use the slippery slope argument against

Gay marriage
Abortion
Active euthanasia
Etc

I feel to engage the slippery slope argument and not have it be a fallacy the onus is on you to delineate the logical, and likely steps that lead to the destination proposed. And to be able to defend how this destination is unavoidable.

I can appreciate that history will demonstrate many salient examples of the line being drawn incorrectly, but I would challenge you then to define that these are more often examples of a "slippery slope" wherein one decision makes the next more likely and so forth, until the distinction that was once made is no longer in sight. I say this, because often it is also that the line is incorrectly placed initially. I would argue that increasingly we see evidence that as we revisit concepts we refine our understanding and arrive some-where more reasonable then initially.

RN's take anatomy, physiology, pathophysiology, and pharmacology. Naturopaths for example often do not. They are also not licensed, nor do they agree to engage in evidence based practice. We have a lot of commonalities between MD's and RN's to find common ground with, and few for naturopaths. With such distinctions there seems to be good basis for how such limits could be made relating to who can prescribe, and what they can prescribe.

For as much as there is that RN's learn through education, there is more they don't. Thus we have many places to exact definite limits on what can be prescribed by who.

I guess I would ask, what is the slippery slope? What are the plausible next steps that are uncontrollable and unavoidable. Where does the lack of decision-making, and control, factor in that lead to RN's becoming family doctors? Or to naturopaths prescribing medications. Why are limits unavoidable?

One good reason for RN's having the ability to prescribe - wait times, and physician load.
Now my take is that, sure RN's could (in limited settings, with limited drugs) have prescribing privileges. They should not be paid more for this. Really, we should have RN's doing the work they were trained to do, and have LPN's doing the work they were trained to do, and NA's....so forth.

I would propose having less RN's more LPN's and even more NA's. RN's have been engaged in a turf war that sees them clinging onto tasks like bed baths, but then demanding the privilege to do higher level tasks. At 100 000k a year in Alberta for example for a yearly RN wage, something has got to give.

I do think we get fairly compensated, but also think we spend a lot of time doing tasks that don't require the skill set of an RN. To be fair, I'm about to commence training as a physician, and maybe with new perspectives I will feel different about RN's with prescribing privileges. I do know I feel like physicians could have their hands freed in SOME situations and patients could have expedited care.

While I talk about drawing the line. I don't know where it is. But I do believe it can be determined, and that patients and the system generally would benefit from revisiting some of these things. This of course could just be a demonstration of my naivety.
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#23 calcan

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Posted 20 May 2017 - 01:30 AM

Many of ralk's arguments do resonate: the idea of increased system level checking, the potential for more overprescription, the potential complications, etc..  

 

It's just that not so long ago, people would have never believed NP or PA (Advanced Practice Clinicians) to be able to provide the same level of care as a physician.  Yet, a recent study that I saw basically states that for "low value health care", APCs do indeed provide an equivalent level of care (link).

 

Of course the evolution of the the roles didn't happen overnight, and proceeded in small incremental steps.  I just don't see how for RNs if greater competency can be achieved, that's really a negative - but perhaps, this is too much of a change and that the negatives do outweigh the potential gains.

 

I do understand the "turf war" concept but just feel health care as a whole should be forward looking rather than fixed in a static image of today's practice models.  But, of course with health care, almost more than anything else, change requires the greatest prudence and care.  

 

While I understand JohnGrisham's point concerning the slippery slope in the US, I feel this also reflects American culture.  Americans (esp current administration for instance) are somewhat anti-regulatory, so I'm not surprised that naturopaths have greater scope, for example.  And I was also under the impression that the AMA was powerful voice, but I'm far from an expert on US health care.       






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