Rethinking Prescribing Authority For Registered Nurses

Supplementary and independent nurse prescribing has taken some years to materialise; this movement was facilitated by Department of Health (DoH), nursing regulators, nursing professional bodies, and general practice (GP) supporters (RCN, 2012). Following the Medicines Act (1992) where only Health Visitors and District Nurses were allowed to prescribe from a limited formulary, over time legislations were subsequently amended allowing non community nurses to prescribe from an extended formulary. In 2003, supplementary prescribing was being recognised and by 2012 The Misuse of Drugs Regulations allowed the nursing formulary to access all of the British National Formulary including controlled drugs. In line with these changes and to ensure that

Nurse prescribing was first suggested by the Royal Collage of nursing (RCN) in 1980, it was to take another six years for it to become part of the government’s agenda with the Cumberlege Report in 1986 (Department of Health and Social Security (DHSS)(1986). These two report

Nurse prescribing has an important contribution to make in improving the service to patient’s clients within the primary health care setting, its benefits was highlighted in the crown

In the United States, health care accessibility, quality, and affordability continue to be ongoing topics of discussion that effect many Americans on a regular basis. The need for affordable, quality healthcare continues to grow, not only due to a growing elderly population, but also as a result of the Affordable Care Act which has allowed millions of previously uninsured Americans access to health insurance and therefor better access to healthcare services (Patient Protection and Affordable Care Act, 2010). According to the Institute of Medicine (IOM) the projected demand increased for healthcare have led to a call for expansion of primary care services by policy makers (Institute of Medicine, 2010; National Governors Association, 2012). Since Advanced Practice Nurses or Nurse Practitioners (APNs or NPs will be used interchangeably for the purpose of this paper) are one of the fastest growing groups of healthcare providers, and continue to practice and provide care in a range of settings including primary care, it is important to investigate and address any potential barriers to practice. This author believes that allowing APNs to write prescriptions for commonly used controlled substances will help improve timeliness and flexibility in health care delivery; studies have shown that there is a positive impact on high

For nurses extending their role to include prescribing there is much to consider. Revelay (1999) states that, accountability involves an individual giving an account of their actions with the rationale and explanation given for these actions. The decisions regarding boundaries of practice are firmly placed in the hands of the individual practitioner (Carlisle 1992). Accountability means being able to justify any actions and accepting responsibility for them, and is an integral part of nursing practice (Rowe 2000) The NMC Code of Professional Conduct (2004) states that a nurse is personally accountable for her practice, has a duty of care to patients and must work within the laws of the country.

The scope of practice for non-medical prescribers (NMP) has expanded greatly over the last 2 decades, with legislation now allowing NMP’s to prescribe from the whole BNF (with the exception of treatment in addiction and within the prescribers competency). Since the introduction of the Medicines Act in 1986 there have been over 15 different governmental reports and legislative changes (see Appendix 1 timeline) that have allowed for the development and growth of the NMP role. Initiated by The Cumberledge report of 1986 and followed by advisory group report in 1989 legislation was introduced with the Medicinal products: Prescription by nurses act of 1992 which allowed primary care nurses to prescribe from a limited formulary (V100 & V200). This advancement in legislation recognised previous recommendations and placed the improvement of patient care and effective use of resources at the core of its practice. However these acts did not reflect on other areas like secondary care or pharmacist and it wasn’t until 1998 The Crown Report and its second report published a year later that led to supplementary and independent prescribing (V300). In 2003 legislation was passed allowing some prescribing of controlled drugs in palliative care with restricted circumstances (amendment to Misuse of drugs Act 1971). In May 2006 nurses were empowered to prescribe from the whole BNF with the exception of some controlled drugs, and in 2009 further legislative changes were made to include the

One of the most talked about subjects regarding health care in Canada is the time it takes to be seen by a physician. For acute illnesses, an

