Independent Prescribing

In 1986 the Cumberlege Report (DHSS 1986) recommended that there should be a limited list of items that could be prescribed by nurses. These recom mendations were reviewed by the Department of Health in the first Crown Report (DH, 1989). In 1998 nurse prescribing was introduced in England for district nurses and health visitors as a result of changes in legislation between 1992 and 1994. This enabled them to prescribe from a limited formulary of dressings and appliances and some medicines. Following the Review of the Prescribing, Supply and Administration of Medicines (the second Crown Report, DH 1999) the Department of Health introduced a more comprehensive formulary for independent nurse prescribing that broadened the scope for independent and supplementary prescribing and also allowed all first-level registered nurses to undertake training to become prescribers. This formulary is known as The Nurse Prescribers' Extended Formulary (NPEF; www.bnf.org) and lists the specific medical conditions that nurses can prescribe for, and the medicines that they can prescribe.

Recent research, carried out by the University of Southampton (DH, 2005a), found that independent nurse prescribing was viewed positively by patients, doctors and nurses themselves, with patients citing accessibility as a major advantage when obtaining their medicine from a nurse rather than a doctor. The research evaluated the first two years of extended formulary nurse prescribing and used a national survey, observation of prescribing nurses and the views of stakeholders in its assessment. Nurse prescribing is a registerable training, and nurses may not prescribe without being registered with the Nursing and Midwifery Council (NMC).

John Reid, as health secretary in 2003, stated that 'by opening the prescription pad to nurses we have given them a powerful and symbolic tool. One that makes choice a reality for patients' (Lanyon, 2004).

Adams (2004) considers the ability to prescribe medications as creating an inequality between the prescriber and the patient. He considers this a power inequality, and goes on to analyse the ethical dimensions of how this power is used by the prescriber. Prescribing treatment is a step further for nursing, as it allows nurses greater independence, enabling them to practise their craft with greater autonomy and freedom; but as with all freedom, this comes with a responsibility to use that freedom and autonomy in a way that benefits patients and society.

The Department of Health had a vision of 10,000 nurse prescribers by the end of 2004 ... by November 2004, there were 5,000 (Ring 2004).

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