Nurses prescribing

**dave_shucks2004** · 12-11-2005, 06:20 PM

Firstly, apologies if this thread has already been explored...

What do you all think of nurses getting more responsibility, and being allowed to diagnose and prescribe- for more serious conditions such as diabetes and heart disease? I personally would welcome the change, I think working in a team is the way forward. But then I change my mind and think, what with all the current problems with the NHS, is "lowering the standard" of quality of care by allowing someone other than a fully fledged doctor to diagnose and prescribe etc, only going to make the NHS seem more "shoddy" (for those critics that say it's shoddy, not me!). I'm not sure what I think. I fully appreciate nurses and I'm sure they'd welcome the change to lessen their reliance on doctors. Only specially trained and speciality nurses get to do this, and of course, prescribe within their own speciaility.

The BMA, however opposes this, saying "it is an irresponsible and dangerous move", and that the patients will suffer from it! What is all your views on this?

**Ostrich** · 12-11-2005, 06:26 PM

well i'm not to keen on this change but i wouldn't say that it is an irresponsible and dangerous move!!! i have always thought that doctors were the masters of prescibing although specially trained nurses have the right to prescribe too.......... my thoughts are kind of mixed but i think this move was quite risky and a big jump!!

**Dave_Thorpe** · 13-11-2005, 09:37 PM

I feel that in order for nurses to be allowed to prescribe drugs of this nature they must have some specialist training in order to do so. Once they have been through a training programme for this I feel it is fine for them to prescribe certain drugs. This is because, as mentioned in a previous post, working as a team in medicine is essential for success. When I was on work experience at a medical centre, I did think it slightly ridiculous that a nurse would have to see the doctor I was with regularly in order for his approval on certain prescription drugs as I feel it is a waste of his time having to do this so regularly. I think with the right training, qualified nurses should be able to prescribe drugs for heart disease and diabetes to at least save wasting a doctor's time. However, I do take some views from the other side of the argument. For example, people who have these serious diseases (such as heart disease), may feel a little anxious that a less qualified person than a doctor is prescribing them these drugs which in turn i suppose would be unfair on the patient. Also, if a nurse prescribed these drugs to a patient and it turned out the side effects had a great effect of harming the patient due to some other health problem the patient has that the nurse is unfamiliar with, allowing nurses to prescribe such drugs would look very bad on healthcare in the UK. These are some of my views on the topic so please feel free to comment.

**safa** · 13-11-2005, 11:11 PM

I feel that nurses shoudnt be given the power of prescribing as the two years training they have to undertake in order to become a physician assistant (PA) is simply not adequate and doesnt match up to the training that doctors recieve. Therefore it would be more than a bit risky and irresponsible to allow nurses to be given the power of diagnosis and prescription. Also if you think about it, if the government's trying to save money by introducing PA's it will actually not make any difference because it will take nurses double the amount of time compared to doctors to diagnose patients. Nyways in a nutshell i cant see it working for the best but thats my opinion, maybe im wrong?

**Renal** · 14-11-2005, 12:13 AM

There are more than a few grades of nurse, we're not talking about some green D grade fresh from three years of uni prescribing.

If you've ever been on a specialist ward you will have seen that the senior nurses, certainly the ward sisters, will know far more about the conditions that are seen than SHOs who rotate in for a few months and disappear again shortly after.

p.s. http://www.medschoolguide.co.uk/foru...ad.php?t=17549

**Big_D** · 14-11-2005, 02:46 AM

There is a reason why doctors are allowed to prescribe medicines, and that is because they have undergone the most rigorous education and training. This cannot be overlooked for something as trivial saving time.

I personally believe that this will create conflict between doctors and prescribing nurses. I also think that the most important aspect (the patient) is being overlooked here for the sake of faster patient turnover. If this move is indeed to save 'wasting a doctors time' from having to give the ok to nurses then I feel it is sadly misplaced and represents a major failing on behalf of the government. Personally, I think that the majority of patients will still want to see a doctor rather than a nurse, which may create a rebound effect of sorts.

After all, since when did it become acceptable to refer to patient care as wasting time?

Too many NHS pen-pushers are a waste of time.

**sea tea** · 14-11-2005, 03:19 AM

when i was on work experience, (as has already been mentioned) the senior nurses on the specialist wards knew far more about the drugs needed in different situations than the SHOs on rotations. but they had to waste time bleeping an SHO for a signature, pointlessly.

obviously they might not be experts in pharmacokinetics, but they can still use their experience to ensure their ward runs more smoothly, and the patient don't have to wait unneccessarily for drugs they need

**Renal** · 14-11-2005, 04:47 AM

Originally Posted by sea tea

and the patient don't have to wait unneccessarily for drugs they need

To paraphrase a post of mine from the (near identical) other thread;

Why should nurses not be able to prescribe and admisinster drugs where the use and dosage are clearly set out by guidelines such as the pain control ladder and the ALS algorithms. Would someone please tell me the benefit of waiting for a doctor to prescribe well known, safe and standard dosed analgesia to a patient in pain or waiting for a doctor to turn up to a resus when an experienced pracitioner is more likely to be available and can initiate basic treatment earlier thus benefiting the patient.

**rachelm** · 14-11-2005, 05:23 PM

I can't really see what the problem is, to be honest, though I'm not experienced in clinical practise. Nurses can already prescribe some drugs (they do so in the hospice I work at).

There does need to be a clear structure though, and someone needs to have overall responsibility for the welfare of the patient. If we start dividing responsibilities like this then the boundaries of responsibility become blurred. I'm assuming doctors will be able to override nurses' decisions when it comes to prescribing drugs, you have to have *someone* ultimately in charge.

**dave_shucks2004** · 14-11-2005, 07:19 PM

There is a good topic on Doctor's Mess with some good content.

I certainly think that a specialist nurse eg for Diabetes would have far more knowledge, than say, a PRHO or SHO. I mean, they have their 4years initial training, then 3yrs masters (?) then those 2 years for prescribing. I think it makes everyone's job easier, and of course, nurses tend to spend more time with the patient, reassuring them and explaining everything (well from what I've seen) (as someone has referred to as patient turnover) I think some people oppose this because nurses' roles are becoming closer and closer to a doctor's. Yes of course doctors have done their lengthy and thorough stint at medical school for a reason, but I don't think nurses are gven the credit they duly deserve, and they rely far too much on doctors. As someone has said no one would be as stupid to allow a newly qualified nurse let loose on the drug cupboards. Yes this may be a time and money saving venture, but then isn't most things? Anyway I still haven't made up my mind..I don't know, I'm probably wrong!