In Ontario, there is growing interest in the changes to the NP role that will be impacted by Bill 179 - legislation that once passed will take away the "lists" that NPs working in acute care organizations (ie not Primary Care NPs) are bound by in practice. Currently, NPs working in outpatient settings can prescribe independently but only from set lists for drugs, diagnostics and labs. The problem is that these lists are not broad enough to cover our practice in nephrology - many drugs are "reorder only" and many are not represented at all. Therefore, we work under Medical Directives - that allow us to write orders that RNs and other health disciplines can carry out. With Bill 179, there will be no more lists. NPs will be able to prescribe all investigations and treatments excepting narcotics. This will eliminate in many cases the need for medical directives. However, our organization needs to be ok with this, and approve our working to full scope once the legislation is passed.
Out of curiosity - how many of you across the country who work in outpatient areas (dialysis, clinics) are able to work to full scope of practice within your organization without medical directives?