This paper explores the context of mental health nurse prescribing and covers such considerations as rationale, supervision, training and evaluation. Although well researched and systematically argued, its perspective is medically orientated and this narrows the scope of the discussion.
The rationale is rightly argued from the basis of patient need; but it is from a public health and resource viewpoint, rather than the more compelling one of continuity of care. As in other areas of chronic disease management, the continuing contact of the nurse with the patient informs the process of prescription review and adjustment. Nurse involvement could alter the focus from treating patients pharmaceutically, to putting medication in the context of a care plan, which balances symptom control against side-effects.
A somewhat sweeping assumption is made against nurse prescribing through citing the ‘anti-medical’ model adopted by some mental health nurses, thereby assuming they would be reluctant to prescribe. As for the medical profession, nursing has a code of practice that is subject to professional and legal accountability. Therefore, it is slightly presumptuous to consider that nurses would fail in their duty of care in prescribing to any greater degree than psychiatrists. The same principles apply to the rather convoluted discussions around which nurses should prescribe which drugs.
The paper only considers the role of community mental health nurses, ignoring the fact that this group comprises only 12% of qualified mental health nurses. The more urgent need for nurses to be able to initiate, titrate and alter medication often lies in the hospital or group home environment. It would be useful to consider these issues in relation to independent and/or supplementary prescribing, and the need for good collaborative working and robust shared-care arrangements.
The discussion around evaluation of the effectiveness of nurse prescribing suggests using randomised controlled trials. Although this method is often considered the gold standard of research, it may not evaluate adequately the finer points of prescribing practice or user satisfaction. Given the evidence base quoted in the paper on current prescribing efficacy by psychiatrists, it might be timely to consider robust evaluation of all prescribing for mental health patients, using both quantitative and qualitative methods.
In conclusion, much of this paper has been superseded by recent events and this is its main weakness. The Government is moving fast on nurse prescribing. If this paper is to have any real impact on the current debate, it needs to link more directly with the mainstream to avoid being dragged along on the coat-tails of directives from the Department of Health.
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