However, despite the indignation of the residents that it may become even more difficult to get through to the doctors, because they will first go to the nurse and not the family doctor, the medical institutions themselves reassure that the queues will decrease.
According to the new procedure, since January, patients can be consulted independently by nurses and midwives. From February, GP nurses will be empowered to carry out even more functions.
As the Ministry of Health told tv3.lt portal, from February 1 The amendments to the Law on Nursing Practice and Midwifery Practice that came into force give general practice nurses the right to consult patients in the provision of primary outpatient personal health care services, as well as – prescribe and prescribe medications for the treatment of chronic diseases when the patient’s health is stable and make referrals.
The aforementioned amendments to the law give obstetricians the right to consult patients in the provision of primary outpatient personal health care services and to issue referrals.
Already provides independent consultations
Renata Šturienė, the deputy director of the Šeškina polyclinic for nursing, assured that the changes are very much expected and will reduce the burden on family doctors and, at the same time, the queues to see them. She said that the institution currently employs district, general practice and advanced practice nurses who have separate admission vouchers and consult patients live or remotely.
“What do they do? The main subject is the appointment of certain laboratory tests before operations, diagnostic tests, medical assistance measures, consultations on preventive programs, immunoprophylaxis, counseling of patients on issues of healthy lifestyle, preservation and preservation of health, management of chronic diseases.
Another important area is medication administration, preventive health check-up of newborns and children. District nurses work together with the family doctor and receive patients live and during remote consultation. We also have a separate office where an advanced practice nurse and a self-employed general practice nurse work,” she explained to tv3.lt portal.
Will be able not only to prescribe and renew medications, but also to issue referrals
The interviewer pointed out that today their functions are somewhat different – the competencies of the advanced practice nurse are much broader. When new ministerial orders come into effect at that time, all general practice nurses who now work with doctors will be able to carry out additional functions themselves.
“The advanced practice nurse now prescribes medication for patients throughout the facility. In this way, we ensure that patients who apply on the same day receive the service on the same day. It is possible that they forgot or for other reasons could not continue the medication prescription, and they cannot get to the family doctor that day, so the extended practice nurse ensures this.
A self-employed nurse can certainly both order tests and take care of a patient who came for high blood pressure, pain, stuffy ears, order diagnostic laboratory tests, determine body mass index, etc.
Of course, we are very much waiting for the minister’s order, according to which we would be able to perform other functions much more confidently – all nurses will be able to prescribe medications and provide referrals, for example, when a patient with diabetes comes. Then after assessing his condition, diabetic foot care, she will immediately be able to register the patient with a diabetes nurse. This would really ensure continuous service”, commented R. Šturienė.
According to her, it should also be possible for nurses to extend sick leave for family members who care for their children: “Especially during the virus season, it would be a big help. Basically, there will be some clear indications of what the nurse will be able to do and when.” It is true that although the initial plans mentioned that this option could be there, currently such a function is not provided to nurses.
Registration is possible not only by calling
When asked how a patient applying to a polyclinic is sent to a nurse instead of a family doctor, the interviewer indicated that for now there is only one way – to call the reception directly.
“Registrars really know the algorithm in force at our institution and if they see that the patient needs medicines, their continuation, they register with the extended practice nurse if they cannot get to the family doctor that day. Self-employed general practice nurses will also be able to do this from February.
In the future, I think, there will also be separate vouchers for a general practice nurse in the IPR system. But we will need to work a lot with our patients and publicize the information”, commented R. Šturienė.
Vaida Danielė, Nursing Administrator of the Karoliniški Polyclinic, said that patients can register for a nurse’s consultation online, by calling, or by coming in person.
“Her employees really know the algorithm valid in our institution and if they see that the patient needs medicines, their continuation, they register with the extended practice nurse if they cannot get to the family doctor today.”
“By registering through the IPR, patients can decide for themselves whose consultation – doctor or nurse – they need. When calling the reception, the employees have a template for when they can also offer the services of a nurse during the conversation.
If the patient needs an extension of the medicines or a consultation about their use, the appointment of basic tests, there is really no need for a doctor. If the patient complains of deteriorating health, he will only be referred to a doctor,” said the polyclinic’s representative.
She added that the procedure for consultations by nurses has remained in the institution since the times of the pandemic, when nurses could extend medications: “We had left their consultations for patients before operations, for immunizations, for preventive programs. It’s something fundamental for our nurses that hasn’t changed, except maybe the registration times have increased.”
The queues have already reduced
R. Šturienė asserted that patients have already felt the benefits of consultations provided by individual nurses: “The advanced practice nurse is fully loaded – she sees patients every 15 minutes. So there is definitely a flow – most of the time people apply for an extension of the medication.”