While the new CDMR appears to be a promising care model, BCNU and nurses from across the province became increasingly concerned when the launch of CDMR at the Nanaimo Regional General Hospital resulted in a large number of RN and LPN positions replaced by HCAs (BC Nurses ' Union, 2013). Despite protests, Island Health continued with cuts in nursing staff (BC Nurse ' Union, 2013). CDMR

Nurse prescribing was first recommended, by the RCN, in 1980 and became part of the government’s policy agenda in 1986 with the Cumberlege Report (DH 1986). Further, the Crown Report (DH 1989) advocated prescribing by trained community nurses from a limited formulary. Legislation was introduced in 1992 -The Medicinal Products: Prescription By Nurses Act, 1992 followed by secondary legislation,

In the UK, nurse prescribing was born out of the need to increase efficiency in the NHS by making best use of its resources. Nurse-led services are one means of improving healthcare provision and a string of legislative change has gradually broadened the scope of nurse prescribing in the UK. (Courtenay et al 2007).

The waiting time for medical services is long in both countries. The waiting time is mostly determined by the number of medical doctors and facilities available in relation to the population. According to the report done by the American Medical Student Association (2011), it was discovered that the doctor-to-patient ratio in the U.S. is more than in Canada. As a result, the survey discovered that about 42% of patients in Canada had to wait for about two hours compared to the U.S. whereby 29% had to wait for two hours. Also, 43% of Canadians compared to 10% of Americans are forced to wait for about four weeks to see a specialist. In addition, the same study discovered that 37% of Canadians compared to 34% of Americans found it difficult to access medical services during weekends and holidays. As a result, 47% of Canadians compared to 50% of Americans felt that it would have been possible for them to be treated on a regular basis than on an emergency basis if medical personnel were available (American Medical Student Association, 2011).

Accessibility and quality are being threatened due to cutbacks coupled with a lack of funding. There is a consensus now between medical professionals, the public, and the government that the health care system is deteriorating. It is failing to provide the quality of care promised in the CHA and prided by so many Canadians.

Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs) are both considered advanced practice nurses (APNs) in Canada (Donald et al., 2010). Although these roles have existed in Canada for decades (Canadian Nurses Association, 2008), confusion still remains about the titles and exact roles that these professionals play (Donald et al., 2010). This paper will use the Saskatchewan Nursing Advanced Practice model as a framework to highlight the similarities and differences between both types of advanced practice nurse. The scope of practice, registration, education, practice settings, and effectiveness of CNSs and NPs will be examined. Although their roles overlap, CNSs and NPs have both been shown to be important members of the health care team (DiCenso & Bryant-Lukosius, 2010). Research has shown that adding CNSs and NPs to our health care system can increase patient satisfaction, decrease wait times, and decrease readmissions (DiCenso & Bryant-Lukosius, 2010). Increased public and health care professional awareness is needed to have these roles fully incorporated into our current health care system (DiCenso & Bryant-Lukosius, 2010).

In order to meet the growing demand for primary care, nurse practitioners need prescriptive authority to provide quality, safe, and cost-effective healthcare to patients. The development of nurse practitioners, plus physician shortages in primary care, leads to an increasing need for nurse practitioners and access to health care. However, nurse practitioners currently face prescription regulations for controlled substances, which limits their scope of practice. The regulation of nurse practitioners prescribing controlled substances diminishes comprehensive health care services by increasing the wait time for patients and liability claims for physicians. The number of nurse

Canada’s health care system “can be described as a publicly-funded, privately-provided, universal, comprehensive, affordable, single-payer, provincially administered national health care system” (Bernard, 1992, p.103). Health care in Canada is provincial responsibility, with the Canada Health act being a federal legislation (Bernard, 1992, p. 102). Federal budget cuts, has caused various problems within Medicare such as increased waiting times and lack of new technology. Another problem with Medicare is that The Canada Heath Act does not cover expenditures for prescriptions drugs. All these issue has caused individuals to suggest making Medicare privatized. Although, Canada’s health care system consists of shortcomings, our universal