The number of nurse practitioners working in Canada may be slowly increasing, but health officials say there are still significant obstacles to the profession receiving full acceptance in the health-care system.

The difficulties were highlighted recently in Prince Edward Island, where a pilot project for nurse practitioners collapsed amid professional mistrust and mudslinging over the nature of the doctor and nurse role.

"The project was soured by all the negative publicity around the politics of doctors not wanting to sign on and nurse practitioners not being able to practise," said Margaret Duffy, president of the P.E.I. Nurses Union.

"The nurse practitioners were called 'wannabe doctors."'

Duffy says the pilot project in O'Leary, P.E.I., has been cancelled and the two nurse practitioners, who were paid to sit at home for the last four months, have been reassigned to traditional nursing jobs elsewhere on the island.

The experience has created bitterness, especially on the part of Island nurses who are anxious to do their part to alleviate health-care pressures.

These registered nurses can diagnose and treat common illnesses, prescribe medication, order tests and refer patients to other health-care professionals.

The qualifications for nurse practitioners include a nursing degree, two years of one-the-job training, and further university studies.

"The nurse practitioner is a new breed," Duffy says.

"So when doctors come out in the media and say, 'If you want good care come to me and not them', well, people trust doctors. The nurse practitioners were made out to be people who could harm you if you went to them, who were doing something they weren't trained to do.... It had a horrible deterrent effect on people coming to the clinic to see the nurse practitioners. Soon all the patient support dried up."

Dr. Herb Dickieson, president of the Island's medical society and one of the doctors in O'Leary who opposed the nurse practitioner program, says P.E.I. doctors in general have doubts about the scope of practice prescribed for the nurse practitioner.

Dickieson says those duties intrude on the traditional role of the physician.

"There is a danger in setting up parallel practice situations where there is a lot of overlap," Dickieson says.

"That needs to be avoided. It needs to be a complimentary relationship where the expertise and skills of both professions can be used in the most efficient manner."

Dickieson has a clear idea of the function of what he calls the "advanced practice nurse" and it includes some clinical work, such as pap tests and educating patients.

It does not include, he says, diagnosing illnesses and writing prescriptions.

"Making the diagnosis and prescribing treatment is the core area of the physician's focus," he says.

Around the world, nurse practitioners are assuming more responsibilities in patient care as governments turn to these skilled professionals to help out, especially in areas where there are physician shortages.

Marion Knock of the Canadian Nurse Practitioner Initiative, which is funded by Health Canada, says there are still fewer than 1,000 registered and licensed nurse practitioners in Canada, but the numbers are growing steadily each year.

She says it is encouraging that all provincial and territorial governments, except the Yukon, have passed legislation clearing the way for nurse practitioners - although Prince Edward Island has yet to proclaim its law.

Knock says legislation indicates a political recognition of the importance of bringing nurse practitioners into Canada's stressed health-care system.

"There have been some falterings, and Prince Edward Island is an example, but what we've heard for the most part is that when other health professionals, and specifically doctors, have an opportunity to work with nurse practitioners, they really appreciate it," she says.

Provinces, including Ontario and New Brunswick, have been hiring nurse practitioners to help alleviate doctor shortages in rural areas.

Ontario is encouraging doctors to develop family health teams that include several doctors, nurses, nurse practitioners and other specialists to offer a range of health services in one location.

Ruth Collin-Nakai, president of the Canadian Medical Association, says there has been some resistance to nurse practitioners.

"In some areas, there are concerns about scope of practice - who does what and so forth," she says.

"But in other areas, it's working very well."

Knock says the key to introducing nurse practitioners is to carefully lay the groundwork for their arrival in a community so that people and other health professionals clearly understand their role and their abilities.

Knock says the nursing practitioner initiative will be making recommendations in March calling for clarification of credentials for the profession.

She says there needs to be a common curriculum for training nurse practitioners, a national examination and better funding models for positions.

"We need some consistency so that people know what the credentials are across the country."