A nurse practitioner programme was established in Jamaica in the 1970s when it became clear that the demand for health centres which provided curative as well as preventive care could not be met by medically-trained personnel alone. Nurse practitioners (NPs) were to assume specific medical responsibilities beyond those normally assumed by nurses. It was recognized that for the scheme to work efficiently the medical and nursing professions would have to co-operate and that doctors would have to accept the expanded role of the NPs. The initial plan also emphasized the need for legislation controlling the training and practice of nurse practitioners. However, the matter of legislation was not dealt with when the programme was implemented. In the implementation of the programme great care was taken to consult with doctors and gain their acceptance of the programme. It was not appreciated, however, how important acceptance of the programme by pharmacists would be. When trained NPs began to practise, pharmacists refused to accept their prescriptions unless they were countersigned by a doctor, since the legal right of NPs to prescribe had not been established. This decision by pharmacists threatened the operation of the whole programme. The problems were discussed and eventually practice protocols directing the practice of NPs were prepared and accepted by all professional groups involved. Standing orders which define the relationship of NPs to other health workers were also prepared with a view to moving on to legislation as soon as possible.
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