This section features a constantly updated list of recently published articles relevant to nurse prescribing.

Abstracts of the papers are included and incorporate an expert's opinion about the article. Users are encouraged to submit their views about published papers through the feedback section.

Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribing Formulary and Drug tariff if they are in any doubt.

Mental and neurological health
Click on the article title below to read the summaries.

• What do mental health nurses think about nurse prescribing?
• Learning from the US experience
• Prescribing and Parkinson's disease
• Mental health nurses and prescribing practice
• Views of community mental health nurses

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• What do mental health nurses think about nurse prescribing?

Nurse prescribing in mental health would have benefits for clients provided that the issues of further training, supervision and medical co-operation are addressed, according to this survey of mental health nurses.

Questionnaires were distributed to 110 mental health nurses attending a conference on nurse prescribing and 73 were returned (66%). This is not, therefore, necessarily a typical group as all the nurses had an interest in nurse prescribing. Nearly 80% of respondents thought that mental health nurses should be able to prescribe medication, with the vast majority feeling that they would need additional training to do so. All the respondents were involved in patient education, most were involved in monitoring and reviewing medication and 89% advised doctors on what medication should be prescribed.

The perceived benefits that would result from nurse prescribing included easier access to medication, especially in primary care. Compliance would be improved and faster recovery promoted because nurses’ knowledge of their patients and regular contact with them would allow them to adjust medication to minimize side-effects and maximize response. They are seen as being able to respond rapidly to patients’ needs.

The responses agree with previous work identifying inadequacies in mental health nurses’ grounding in psychopharmacology and the biological basis of mental illness. As well as further training, respondents also wanted rigorous supervision and identified the attitudes of GPs and consultants as crucial. [back]

• Learning from the US experience

Nolan P et al. Mental health nurse prescribing: the US experience; Mental health nurse prescribing: Part 2. Mental Health Practice 2001; 4(8): 4-6; 4(9): 20-23

Summary: In these two papers, the authors examine the US experience of nurse prescribing, in an attempt to ensure that mistakes made elsewhere are not repeated in the UK and that instances of best practice from the USA are incorporated here.

In the first paper, the authors examine the benefits that have been identified and also look at the disadvantages and tensions surrounding nurse prescribing in mental health.

Practice in nurse prescribing varies considerably between states in the USA. Its introduction for mental health practitioners was due to a variety of factors but particularly the perceived increase in psychopathology accompanied by a reduction in numbers of mental health care providers. This, some would argue, is a situation those working in the UK are familiar with. Two types of nurse prescribing are in operation: substitutive (without physician supervision) and complementary (supervision by collaborating physician, less autonomy), the latter being more commonly granted to nurses in advanced practice roles.

Research at the level of individual states has identified an impressive list of benefits of nurse prescribing in mental health including increased quality of care and patient satisfaction, provision of more holistic care, better patient education and reduced side effects from drugs.

The authors report that the US nurses attribute non-compliance with medication to the poor relationships formed during patients' initial encounter with health professionals. They see nurses as being ideally placed to work with families and patients to address this problem.

The authors then discuss the tensions that have arisen between and within the medical and nursing professions. It would appear that the worries of some physicians are shared by many of the advanced psychiatric nurses eligible for prescriptive authority, two-thirds of whom choose not to apply for it. They feel that their psychopharmacology training is inadequate, that the remuneration does not reflect the responsibility, and that complex nursing skills may be eroded in favour of a "quick fix". Nurse prescribing is seen as a cost-saving exercise by many doctors and nurses.

The authors believe that if UK mental health nurses were to take prescribing responsibility, they would be in an excellent position to ensure their patients receive the best possible care. Rather than restricting or medicalising nursing, nurse prescribing should enhance it: the application of the nursing paradigm to mental health could help eradicate some of the problems experienced in the past in the treatment of people with mental health problems.
In the second article, the authors look at how nurse prescribing in mental health could be introduced in the UK in the light of the US experience. They point out that the nursing syllabus has gradually moved nurses away from the traditional biomedical approach towards psychological ones. It is not clear today what role nurses play in managing medication and it may be that some nurses will wish to dissociate themselves from this aspect while others will prefer to extend their knowledge of and responsibility for medication.

Key lessons from the US experience are that: the relationship between doctors and nurses should not be jeopardised; the main reason for nurses to extend their skills is to ensure the best services; and that nurses' desire for autonomy should not be seen as a drive to appropriate medical skills for professional gain. The authors discuss the qualities necessary for mental health nurse prescribers in the UK and stress that they should be able to locate prescribing within a nursing/caring paradigm. Prescribing should be seen as part of a package of care. Nurses should reflect on their prescribing experiences and identify and share best practice with colleagues.

Possible content for introductory and advanced courses is discussed, and the course at one US school of nursing is described. The US nurses stressed the need for further education and training, with support and supervision crucial in all educational programmes and practice. back

• Prescribing and Parkinson’s disease

Handley J. Nurse prescribing and Parkinson’s disease nurse specialists – the debate. Primary Health Care 2001; 11(2): 20-23.

Summary: This is an account of a national meeting held last year to discuss nurse prescribing by Parkinson’s disease nurse specialists (PDNS). Most of these nurses would welcome the opportunity to prescribe for their patients but were concerned that the impetus for this should not arise from the lack of doctors and particularly neurologists. There is also a shortage of PDNS and concerns centred around what would happen to the specialist nurses’ role if they take on more medical responsibilities. Polypharmacy is common in PD, rigorous monitoring is needed because of the severe long-term side effects of some of the drugs, and some patients have complex pathology. Although an extension of the formulary could allow better patient care, many felt that some of these areas should remain medical ones. Patient safety is paramount and prescribing decisions should be driven by local and service need. Once again, concerns were expressed about training. back

McHale J. Directions. Nurse prescribing. Mental Health Care 2001; 4(5):170-173.

Summary: The development of nurse prescribing and the recent consultation paper are reviewed in this article, published before the May announcement (see News), which then looks at the options for mental health nurses. Some see the increased responsibility for nurses as a way of compensating for the lack of GPs or reducing costs. Another concern for mental health nurses is the extent to which an expanded role takes them too far from the ‘Nightingale’ model of nursing practice. Diagnosis can be particularly problematic in mental health and nurses and other prescribers risk legal action against them as individuals if things go wrong. Although it is important to recognize this, nurses are at present making more decisions and administering drugs under protocols (whose legal basis could be challenged in court if something went wrong). New prescribers will have to undergo training and demonstrate professional competence and this may ameliorate the risk of litigation. The author concludes that nursing groups should reflect carefully on whether they want an expanded role, how it relates to their professional practice and must realize the implications for professional responsibility boundaries. back

• Views of community mental health nurses

Hemingway S, Flowers K and Ramcharan P. Nurse prescribing – an interim report: what do you think? Mental Health Nursing 2001; 21(1):6-10.

Summary: Although many community mental health nurses favour the adoption of nurse prescribing, they also have important concerns, according to this initial analysis of the first 219 questionnaires of about 2250 distributed in one edition of the journal. Although 75% expressed agreement with the development of nurse prescribing in mental health, 91% felt that they were de facto prescribing psychotropic drugs already. This raises the question of whether they were really welcoming a clear legal framework for what they were already doing: if so, do they actually want increased prescribing powers? Reservations centred around what were seen as political motivations for the policy, the challenge it raises for relationships with clients, perceived increase in responsibility and added complications. Many nurses were not confident about their knowledge of the drugs and were concerned about the legal implications of prescribing. Further research is clearly necessary and given that so many of the respondents felt they were already prescribing, an analysis of the way this operates might be a useful starting point. back