Prescribing the boundaries of nursing practice: Professional regulation and nurse presaibing

Abstract

In October 1994 nurse prescribing was launched for the first time in Britain in eight community demonstration sites. Using nurse prescribing as an illustration, this paper aims to explore the regulation of nursing and the influence of medicine on the expansion of the nurse's role. Arguing that professional development and regulation must be understood within the context of state control, the paper questions whether nurse prescribing represents a genuine development in nursing roles or is merely an act of tacit delegation by a medical profession which is itself subject to loss of autonomy. Recognising historical renegotiation in divisions of health-care labour, sections on the introduction of nurse prescribing; changing professional boundaries; and regulation in nursing, medicine and pharmacy, are used to critique nurse prescribing as an example of growing nursing professionalisation.

Nurse‐led intermediate care: an opportunity to develop enhanced roles for nurses?*

“…1994). Thus, the danger exists that doctors may resist nurses taking on tasks that might be seen as undermining doctors’ status unless they can maintain control over these activities (Shepherd et al . 1996).…”

“…On the one hand, increasing workloads have encouraged doctors to express a desire to share more of their activities (Royal College of Physicians 2000), whilst on the other hand, some appear to feel their status and autonomy are under threat from a range of quarters (Gabe et al 1994). Thus, the danger exists that doctors may resist nurses taking on tasks that might be seen as undermining doctors' status unless they can maintain control over these activities (Shepherd et al 1996). Such resistance may mean nurses take on more medical tasks but only the routine jobs that doctors are happy to pass over, and nurses may not have overall control over these activities.…”

Nurse prescribing: radicalism or tokenism?

“…These are now used to structure courses by those institutions of higher education who provide this training, and all the nurses involved at the pilot sites undertook such a course. The course consists of 10± 20 hours of open learning and about 15 hours of formal college education (Shepherd et al 1996). It is important to recognize that it is the level of knowledge provided by these courses which will now form the standard against which nurses will be judged, rather than the level of knowledge possessed by the generality of nurses.…”

“…In order to see the nursing position accurately within professional power brokering the gender composition of the professions has to be considered. Shepherd et al (1996) have discussed the`predominantly female character of nursing' and the historical battle there has been for the modern identify of nursing to be achieved. They argue that professionalization has been a dif®cult route for a female-dominated occupational group to take.…”

Nurses as change agents for a better future in health care: the politics of drift and dilution

“…This is one way of trying to halt the politics of drift. The development of nurse prescribing was only won after a battle with the BMA and a campaign and lobbying effort countering medical opposition (Shepherd et al ., 1999). Securing the state registration of nurses in the United Kingdom in 1919 was a battle lasting almost 30 years and the product of significant and sustained lobbying activity, campaigning and political leadership on the part of nurses.…”