November 1, 2005
Health Statutes Amendment Act, 2005 (Bill 15)
Second Reading of Bill

M. Polak: I rise today to be extremely supportive of what I see as a tremendous move toward further innovation within our health care system in British Columbia. We know that primary care is an area that we all struggle to meet the demands of in this province. One of the ongoing issues that we face is one that really has little to do with funding pressures and more to do with the number of people who are available, and that is the area of providing the people who would be offering and assisting with primary care. In that regard, I'm very pleased to see the advancement of nurse practitioners. I'm very pleased to see their inclusion in the multidisciplinary approach that we know is going to advance the health care, the primary care, of all British Columbians.

           I have to say that I don't really share the concerns expressed by the member opposite with respect to the excluded nature of the employment of nurse practitioners. I think we see this kind of approach taken in many different fields in the public sector in British Columbia, where there's a recognition that different roles require different approaches in terms of negotiating their relationship with their employers. Certainly, when it comes to nurse practitioners, we're all well aware that they have a different degree of educational background and that they, also, will play a very different role within that sphere of primary care than a registered nurse, who would be part of the BCNU.

           We do know that when it comes to the service we provide to British Columbians in our health care system, there are many reasons why nurse practitioners are better able to serve in some circumstances. I'm mindful of experiences that I've had in rural British Columbia with respect to working with other professionals when a doctor wasn't available. To have someone with the ability to diagnose common illnesses, order appropriate tests or, indeed, prescribe medication in lieu of a doctor's availability is going to be a tremendous assistance to our health care service and, certainly, to providing for primary care throughout British Columbia.

           I also think we have to look at the way in which nurse practitioners will be viewing themselves. Obviously, this is an evolving field in British Columbia. It will take some time for those people who are working in the field to address the ways in which they want to relate to their employer, and it's important that they are afforded the capacity to determine that themselves.

           There's nothing stopping them from deciding that they wish to form their own association and to utilize that to establish their own employment relationship. I think that's certainly a recognition of their independence and their role as professionals within the system. They should have the opportunity to make that determination themselves, and I think it aligns with their role in primary care in British Columbia.

           We need to remember that if we were to try and equate the role of nurse practitioners within the system, we would be looking more toward the direction of physicians, midwives and dentists. When we picture it that way, it becomes very obvious that there is, indeed, a requirement that we exclude these professionals so that they can function within the sphere in which they are intended.

           We also need to note that in encouraging the addition of nurse practitioners, more and more of them, into the system and encouraging young people to take up this career, there needs to be a look for them at what they see their role as in the future. We know that initially, there was some hesitancy, I suppose we would say, with respect to takeup of some of the training positions. It would probably be fair to say that that had some wrap-up with respect to their perception of what their role would be. I think this assists in clarifying that — that they will truly be operating as independent professionals. To have them as excluded staff in that regard reinforces that. They are independent professionals, and as such, they're going to provide so much to what we can offer for our patients in British Columbia.

           Again, it's one of those areas where as you move forward, you have to do things in new ways. We very frequently hear that we ought to keep things the same. I would argue that the position of the member opposite with respect to expressing concern around the nurse practitioners not being included in the BCNU bargaining unit is really just that argument masquerading as something else. I think it is just a push toward keeping things the same rather than taking a look at how our health care system is changing and how we need to change with it.

           That's what this is a recognition of. We need to constantly be examining the service we provide, examining the ways in which we provide it, and we have to be willing to change. We have to be willing to adjust.

           By allowing the nurse practitioners the opportunity to make their own determination in that regard, we allow those who are most familiar with their own roles, their own practices, to have a say in how that's going to look on the ground and in their relationship with their employers. I think that's extremely important. Very often governments have their own opinion about how things ought to be structured. Sometimes it works well; sometimes it doesn't work very well. When you involve those who are on the ground, when you involve those who are in the role in making that determination, I think that's when you make the best decisions.

           Certainly, when it comes to the nurse practitioners, they are afforded that opportunity to grow and evolve with their roles and to make determinations around how their relationships with their employers might augment that and, in fact, be of benefit to them. That's another thing that we don't talk a lot about in British Columbia. In British Columbia, when we talk about unions and labour relations, unfortunately, we're often wrapped up in the arguments and the debates around what benefits each can gain from the other. Really, at their best, professional associations and unions are there to work together with employers to develop what can be not only the best circumstances for employees but also the best service for those that they are charged with delivering service to.

           I think that's a role that the nurse practitioners will be able to fulfil very well, given their excluded nature. It means that as their role develops within the system, they are able to make their determination as to how they will work together with the employer, develop those roles and see that they fit in with the multidisciplinary approaches that are on the horizon as we innovate and move forward in providing quality health care to British Columbians.

           It removes the uncertainty for nurse practitioners. They know that they're going to be true front-line, autonomous providers. They know that they're going to be independent professionals. I believe that's going to increase the takeup in terms of those who wish to see this as a career. It also means that it puts them into a professional relationship alongside those with whom they work, such as physicians, in a different manner than those who are part of the existing bargaining unit within the BCNU.

           It's appropriate that you have these different groups of folks able to determine their own fate with respect to their employers, so I'm very supportive of this as an amendment. It's an appropriate aligning of where the nurse practitioners fit within the primary care team.

           I think this is all leading toward improving and innovating in British Columbia's health care system. It will allow us, yet again, to add to our ability to provide the best possible health care for British Columbians. That's where we're on the road to, and I think this adds to it, so I speak in favour of the amendment and of having the nurse practitioners held as independent professionals in our system