The Pharmaceutical Journal
Vol 268 No 7201 p802-803
8 June 2002

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  Nurse prescribing
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Letters to the Editor

Nurse prescribing

Nurses are skilled clinicians

From Mr G. Bell

I refer to the comments attributed to Robert Gillespie (PJ, 4 May, p607), "we are not convinced that the switch from POM to P is appropriate. The majority of drugs listed require medical initiation or guidance", and "reclassification of these drugs from POM to P would presumably also allow them to be prescribed by nurse prescribers which may be inappropriate".

Mr Gillespie seeks to question whether the switch from POM to P for some medicines is appropriate, but fails to debate why purely on pharmacological grounds. Rather he uses pleas to "conventional wisdom'", ie, "we are not convinced" — who is the collective we he refers to? He then suggests that "medical initiation and guidance" is required when these drugs are made available to the patient. Is he by inference saying pharmacists are best qualified to offer this and nurses are not? With breathtaking arrogance he suggests that after all they (the reclassified drugs) might well become prescribable by nurses if their status is changed to P.

Forgive me for questioning this but since when have pharmacists been engaged in clinical practice sufficient that they can conduct history taking, clinical examination and arrive from differential diagnosis at a tentative diagnosis which acts as a basis for prescribing? To my knowledge pharmacists are undoubtedly experts in pharmacology and are rightly respected by other members of the primary health care team, including nurse prescribers, for the contributions they make in supporting the management of complex drug regimens. In the same breath it would be nonsense to claim that nurse prescribers are experts in pharmacology. But as senior practitioners, many at masters level and above, they are skilled clinicians and well qualified to initiate certain treatment regimens as independent and, in future, supplementary prescribers, and offer guidance to patients based upon a comprehensive history and full clinical examination.

I am course leader to the extended nurse prescribers course at the University of Northumbria, and it has been apparent from students of the course that in some areas, especially in the secondary care sector, "local pharmacists" seem to see their role as that of "gatekeepers" to all things pharmacological by attempting to restrict what and to whom nurses can prescribe. I believe Mr Gillespie's covert message is that he also wishes to be the gatekeeper to all drugs. This is indicative of the old medical paternalism that sees patient as object and not subject.

Maybe he needs to move with the times. After all the necessary legislation is in place to give nurses the power to prescribe, it should not be at the whim of another health professional whether or not they can exercise that power.

George Bell
Course Leader,
Extended Nurse Prescribing Course, University of Northumbria

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