Nurse wants prescribing rights widened

Jackie Robinson

Auckland nurse Jackie Robinson reckons letting her prescribe drugs would enhance the care some of her patients receive.

A nurse specialist in palliative care at Auckland City Hospital, she cares mainly for cancer patients who are dying.

Mrs Robinson, 41, is a consultant who covers the whole hospital, and recommends pain relief and other drugs to the doctor providing a patient's ongoing care. The doctor writes the prescription.

This team approach works well, but delays occasionally occur in finding the doctor, she said yesterday.

Late on a Friday afternoon, for instance, when a patient was going home to die and the doctor was not immediately available, the process would be quicker and easier for the patient if she could write the script herself.

Mrs Robinson has 20 years' experience in nursing, including eight in palliative care.

She has applied to the Nursing Council to become a nurse practitioner, having completed a master's degree in her specialist area.

Next year she intends to complete the one remaining university paper she needs and ask the council for approval to begin prescribing.

The plan's missing piece is an expansion of nurse prescribing rights, introduced in 2001, but so far restricted to child and aged care.

The Nursing Council has proposed opening up independent prescribing to all suitably qualified nurse practitioners. But each nurse would be able to prescribe only in his or her specialist field, such as palliative care or sexual health.

The Ministry of Health is seeking public submissions on the scheme until August 26 and a Government decision is expected next month.

Some nursing leaders say the delay in extending nurse prescribing, which they blame in part on the opposition of doctors' groups, is holding back the development of primary healthcare.

The Medical Association has said, since the law permitting independent nurse prescribing was debated in the 1990s, that it puts the public at greater risk from medicines.

Chairman Dr Ross Boswell said: "It seems bizarre to me that a medical graduate spends six years studying medicine and - having been trained in diagnosis, pharmacology and prescribing - is not then allowed to prescribe independently as an intern in hospital, yet a nurse practitioner can do a master's course and be unleashed directly on the public."

Auckland District Health Board director of nursing Taima Campbell rejected this "scaremongering" and said: "Just because you've done the time doesn't mean you've got the quality." She said the proposal contained a safety monitoring framework.

Expanding nurse prescribing would make treatment more efficient in many areas. For instance, a public health nurse would no longer need to refer a child with an ear infection to a GP - or obtain the doctor's approval by fax and phone - for an antibiotics prescription.

The Government's health workforce advisers also want to see nurses and other health workers who are paid less and train for fewer years than doctors - becoming a GP takes at least 13 years - take on some of the doctors' straightforward work.