Nurse prescribing: radicalism or tokenism?

Abstract

The creation of The Medical Products (Prescription by Nurses, etc.) Act 1992 has been generally welcomed by the nursing profession. This article seeks to introduce a note of scepticism about the assumed motivations for its introduction through an analysis of various legal, ethical, economic and political dimensions. In reviewing the position of nursing vis-à-vis medicine it is argued that one of the ways that nursing has sought to improve its professional position is to take on work previously done by doctors, and nurse prescribing can be seen in the context of the concurrent de-regulation of medicines, allowing greater access to medicines and therefore greater consumer choice. This de-regulation stems from the liberation ideology of the previous Conservative government. Viewed in this way nurse prescribing, particularly with reference to the limited nature of the nursing formulary, can be seen to be anomalous. In the light of this analysis, the reasons generally put forward (notably in the Crown Report 1989) for the introduction of nurse prescribing could be seen to be peripheral to its real purpose. It is argued that the most convincing reasons for its introduction relate to the medical profession as a social institution. It is proposed that the three primary aims behind the introduction of nurse prescribing are: the saving of money; the transfer of routine medical work to nursing; and a challenge to the professional monolith of medicine.

Non‐ medical prescribing in Australasia and the UK: the case of podiatry

“…First, 'indicative' prescribing was introduced, limiting doctors prescribing habits in the interests of fiscal probity, whilst acting to diminish medical power [49]. Within a short time, plans to grant specialist nurses and midwives enhanced 'prescribing' rights were unveiled [50,51]. …”

Managing adverse drug reactions: an orphan task

“…The nurse prescribing initiative is one response to changing patterns of care needs, from acute to chronic conditions. However, it raises complex issues, including advancement of the nursing profession, erosion of the medical monopoly on control of medication management and compensation for physician shortage by transfer of routine medical work to nursing (Jordan & Hughes 1996, McCartney et al . 1999).…”

Nurse and pharmacist supplementary prescribing in the UK—A thematic review of the literature

“…Horton [67] argued that nurse prescribing could offer valuable benefits but political expediency may see it introduced too rapidly, without attention being given to the scope of prescribing and safety. Arguing that nurses were being manipulated to fill workforce shortages -and echoing arguments advanced by McCartney et al [68] in relation to cost and labour savings -the pace of nurse prescribing was, he argued, 'reckless' and amounted to an 'dangerous uncontrolled experiment.' Croskerry [69], writing about Canadian pharmacists' prescribing rights generally, argued that patient safety would be compromised by pharmacist prescribing and that pharmacists may be especially vulnerable to commercial influences from the pharmaceutical industry.…”