Transforming and Supporting Patient Care - Health Professions ...

291Chapter 12 – Profession of Nursingpatients’ compliance with nurse prescriptions are high, and nurses takedetailed medical histories before making a decision about an interventionand may be more likely to prescribe a non-pharmacological intervention. 47During the scope of practice review, HPRAC heard from stakeholders thatNPs prescribing in specialist roles is useful in hospitals, provided there is acomplete record of prescribing activity documented through centralizedhospital records. A number of professionals came forward and noted NPs’expertise and contribution to care and supported their right to prescribe.What Other Leading Jurisdictions DoIn Alberta, NPs have been authorized to prescribe Schedule I drugs since1994. In British Columbia, the CRNBC sets strict standards outlining whatcan be prescribed and under what circumstances. These standards are setin consultation with physicians and pharmacists.In Great Britain, nurse prescribing, introduced in May 2006, is well receivedand understood by the public and other health practitioners. HPRAC heardin consultations with authorities from Great Britain that nurse prescribing isboth time- and cost-effective and results in higher patient compliance.Among the challenges and barriers identified in the implementation ofnurse prescribing in Great Britain were the limitations of the formulary,which impacts the effectiveness of patient care; the bureaucracy associatedwith writing Clinical Management Plans; the degree of closeness of theworking relationship with the physician; a perception by some physiciansthat their role is being eroded; physicians’ concerns about patient safety;the lack of institutional strategy for implementing nurse prescribing; accessto computerized prescribing; and a number of education and practiceissues that warrant ongoing attention. 48,49,50Managing the Risk of HarmPhysicians told HPRAC in key informant interviews they are concernedabout the implications of bypassing the traditional gate-keeping role of MDsand pharmacists if open prescribing by NPs were to become a reality. Theyraised concerns about the CNO oversight and about the drugs the CNO hasrecommended for inclusion in the designated drug lists for nurses.47HPRAC. Prescribing and Administration of Drugs by Non-Physician Health Professionals: LiteratureReview. 19.48Evaluation of non-medical prescribing within the Essex Health Economy. 2005-2006.49Latter, S., Maben, J., Myall, M., Courtnay, M., Young, A, Dunn, N. (2005) An Evaluation of ExtendedFormulary Independent Nurse Prescribing. Executive Summary of Final Report. Policy ResearchProgram at the Department of Health and University of Southampton.50Latter, S., Maben, J., Myall, M., Young, A. Evaluating Nurse Prescribers’ Education and ContinuingProfessional Development for IndependentPrescribing Practice: Findings from a National Survey in England (2007) Nurse Education Today. 27:685-696.HPRAC Critical Links January 2009