Nurse prescribers fight back
• From Sheila Smith, nurse practitioner, Leatherhead, Surrey
I am compelled to write in response to the story about doctors believing patients are not adequately protected by the regulations on nurse and pharmacist independent prescribing (News, 5 October).
I was on the first cohort of nurses taking the course and have been prescribing ever since. I work in a GP practice where I have the full support
of my doctors, run a nurse-led respiratory clinic and see patients for minor illness. As a professional I have continued to update my knowledge using reading, study days and discussion with my GP colleagues. The original course was only the beginning.
I can understand some of the concerns expressed but would like to assure you that having access to an almost full formulary does not mean that nurses are going to use it all! I have a good knowledge of respiratory medication and can now prescribe inhalers. I am aware of interactions and so on, and feel fully competent to prescribe them. I would not consider prescribing drugs for diabetes as it is not within my area of expertise. A specialist diabetic nurse would need to be able to prescribe in this way.
I do prescribe for some minor illnesses but only within my competence. I do not consider myself a 'mini doctor' and would not dream of prescribing for areas outside of my understanding. My understanding is increasing over time but I still recognise my limitations.
The roles of specialist nurses are many and diverse. The formulary was opened up to enable nurses in these specialist areas the ability to do their job and for patients to be able to access medication swiftly and safely.
The doctors that I am lucky enough to work with have expressed how pleased they are with the way that I prescribe and have said that one of my strengths is that I recognise when I don't know, but then find out. I find it very insulting that some doctors think so little of the nursing profession that they fear we are going to run wild with our prescription pads. Yes, no doubt some mistakes will be made, but let us not forget that mistakes are also made by doctors.
Could we not progress together? After all, we are all working towards the same goal of helping patients.
• From Jane Stanford, nurse practitioner, Bicester, Oxfordshire
It was with great sadness that I read your article on nurse prescribing. I am undertaking the nurse prescribing course with fantastic support from my GP mentor and from the other eight doctors I work with. The course is extremely hard work and I have heard it is being considered for use with medical students.
The course does not prepare you to prescribe from the whole BNF. What it does is provide an awareness of issues and knowledge around prescribing so that nurses can prescribe from those parts of the BNF relevant to their field of work. Nobody should prescribe 'wildly' from the whole of the BNF and I hope this includes doctors.
The NMC code of conduct is explicit in its stipulation that nurses work within their sphere of competence. I have been a nurse in general practice for 13 years and have found that much of the doctor's traditional work has been delegated to nurses who do have to diagnose regularly.
I have asked doctors to sign prescriptions for patients that they have not seen or assessed for years and I do so several times daily. How does this leave the doctor legally?
The reason access to the whole BNF has been granted is because nurses (like doctors) work in such diverse roles. Some will only prescribe drugs for diabetes, some in primary care will prescribe from a wider formulary but all nurses should only prescribe within their competence. Of course there is always the possibility that a nurse (or doctor) could ignore this crucial point and this is why clinical governance systems have been put in place.
In fact, one of the biggest risks with nurse prescribing is pressure from doctors for nurses to prescribe more! It might be tempting for GPs to hand over some of their repeat prescribing or try to get the nurse prescriber to sign scripts for the non-prescribing nurses. Nurse prescribers will need to be assertive and say no when they feel it is inappropriate.
Nurse prescribing should provide for a more efficient service, improve access for patients, free up doctor time and eliminate the situation where one health professional is signing a prescription for a patient that they didn't see. In an environment where nurses have support from doctors there is every chance of success.