The case for nurse prescribing: in a recent New Zealand Medical Journal editorial, two doctors claimed nurse prescribing was a threat to the standard of health care. NZNO's professional services manager rebuts their arguments.

The November 11 issue of The New Zealand Medical Journal contains the Latest attack in a long history of medical opposition to nurse prescribing. In their editorial, rheumatologist Peter Moller and Professor Evan Begg assert that the extension of prescribing responsibilities to nurses will threaten the standard of health care in New Zealand. (1) They base their argument on three claims: that only medical practitioners can diagnose and therefore prescribe appropriate treatment; that only medical education and training prepare people to prescribe safely; and that independent nurse prescribing goes against the principle of good team work, which is essential for good medical care. The fears that Moller and Begg express are unfounded. Furthermore, their position is irresponsible because it could result in the unwarranted undermining of public confidence in nurse prescribers.

Nurses do not believe that nurse prescribing is a threat to the standard of health care. They believe it will raise the standard of health care.

Right treatment at the right time

They will be able to provide prompt access to the right treatment at the right time to many people who currently face delays in getting access to GPs, especially in rural areas. In specialist areas, eg diabetes and neonatal care, patients will not have to wait to get access to drug treatment until a medical professional is available. For "Mr Smith", a diabetes patient with high blood pressure, this could mean that he needs to see his medical specialist consultants Less often. Instead, his diabetes nurse practitioner (NP), who has prescribing rights, becomes his one-stop-shop for insulin and anti-hypertensive supplies. That is not all he can expect from her. She will also provide a full nursing assessment, advice, support and continuity of professional care. Prompt intervention leads to early recovery and less cost to the health service. This means that more of the medical consultant's time is then available for those who have more serious and unstable illnesses. The NP will refer "Mr Smith" to the relevant medical specialists when further medical assessment becomes necessary. Mr Smith should expect that his NP and the relevant medical specialists will keep each other informed and have a dose, cordial working relationship.

Careful control of nurse prescribing will ensure patient safety. Only those experienced nurses who have advanced, specialised qualifications can work as an NPwith prescribing rights. Out of a total New Zealand nursing workforce of over 35,000, fewer than 20 nurses so far have prescribing fights.

In almost her last act as Minister of Health, Annette King gained Cabinet approval for the regulations to implement nurse prescribing. These came into effect on December 8. Many of Begg and Moller's medical colleagues have supported this policy initiative through engaging in the necessary negotiations with government, and in agreeing to participate in the systems set up to assess, monitor and evaluate nurse prescribing practices.

Nurses have not achieved these outcomes in splendid isolation. Nor do they wish to prescribe in splendid isolation, as Begg and Moller's claims would suggest. The professional initiative to extend prescribing rights to nurses was developed over many years and has involved consultation with many health sector colleagues, including medical professionals.

This collaborative approach will continue and is already evident in a number of ways. At every Level of the prescribing changes, nurses have worked with other health professionals to ensure safety for people needing health care. The ministerial New Prescribers Advisory Committee (NPAC), set up to plan and implement the changes, represents both nursing and medical expertise. A proposed medicines List for nurse prescribers was drawn up. It was not left to nurses to decide what drugs would be on this list. A number of parties were consulted. For example, the College of Anaesthetists opposed the inclusion of certain anaesthetic drugs and, as a result, NPAC deleted these drugs from the List. Medical professionals are involved in the education of nurse prescribers. They are also on the multi-disciplinary panel set up by the Nursing Council to assess and monitor NPs' ability to prescribe. Nurse prescribers can only prescribe drugs in their defined area of practice and on the basis of Nursing Council authorisation and auditing of their individual practising certificates. Nurses are used to working in teams and the right to prescribe drugs will not change that practice. It is in the interest of both patients and health professionals to work together. It is important that each member of a team understands their level of authority and accountability. When NPs take on the right to prescribe drugs, they are also accepting responsibility for taking the consequences if their drug prescribing practices are found to be wanting. They are subject to the same kind of patient complaints systems as medical practitioners. The public will be aware of the occasional complaints that have been made against medical practitioners for abuse of prescribing rights. Their nursing colleagues will expect those nurses who do not practise safely to be judged by the same complaints systems that judge medical practice. What nurse prescribers need from their medical colleagues is the following:

* credit for taking on responsibility for improving health services;

* co-operation in sustaining collaborative relationships;

* participation in sharing knowledge and improving health services; and

* respect for what they know and can achieve. After all, nurses have always offered these things to their medical colleagues.

* An abridged version of this article was originally published in The Press on November 21, 2005.

Reference

(1) Moller, P. and Begg, E. (2005) Independent nurse prescribing in New Zealand. New Zealand Medical Journal; 118: 1225.