One issue that prescribing reform will hopefully improve is the current grey area over when a nurse is ‘advising’ or ‘prescribing’ an over-the-counter (OTC) medicine like paracetamol.
Currently a registered nurse cannot prescribe paracetamol but they can provide advice about such OTC medications if they are knowledgeable and accountable for their advice and remain within their scope.See below some excerpts of recent advice on how to safely recommend OTC medicines by the New Zealand Nurses Organisation and Nursing Council.
Guidelines for Nurses on the Administration of Medicines*
11.4 Over the Counter Medicines
RNs, ENs and midwives who recommend an over-the-counter (OTC) medicine to a person (this may be a client, friend or family member) must be knowledgeable of the associated responsibilities and accountabilities of this activity. An OTC medicine is any medicine you can buy without a prescription and includes the following:
- restricted medicines that can only be sold or supplied by a pharmacist;
- pharmacy-only medicines: a medicine that can only be sold or supplied from a pharmacy; and
- general sale medicines that can be sold at any retail outlet.
A RN, EN or midwife is accountable for their nursing advice on and off duty, 24 hours a day and must remain within their scope of practice. A RN, EN or midwife recommending OTC medicines must ensure they have sufficient knowledge of the medicine, be able to undertake a comprehensive assessment of the client, understand the limitations of their knowledge related to OTC medicines, use appropriate referral, and know how to communicate this effectively to clients, friends and family members when appropriate (Thompson, Kai Tiaki, June 2008).
*excerpt from New Zealand Nurses Organisation. (2012). Guidelines for nurses on the administration of medicines. Wellington: New Zealand Nurses Organisation. Published in May 2012
Advice re: Nurses Becoming Quit Card Providers*
II. What responsibilities do nurses have when recommending OTC medicines?
Nurses need to remain within their scope of practice. The RN scope (2010 version) states: Registered nurses use nursing knowledge and judgement to: assess health need; provide care; and advise and support people to manage their health. They practise independently and in collaboration with other health professionals, perform general nursing functions, and delegate to and direct enrolled nurses, healthcare assistants and others. They provide comprehensive assessments to develop, implement, and evaluate an integrated plan of health care, and provide interventions that require substantial scientific and professional knowledge, skills and clinical decision making.
To ensure that RNs work within their defined scope of practice, they need to think through the following factors before recommending OTC medicines:
- Does your employer and multidisciplinary team support this practice?
- Are there policies or guidelines on this issue?
- Is there adequate education and resources to support it?
According to the RN scope of practice, nurses should have “substantive scientific and professional knowledge and skills to advise”. It is vital to be up to date on the OTC medicine and its contraindications, the side effects and potential medicine interactions.
The completion of education and training ensures that nurses have such “substantive scientific and professional knowledge and skills to advise”.
Under their scope of practice, RNs also “provide comprehensive assessments to develop, implement and evaluate an integrated plan of health care”. Thus recommending an OTC medicine for a “sore tooth” needs to occur within what is a nationally acceptable standard for such a presenting complaint.
Finally, RNs need to consider other health professionals and their standards of practice in this process. For example, a pharmacist must assess the consumer before supplying an OTC medicine. Thus, an RN may be well advised to refer a client to a pharmacist for OTC medicine assessment rather than recommending a specific medicine her/himself (Thompson, 2008).
*Excerpts from advice sheet Advice re: Nurses Becoming Quit Card Providers prepared August 2010 by:Charlotte Thompson, Professional Nursing Adviser NZNO, Margaret Barnett Davidson, Legal Adviser NZNO and Carolyn Reed, CEO NCNZ.