LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publication les lettres recue$ en double dont la longueur n'exce'de pas 450 mots. Elles doivent etre mdcanographides en qualite sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Nurse practitioners and family medicine As the nurse practitioner (NP) whose practice was stopped by the College of Physicians and Surgeons of Alberta (CPSA) I was interested in Dr. Peter P. Morgan and Lynne Cohen's article "Should nurse practitioners play a larger role in Canada's health care system?" (Can Med Assoc J 1992; 146: 10201021, 1024-1025). Public allegations made by the college that I was "practising medicine without a licence" have not resulted in any charges being laid in the past 13 months. Nurses continue to provide health care in isolated communities where physicians have chosen not to live. Does a plane ride -
For prescribing information see page 1086
south destroy our skills? Is it setting that creates skill? If Northern health care calls for the practice of medicine, then why is medicine not being practised by physicians in all settings? Perhaps medical acts that can be delegated to a nurse who has a nursing degree are not the sole domain of medicine. Are there double standards that are reinforced by the arbitrary and differential application of legislation? If Northern residents do not deserve equality in health care are they worth less? Is this the message we want to convey? I have never considered the care that I provide to be substandard or not as good as a physician's. I cannot ethically provide care if I devalue myself. I have always provided the same standard of excellence regardless of setting, recipient or accessibility of colleague support, working with authority, responsibility and accountability. Excellence is not within the mandate of licensing bodies or government legislation and does not depend on the presence of another professional; it is the basis of self-respect. The documented delegation of responsibility to nurses in isolated areas that has been signed by provincial colleges and nursing associations has never existed in Alberta. What is the definition of a medical act? Who can say that health care as evidenced in Northern nursing is the practice of medicine? It is not clear whether delegation of medical responsibility to nonmedical personnel is a legal or an ethical matter. Has the documented delegation merely permitted the medical profession to retain its authority and predilection for urban practice while avoiding
responsibility for and accountability to rural and Northern Canadians? Is this a self-serving issue of money or power? The CPSA's perception of omnipotence is demonstrated by its interference in an area of professional jurisdiction of the Alberta Association of Registered Nurses. Respect for this body's ability and legislated authority to license my practice would have resulted in a more positive outcome for the patients, my physician colleagues and me. The CPSA, whose role is physician accountability, is also accountable for its actions - to the public and to its members. The abuse of power is never appropriate and certainly not by a professional association. The comment "We're not angry about [Atcheson's] dismissal because it has provided us with the opportunity for open dialogue with the college" made by Mary Pat Skene, president of the Alberta Association of Registered Nurses, implies an inherent flaw in the system if abuse and destruction of people's lives is required to create an opportunity for dialogue. The practice that existed will be the model of the future, and the CPSA ended it without regard to its creative and visionary value. It is to be hoped that the peremptory behaviour by this licensing body will cease. I hold the CPSA accountable for its actions in my nursing practice; I launched legal action June 1, 1992. Joyce Atcheson, RN, NP, MHSc Athabasca, Alta.
Dr. Morgan and Ms. Cohen raise three issues and by implication CAN MED ASSOC J 1992; 147 (7)
981
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publication les lettres recue$ en double dont la longueur n'exce'de pas 450 mots. Elles doivent etre mdcanographides en qualite sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession des droits d'auteur. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregees ou faire l'objet de modifications d'ordre redactionnel.
Nurse practitioners and family medicine As the nurse practitioner (NP) whose practice was stopped by the College of Physicians and Surgeons of Alberta (CPSA) I was interested in Dr. Peter P. Morgan and Lynne Cohen's article "Should nurse practitioners play a larger role in Canada's health care system?" (Can Med Assoc J 1992; 146: 10201021, 1024-1025). Public allegations made by the college that I was "practising medicine without a licence" have not resulted in any charges being laid in the past 13 months. Nurses continue to provide health care in isolated communities where physicians have chosen not to live. Does a plane ride -
For prescribing information see page 1086
south destroy our skills? Is it setting that creates skill? If Northern health care calls for the practice of medicine, then why is medicine not being practised by physicians in all settings? Perhaps medical acts that can be delegated to a nurse who has a nursing degree are not the sole domain of medicine. Are there double standards that are reinforced by the arbitrary and differential application of legislation? If Northern residents do not deserve equality in health care are they worth less? Is this the message we want to convey? I have never considered the care that I provide to be substandard or not as good as a physician's. I cannot ethically provide care if I devalue myself. I have always provided the same standard of excellence regardless of setting, recipient or accessibility of colleague support, working with authority, responsibility and accountability. Excellence is not within the mandate of licensing bodies or government legislation and does not depend on the presence of another professional; it is the basis of self-respect. The documented delegation of responsibility to nurses in isolated areas that has been signed by provincial colleges and nursing associations has never existed in Alberta. What is the definition of a medical act? Who can say that health care as evidenced in Northern nursing is the practice of medicine? It is not clear whether delegation of medical responsibility to nonmedical personnel is a legal or an ethical matter. Has the documented delegation merely permitted the medical profession to retain its authority and predilection for urban practice while avoiding
responsibility for and accountability to rural and Northern Canadians? Is this a self-serving issue of money or power? The CPSA's perception of omnipotence is demonstrated by its interference in an area of professional jurisdiction of the Alberta Association of Registered Nurses. Respect for this body's ability and legislated authority to license my practice would have resulted in a more positive outcome for the patients, my physician colleagues and me. The CPSA, whose role is physician accountability, is also accountable for its actions - to the public and to its members. The abuse of power is never appropriate and certainly not by a professional association. The comment "We're not angry about [Atcheson's] dismissal because it has provided us with the opportunity for open dialogue with the college" made by Mary Pat Skene, president of the Alberta Association of Registered Nurses, implies an inherent flaw in the system if abuse and destruction of people's lives is required to create an opportunity for dialogue. The practice that existed will be the model of the future, and the CPSA ended it without regard to its creative and visionary value. It is to be hoped that the peremptory behaviour by this licensing body will cease. I hold the CPSA accountable for its actions in my nursing practice; I launched legal action June 1, 1992. Joyce Atcheson, RN, NP, MHSc Athabasca, Alta.
Dr. Morgan and Ms. Cohen raise three issues and by implication CAN MED ASSOC J 1992; 147 (7)
981
