Nursing veteran is first to gain power to prescribe

By REBECCA WALSH

New Zealand's first nurse able to prescribe medication is about to start work in South Auckland.

Aucklander Paula Renouf, who has nearly 20 years' nursing experience, was approved as a nurse practitioner in child and adolescent health last year and has just completed the requirements allowing her to legally prescribe.

Instead of referring a patient to a doctor for a prescription, Ms Renouf will now be able to assess, diagnose and prescribe medication within her specialty area - a development described as "a significant milestone" by the Nursing Council and the Auckland University School of Nursing.

Although nurses have been prescribing in the United States since the 1970s, the move has created controversy here, where some doctors are worried about nurses' experience and skill levels.

"People don't understand the level of education these nurses have nor the level of experience, and the fact they prescribe in a defined area and from a schedule of drugs," said associate professor Judy Kilpatrick, head of the School of Nursing at Auckland University.

"They obviously won't be prescribing for children with significant heart problems. That's a very complex area. They won't even go there."

Ms Kilpatrick said nurse prescribers would save patients and health workers time and were a more efficient use of nurses' expertise. They would especially benefit rural areas and school clinics.

Ms Renouf, who worked as a certified paediatric nurse practitioner in a community-based clinic in San Francisco for 10 years and has a Masters of Science in Nursing, said the move was exciting and important for nursing in general.

Nurses often provided education about medication and monitored its side-effects and effectiveness but found it frustrating they were unable to prescribe, she said.

Ms Renouf can now treat babies through to 19-year-olds for most childhood illnesses and problems, from ear infections and eczema to asthma and respiratory tract infections.

She will work out of Ta Pasefika in South Auckland and is likely to work in schools in the area.

She said she had experienced no negative reactions from doctors and would have no hesitation in consulting and referring to a doctor if need be.

But Dr Tricia Briscoe, chairwoman of the Medical Association, said the important issue was not only whether the person had adequate knowledge to prescribe, but also to examine and diagnose.

"As a doctor, I would be most concerned to be facing prescribing without the depth of knowledge my medical training gave me," she said.

It was vital that new health practitioners "of any sort" worked as part of a team to care for a patient.

Ms Kilpatrick hoped to eventually have between 200 and 300 nurses prescribing.

Although the Nursing Council was responsible for approving nurses, it was up to the Cabinet to approve the scope and drugs for use.

At the moment nurse prescribers can be approved only in two areas - child family health and aged care.

Marion Clark, chief executive of the Nursing Council, said the council would be happy to take on that responsibility if the Government wished.

Nurse practitioners:

* New Zealand has six nurse practitioners.
* They are legally able to independently refer patients to specialists, discharge patients, make diagnoses, order and interpret test results.
* Nurse practitioners must have a Bachelor of Nursing, a clinical Master's degree and have at least four years' nursing experience.
* Nurse prescribers must also complete pharmacology and clinical therapeutics courses, as well as 100 hours' prescribing practise.
* Nurse prescribers can be approved in only two areas - child family health and aged care.