A long-awaited proposal to step-up the number of nurses who can prescribe antibiotics to the contraceptive pill is now out for consultation by the Nursing Council.
Carolyn Reed, chief executive of the Nursing Council says the proposals were designed to make it easier for patients to obtain the medicines they need particularly where there was a shortage of doctors.
“Nurses already have a significant role in health promotion, disease prevention and in the assessment and treatment of minor ailments and illnesses. Enabling nurses to prescribe would enhance the services they can deliver,” said Reed.
At present only 96 nurse practitioners (NPs) and 26 diabetes nurse specialists have prescribing rights (about 0.25 per cent of the country’s nurses) compared to the United Kingdom where 7.5 per cent of nurses have prescribing rights of varying levels.
The Nursing Council is proposing following a similar model to the UK by having three levels of nurse prescribing – independent NP prescribing, specialist nurse prescribing as part of a collaborative multidisciplinary team (like the diabetes nurse specialists), and community nurse prescribing for minor ailments and infections.
Examples given of community nurse prescribing include a school nurse being able to visit a child at home to confirm the skin infection impetigo and write an antibiotic prescription on the spot so parents don’t have to miss work to take the child to the doctor. Likewise a young woman presenting at a sexual health clinic after having unprotected sex can be assessed, counseled and prescribed the emergency contraceptive pill, condoms and an ongoing oral contraceptive by a community prescribing nurse.
The Council says community nurse prescribers will be expected to have been practising at least three years and to have completed a course including at least three days of supervised prescribing practice in their prescribing area.
Specialist nurse prescribers will be expected to have completed a postgraduate diploma in prescribing including 150 hours of supervised prescribing practice with a designated medical prescriber.
The council says specialist nurse prescribers could include nurses working in speciality services like diabetes or nurses working in general practice including rural nurse specialists. The nurses would work as part of a collaborative multidisciplinary team and be expected to be able to manage and monitor patients with long term conditions like chronic respiratory disease, diabetes and hypertension.
Concerns addressed
The Council’s consultation document says the Council is aware of health sector concern about overprescribing of antibiotics in the community leading to antibiotic resistance but says nurses already supply and administer antibiotics under standing orders and can be educated to prescribe antibiotics appropriately.
“The health priorities that prescribing nurses will address are significant and potential concerns can be addressed by education and audit,” says the consultation document.
“Other concerns have been raised that nurse prescribing could lead to fragmentation of care and undermine medical practitioners leadership role in patient care,’” adds the document. “For many community nurse roles, there is no doctor employed in the service. Nurses already refer patients to a general practitioner and this type of communication and collaboration would continue,” said Reed.
“The diabetes nurse prescribing project found that doctors welcomed the expanded role of nurses. Having nurses look after routine prescription needs and patient management left doctors able to focus on more complex and acute cases and needs. Patients also were happy.
“Nurse prescribing is a significant and historic advance in the evolution of nursing practice but more significantly it is about delivering benefits to all New Zealanders in terms of improving access to timely and convenient health services and medicines,”said Reed.
The consultation document can be found at the Nursing Council website: www.nursingcouncil.org.nz or www.nursingcouncil.org.nz/index.cfm/1,283,html/Consultation-on-registered-nurse-prescribing
Submissions close on April 19.
