Nurses prescribing, a review

In the Netherlands, specific groups of specialized nurses will soon get the authority to prescribe medicines. In several other countries, nurses already have prescriptive authority. NIVEL researchers conducted an international literature study and compared nurse prescribing across Western European and Anglo-Saxon countries. Their study was published in BMC Health Services Research.

The Dutch Senate (in Dutch: Eerste Kamer der Staten-Generaal) will shortly discuss a bill that makes it possible for specialized nurses and nurse specialists to prescribe medicines. In several other Western countries – Australia, Canada, Finland, Ireland, New Zealand, Sweden, the United Kingdom and the United States of America – nurses are already allowed to prescribe medicines. The Netherlands and Spain are currently introducing legislation to make it possible for nurses to prescribe medicines. The scope of nurses’ prescriptive authority and educational requirements differ substantially between countries. In most countries, nurses’ scope of prescribing practice is rather limited and legal responsibility lies mainly with the doctors. The exception is formed by the United Kingdom, where every nurse is allowed to prescribe a wide range of medicines after completing a three month prescribing course.

The United Kingdom and Sweden
“The conditions under which nurses prescribe differ considerably between countries”, says NIVEL programme coordinator prof. dr. Anneke Francke. “In the United Kingdom, independent nurse prescribers, educated at Bachelor level, are allowed to prescribe from the entire British National Formulary for any medical condition within their competence. Whereas in Sweden, only district nurses and nurses working in elderly care are allowed to prescribe, and then only a limited number of medicines for sixty medical conditions. The wide prescribing authority for English nurses is possibly linked with the great emphasis on cost efficiency, while in many other countries the shortage of doctors in remote areas formed the main reason for introducing nurse prescribing, which led to limited prescribing rights.”

The Netherlands will not be faced with an ‘English situation’. Specialized nurses – initially diabetes-, lung- and oncology nurses – will presumably get a limited prescriptive authority. Nurse specialists will be granted wider prescriptive authority, that will be evaluated after five years. This difference in scope of prescriptive authority is related to their different educational background. Specialized nurses have often completed higher professional education in nursing (in Dutch: HBO-Verpleegkunde), followed by a specialization. To be able to prescribe medicines, they are required to complete an additional three-day module pharmacotherapy. Nurse specialists, after having followed higher professional education in nursing, completed the Master of Advanced Nursing Practice and since some years pharmacotherapy forms an integral part of this curriculum.