The Bermuda Medical Doctors Association has doubled down on its position against expanding autonomy for advanced practice nurses.

Kyjuan Brown, the association president, insisted that the stance was “about patient care, not disrespect for nurses”.

Highly specialised APNs can prescribe certain medicines in Bermuda if they have an agreement with a registered physician.

At present, they are unable to put all of their training into practice, including prescribing, diagnosing and treating conditions.

Karen Grant-Simmons, the president of the Bermuda Nurses Association, believes that giving APNs more powers would address an “urgent need” and immediately improve healthcare on the island.

However, Dr Brown said the BMDA still did not support APN independent medical practice nor independent prescribing.

He said: “The BMDA has enormous respect for Bermuda's nurses and the critical role they play in our healthcare system.

“We recognise their education, experience, dedication and contribution to patient care. This is not a debate about whether nurses are valuable, intelligent or highly trained. They unquestionably are.

“The issue is whether Bermuda should grant APNs independent authority to diagnose, manage and prescribe without physician oversight, and whether Bermuda has demonstrated a healthcare need requiring that change.”

Dr Brown explained that the preparation for independent clinical practice was “fundamentally” different between the two “highly educated healthcare professionals”.

He said: “The BMDA's position paper identified approximately 500 to 1,000 supervised advanced clinical hours for APN training compared with approximately 10,000 to 16,000 supervised clinical hours through physician medical education and postgraduate training.”

Dr Brown added: “This does not make nurses less intelligent, accomplished or valuable. It means the professions are trained differently and for different roles. Respecting nurses does not require us to pretend these training pathways are equivalent. They are not.

“When independent diagnosis and prescribing are being considered, that distinction is directly relevant to patient safety.”

Responding to APNs having more autonomy in the US, Canada and Britain, Dr Brown said these countries faced “significant physician shortages” or that there were “underserved communities” that faced “difficulties in accessing primary care”.

He added that an “all hands on deck” approach was “understandable” in these circumstances, with appropriately trained advanced practitioners helping to fill an access gap.

Dr Brown said: “The BMDA therefore asks a straightforward question: what healthcare-access problem are we trying to solve?

“If Bermudians cannot find primary-care physicians, if parts of the island are medically underserved or if patients face unacceptable waits for routine primary care, then the data demonstrating that shortage should be presented publicly.

“If a shortage exists, let us identify it and work collaboratively with Government and our nursing colleagues to solve it.”

He added: “Physician-led medical care does not mean nurses are beneath doctors.

“Healthcare is multidisciplinary. Nurses, physicians, pharmacists and allied health professionals bring essential but different expertise to patient care.

“The BMDA supports nurses and APNs working to the full extent of their education, competencies and regulated scope.

“But collaboration does not require equivalence of training, and working to the full extent of one's training is not the same as assuming the independent scope of another profession.”

Dr Brown said the association’s position “remains clear”.

“We regret that our position has been interpreted as disrespectful to nurses. However, disagreement about scope of practice is not disrespect for a profession,” he said.

“The BMDA remains willing to work collaboratively with the Bermuda Nurses Association, Government and other healthcare stakeholders.

“If evidence demonstrates a genuine gap in primary-care access, we should examine it together and determine the appropriate solution for Bermuda.”