When asked if family doctors have already felt relief due to the reduced workload, the polyclinic’s deputy director for nursing considered that they will probably feel a greater impact when general practice nurses also get the opportunity to extend drug prescriptions.
At that time, the representative of the Karoliniškii polyclinic shared that patients are not yet in a hurry to use the nurses’ consultations. “More and more nurses themselves, when they see doctors’ appointments, take the initiative to consult when they can do it,” observed V. Danielė.
However, he insisted that the contribution of the work of nurses is obvious – queues have already reduced: “We started such a project in the fall – we hired an advanced practice nurse. For example, we assigned one nurse to three family doctors, and today we see the results that the queues for these three doctors have really decreased, because these nurses have been able to renew the medicines until now, and the longest queue is made up of those who came for the renewal of medicines.”
He was afraid that he would no longer go to the doctor
The interlocutors together reassured the frightened residents, who were afraid that it would be more difficult to get to the family doctors, because they would first be booked for a consultation with a nurse.
“Communication, trust and teamwork are the most important things here. If the family doctor tells the patient who came to him that today we provide you with services, but because of the medicine we will register you with a nurse next time, the patient will prepare for this.
He will know that he will renew the prescription of the same drugs, he may not even have to come, he will do it by contacting him by phone or, if necessary, he will check live blood pressure or other indicators for diabetes and the like. It will be very clearly indicated in which specific cases the nurse can give advice”, emphasized R. Šturienė.
“A lot of time still has to pass, the nurses themselves have to prove that they trust themselves, that their competence is high. They themselves have to believe that they can do it. And the attitude of the patients will change by itself.”
V. Danielė did not hide that there was and will be mistrust: “A lot of time still has to pass, the nurses themselves have to prove that they trust themselves, that their competence is high. They themselves have to believe that they can do it. And the attitude of the patients will change by itself.”
The interlocutor also pointed out that it is necessary to adjust the payment procedure for such services. “What we miss the most is the payment for nurses’ consultations, the codes of care are there, but they are priced at zeros, so we hope that in the future their services will be paid for from the sick funds,” she noted.
The representative of the Šeškina polyclinic said at the time that the nurses working separately from the doctors were also given a higher salary: “The kind that would really motivate them to work independently and take on very serious responsibilities.”
Calls for assessment of nurses’ workloads
According to Aušras Volodkaitė, president of the Lithuanian Association of Nursing Specialists, although these changes are very much expected by the community, there are still many uncertainties for both the nurses themselves and the institutions.
“Legislative acts are being changed to give nurses more and more competences, but they forget to talk about nurses’ workloads at the same time. The initial option was mentioned so much that the workload of nurses should be evaluated and their functions are greatly refined – what they have to do and what other specialists can do.
Therefore, while helping family doctors to reduce their workload, we must think that the workload of nurses should also change. If they can perform more functions and duties, those duties that are not necessary for them should be transferred to other specialists,” said the representative of the nurses.
According to her, this should, of course, also be reflected in the salary, but above all, it should be realistically measured whether the employee will be able to perform everything qualitatively during his work shift.
“Sufficient attention must be paid to both the prescribing of referrals and the renewal of medicines. These are not purely mechanical actions. It would be even more desirable if the nurse could have his own workplace, where he could communicate with the patient – whether in person or over the phone. There are institutions that try to deal with these matters, but there are those that are as if we are waiting”, observed A. Volodkaitė.
She also drew attention to the huge shortage of nursing staff – in order to provide significantly more services, more specialists should appear on the labor market.
“So, again, it depends on funding, and the ability and desire of the specialists themselves to come to work in a health care institution. When the workload increases dramatically, it is both physically too difficult and ultimately stressful when the to-do list in one shift is endless. This should not be the case”, commented A. Volodkaitė.
The interviewer did not hide the fact that nurses often work more than one full-time workload – they are forced to do this both because of the great shortage of nurses, but at the same time if they try to increase their wages:
“In the primary care, the situation is maybe a little better, because financial support from the municipality is also received, for various preventive programs, etc., but the workload can again be difficult to regulate, because as many patients arrive, their family doctor’s team accepts them.”
Family doctors: the big changes are happening now
Alma Astafjeva, the deputy chairperson of the Lithuanian family doctors trade union, also assured that family doctors are hopefully waiting for the changes that will come into force in February.
“All the big changes regarding the order of prescribing referrals, the renewal of medicines are happening right now. Obviously, if nurses alone are able to extend medication to patients in stable health, it will help a lot.
Midwives will also be able to issue a sick leave certificate for pregnancy and maternity leave. It’s just that everything is delayed so far, we haven’t seen the legal acts yet,” she remarked a day before the legal acts were to enter into force,” commented the family doctor.