May 2002

From Lancet

Drug prescribing by nurses in the UK - Editor of the Lancet urges caution

N. B. Please note that if you are outside North America the embargo date for all Lancet press material is 0001hours UK time Friday 31 May 2002

The contentious issue of drug prescribing by nurses is assessed by Richard Horton, Editor of THE LANCET, in a Commentary in this week's issue of the journal. He concludes that UK government plans to introduce unrestricted prescribing rights to nurses over the next few years could have serious consequences in the provision of health care.

Richard Horton comments: "Nurse prescribing offers enormous benefits to patients. But the evidence indicates that the rate at which nurse prescribing is being implemented holds grave dangers if the policy set out by Milburn [Minister for Health], Jones [Royal College of Nursing], and others is acted upon - and the first supplementary nurse prescribers are supposed to be qualified by the end of this year - the UK will be embarking on a dangerous uncontrolled experiment."

The Commentary is critical of the motives which underlie current UK government thinking on drug prescribing. Horton adds: "Nurses are being manipulated, under the guise of providing quicker and more efficient access to health care to fill the gaps left by too few doctors. Prescribing is not a major advance in professional status for nurses. It is merely redrawing the boundaries of a profession to serve an acute political problem, with little regard for the impact it will have either on nursing or patient care. Moreover, when doctors prescribe, they make mistakes. Only very recently have we begun to understand why [see Lancet 2002; 359: 1373-78]. Surely we must learn more about why errors take place before further widening prescribing responsibilities. To extend the burden of risk so quickly is reckless."

The additional training of nurses required for drug prescribing is highlighted as a crucial issue, yet there exist major inconsistencies within current nursing curricula, Horton observes: "If prescribing rights are extended to all drugs, nurses will need to know basic and clinical pharmacology - including the mechanism of action of drugs, pharmacokinetics, pharmacodynamics, and how to appraise evidence from clinical trials. In other words, we will be training nurses to be more like doctors. Is that really the future of nursing. This issue is not a question of retraining interprofessional barriers. It is about respecting distinctive professional expertise at a time when there is a serious nursing shortage."

Richard Horton concludes: "Taken together, this evidence, and the uncertainties and arguments that flow from it, send a clear message to government: slow down the process of widening prescribing rights. Nurse prescribing has too much to offer patient care to let it founder through hasty and politically expedient implementation."

Contact: Dr Richard Horton, c/o Richard Lane, The Lancet Press Office, 32 Jamestown Road, London NW1 7BY, UK; T) +44 (0)20 7424 4949; F) +44 (0)20 7424 4912; E)

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