The International Council of Nurses and the World Health Organization have joined forces in a global campaign called Nursing Now.
With the Duchess of Cambridge as Patron, this campaign aims to improve health and healthcare globally by raising the status and profile of nursing, demonstrating how much more nurses can achieve if they’re enabled to maximise their contribution to achieving universal health coverage (Crisp 2018, p.146).
In an article about this campaign in the International Review journal, Lord Nigel Crisp (Campaign Co-Chair), recalls the introduction of nurse prescribing in England, in 2003 and says:
This change…greatly improved access to medicines for patients. ...research now suggests that enabling nurses to prescribe has also increased patient satisfaction. At the time the change was radical and quite controversial, but, 15 years on, it is now quite unexceptional and just normal good practice (Crisp 2018 p.145).
In addition to the United Kingdom, legislated prescribing models for registered nurses have been in place for some years now in several other countries, for example, the United States, Canada, the Netherlands and Sweden.
Meanwhile in Australia, the profession celebrated, when at the start of this millennium, nurse practitioners were given prescribing rights (Fong et al. 2017). Research on prescribing in Australia to date, has shown that nurse practitioners prescribe safely, and at times have de-prescribed in the interests of quality use of medicines for the people for whom they provide care. Fong et al’s. (2017) literature review on nurse practitioners identified barriers to prescribing, attitudes to nurse practitioner prescribing, types of medicines prescribed and prescribing practice behaviours.
With prescribing for nurse practitioners getting a toe in the door for nurses in Australia, discussions began with other health practitioners keen to prescribe. More formalised multidisciplinary discussions led in 2012 to development by the NPSMedicineWise of A Prescribing Competencies Framework (NPS MedicineWise 2012) – which describes competencies required of all health professionals for safe and appropriate prescribing.
Hot on the heels came approval from the Health Ministers, in 2013, for a Health Professional Prescribing Pathway. Commonly called the HPPP, this identified three models for prescribing: autonomous prescribing, prescribing under supervision, and prescribing via a structured prescribing arrangement.
While nurse practitioners undertake autonomous prescribing, the practise of the majority of registered nurses in Australia has been held at the ‘structured prescribing arrangement’ level through nurse-initiated medicines, standing orders and protocols.
The stage is being set though for nurses in this country to move beyond this level of prescribing, so that, like their international colleagues, they’ll be able to provide more comprehensive health care.
Recently, the Nursing and Midwifery Board of Australia (NMBA) and the Australian and New Zealand Council of Chief Nursing and Midwifery Officers initiated exploration of potential prescribing models to establish a model by which registered nurses could be endorsed to prescribe scheduled medicines (NMBA 2018).
A symposium held last year gave the opportunity for frank and fearless discussion on potential prescribing models for nurses and midwives in this country. During the consultation period to follow, the ANMF determined a national position on prescribing, outlined in our statement: Registered Nurse and Midwife Prescribing, available at http://anmf.org.au/pages/anmf-policies. Not surprisingly, the ANMF position declares support for reforms which enable all nurses and midwives to work to their full scope of practice.
Prescribing reforms will inevitably require amendments to drugs and poisons legislation in some states and territories, and the PBS nationally.
Currently, the NMBA is conducting a public consultation on a proposed Registration standard: Endorsement for scheduled medicines for registered nurses prescribing in partnership, with feedback due by 21 September 2018. To complete the NMBA’s survey for this consultation, members are encouraged to go to: https://ahpra.au1.qualtrics.com/jfe/form/SV_bBf3Vxc1LzSVSmh
The ANMF will be reiterating our position that the three models of prescribing should be:
- autonomous prescribing (existing): nurse practitioners and midwives with scheduled medicines endorsement
- prescribing in partnership (proposed): registered nurses complete post-graduate units in prescribing and at least two years full time equivalent post registration clinical experience; prescribe within their scope of practice in partnership with a health practitioner authorised to prescribe independently such as a nurse practitioner or medical practitioner.
- prescribing via a structured prescribing arrangement (existing): registered nurses and midwives prescribe medicines under nurse/midwife-initiated medicines, standing orders and protocols.
The ANMF continues to argue for registered nurses with an existing endorsement for scheduled medicines (rural and isolated practice) to have their endorsement recognised for the life of their registration. These nurses have completed approved programs to enable them to supply medicines under protocol in their rural or isolated area of practice.
This essential prescribing reform will particularly advantage people who are geographically or economically marginalised from mainstream health services.
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers
Crisp, N 2018, ‘Nursing and Health Policy Perspectives’, International Review, pp. 145-147.
Fong, J, Buckley, T, Cashin, A & Pont, L 2017, ‘Nurse practitioner prescribing in Australia: A comprehensive literature review’, Australian Critical Care, Sep 30(5), pp. 252-259.
Nursing and Midwifery Board of Australia 2018, ‘Public consultation paper: Proposed Registration standard: Endorsement for scheduled medicines for registered nurses prescribing in partnership’, NMBA Viewed 3 August 2018, http://www.nursingmidwiferyboard.gov.au.
NPS MedicineWise 2012, ‘Competencies required to prescribe medicines: putting quality use of medicines in to practice’, Viewed 6 August 2018, https://www.nps.org.au/__scrivito/prescribing-competencies-framework-ab0cc7f2a28cc4a1