Nurses prescribe in the same way as doctors

A prescription from a nurse is safe. Nurses prescribe the right medication and dosages, and they do this in the same way as doctors. However, research conducted at The Netherlands Institute for Health Services Research (NIVEL) has shown that the conditions under which nurses prescribe medication differ considerably between countries, and that in the Netherlands, nurses’ prescribing rights have not yet been fully implemented. On September 22, Marieke Kroezen received her PhD from the VU Medical Centre based on this research.

 
In the United Kingdom, certain groups of nurses have the same prescribing rights as doctors, while in other countries nurses are only allowed to prescribe medication under strict conditions and under a doctor’s supervision. In the Netherlands, categories of specialised nurses have limited prescribing rights, and since January 2012, nurse specialists (who have a Master’s degree in advanced nursing practice) can prescribe all medicines that fall within their area of expertise and competence. Even so, in actual practice there are considerable differences in the extent to which and way in which nurse specialists prescribe. In some hospitals they prescribe according to clearly defined protocols or only in consultation with a medical specialist, while in other hospitals they can exercise their prescribing rights to a much larger extent.
 
In the workplace
“In general, the legal prescribing rights of nurse specialists are more extensive than their authority to exercise these rights in the workplace,” says Marieke Kroezen. “Because nurse prescribing in the Netherlands is still evolving, there will be changes to prescribing rights in the workplace over the coming years. A process like this still has to fully take shape.” Her research has shown that many of the partnerships between doctors and nurse specialists are informal. “This will no longer be possible when the number of nurse specialists who can prescribe medication continues to grow. Then these kinds of partnerships will have to be formalised.”
 
Research
“When nurses start prescribing medicines, they are given authority that was previously reserved for doctors. This kind of shift also means that doctors have to give up some ground,” Kroezen continues. She used interviews and questionnaires to study developments before and after the introduction of nurse prescribing among doctors, nurse specialists, registered nurses, and other relevant parties. She also conducted systematic literature reviews. “Doctors in the Netherlands are generally less sceptical of prescribing rights for nurses than those in other countries. Even so, doctors here try to maintain a large degree of control over the prescribing of medicine. We also found that not every nurse believes that prescribing should be included in a nurse’s job description.”
 
The future
In the coming years, prescribing by specialised nurses and nurse specialists will continue to evolve. Kroezen’s doctoral research shows that although prescribing rights can be a valuable addition to the health care system, a number of obstacles need to be addressed and expectations may have to be modified. The new professional profile for nurses in the Netherlands states that prescribing is one of the competencies that every registered nurse should have by 2020, whereas Kroezen has shown that not every nurse actually wants this. In addition, the process of introducing and fully integrating prescribing rights in the workplace takes time. Policymakers’ expectations of this – for example, in terms of cost-effectiveness – will probably have to be adjusted to reflect this. 

Funding
Ministry of Education, Culture and Science
 
Cooperating partners
KNMG
V&VN