An expansion of powers for advanced practice nurses is being explored by the Government as efforts continue to improve efficiency and reduce the cost of healthcare.

The health ministry said that while preliminary interest has been shown about possible changes to the scope of practice of APNs, any formal proposal would need to be assessed by the statutory regulator.

Talks on the issue have generated mixed responses, with the Bermuda Health Council generally in support of greater autonomy for nurse practitioners but the Bermuda Medical Doctors Association standing firmly opposed to the idea.

APNs are nursing professionals with specialised training.

They have received further education, to master’s degree level at least, and are capable of prescribing, diagnosing and treating conditions.

In Bermuda, APNs can prescribe certain medicines only if they have a collaborative practice agreement with a registered physician.

The Ministry of Health said it recognised the contribution APNs make to the healthcare system.

A spokeswoman revealed that preliminary interest had been shown from nursing professionals and other stakeholders about potential adjustments to the scope of practice.

However, she added that the discussions remained exploratory, with any formal proposal needing assessment by the Bermuda Nursing and Midwifery Council.

The spokeswoman said: “The ministry is reviewing the broader workforce needs of the health system, including how APNs may support improved access, earlier intervention and stronger chronic disease management.

“International and local evidence shows that when properly trained, certified and supported, APNs can deliver high‑quality care and contribute to system efficiency.”

Kim Wilson, the Minister of Health, added: “Advanced practice nurses are valued partners in Bermuda’s healthcare system, and we appreciate the engagement from nursing professionals, physicians and other stakeholders who are committed to strengthening care for our community.”

The minister said that any decisions would be guided by the Bermuda Nursing and Midwifery Council.

While recognising concerns, Ricky Brathwaite, the chief executive of the Bermuda Health Council, spoke in support of expanding powers for nurse practitioners.

He told The Royal Gazette that the island’s healthcare needs were “growing” and could no longer be addressed through “traditional channels”.

Mr Brathwaite said: “For context, we define an APN as a registered nurse with postgraduate education in nursing, typically a master’s or doctorate, who is trained to assess, diagnose, treat and manage patient care — independently or in collaboration with other healthcare providers.

“Based on this understanding, it is our position that, provided the qualifications, education and certification requirements are robust, APNs absolutely have a role in providing care in the community up to the level of their training and competency.”

He added: “With the appropriate infrastructure to support integration and ensure accountability, APNs can meaningfully contribute to improving case management, controlling chronic diseases and delivering home-based care.”

The council confirmed it has been providing support to the Bermuda Nursing and Midwifery Council.

The Bermuda Medical Doctors Association said that a “fundamental issue” was the difference in training hours between an APN and a physician.

It outlined a list of reasons in a document prepared by Kyjuan Brown, the BMDA president.

Dr Brown wrote: “Bermuda does not require independently practising APNs.

“The country has a sufficient number of physicians, and introducing independent APN prescribing would escalate costs, heighten patient risks and degrade healthcare quality.

“Given these risks, the BMDA urges the Government to reject any proposals for independent APN prescribing and to maintain a physician-led model of patient care.”

It is understood that the BMDA has made the health ministry aware of its position.

Records were released in response to a public access to information request made by a member of the public and seen by the Gazette.

It asked for records of revisions to the Nursing and Midwifery Act 1997, and included an e-mail sent to the Permanent Secretary of Health — said to be from a nurse in response to the position of the BMDA.

They said: “Contrary to the position of the BMDA, access to NPs with full prescribing ability will offer significant savings to the Bermuda healthcare system.

“I have had several physicians saying in the past they would like to hire NPs for their practices. However, the inability to prescribe does not make them beneficial to their business operations.”

The nurse added: “I hope that the regulatory body sees the tremendous potential NPs have for our ageing patient population and instead of simply [denying] the request of the nursing council to allow prescribing ability to the NPs, they will find, at least, middle ground on this issue”, including a start with “non-narcotics prescribing privileges”.

All Canadian provinces and territories have legislation in place that allow APNs more autonomy. Most of the time, APNs can diagnose and treat diseases, view tests, prescribe drugs and perform procedures.

Thirty US states allow full autonomy, while in Britain they can prescribe medicines and make treatment decisions.

The Bermuda Hospitals Board did not wish to comment on the matter. However, the organisation confirmed it had one Bermudian-licensed nurse practitioner on staff.

The Nursing and Midwifery Council and Nurses Association were both contacted for comment.