RACGP questions push for nurse prescribing

Doug Hendrie

27/09/2018 11:51:35 AM

A proposal that will allow registered nurses to prescribe medication alongside nurse practitioners has been queried by the RACGP.

The RACGP recognises the valuable role nurses play as part of a GP-led team, but remains concerned that nurse prescribing could increase fragmentation of care and lead to worse health outcomes.
The RACGP recognises the valuable role nurses play as part of a GP-led team, but remains concerned that nurse prescribing could increase fragmentation of care and lead to worse health outcomes.

The Nursing and Midwifery Board of Australia (NMBA) has proposed a new prescribing endorsement for registered nurses, allowing them to prescribe with a ‘partner prescriber,’ who could be a GP – or another authorised prescriber, including a nurse practitioner.
In its submission to the NMBA, the RACGP recognised the valuable role nurses play as part of a GP-led team. But the college raised significant concerns about the consequences of the proposal, stating that it could result in registered nurses prescribing independently from the GP-led team.
The RACGP was particularly concerned that the proposal could increase fragmentation of care and, in turn, lead to worse health outcomes for patients.
‘Introducing multiple prescribers is not the solution to addressing challenges in Australia’s health system,’ the submission states.
‘GPs must remain patients’ first point of contact within the healthcare system and retain ultimate oversight of patient care.’
The stated rationale of the NMBA proposal was to increase access to medicines for patients in underserved communities.
However, the RACGP maintains there are already programs in place to increase access to medicines in areas of need, and believes the NMBA proposal, which is intended to be applied universally, will have more adverse consequences than benefits.
‘International and Australian experience has repeatedly demonstrated that GP-led multidisciplinary healthcare teams achieve the best health outcomes for patients,’ the RACGP stated in its submission.
The NMBA proposal envisages two years’ post-registration experience and two units of additional study before being able to prescribe alongside a partner.
But the RACGP believes this is insufficient.
‘Prescribing medicines is not always as straightforward as it may initially appear, and is a responsibility that should not be taken lightly,’ the RACGP submission states.
‘Many patients suffer from multiple chronic conditions with a complex interplay of medications and medical conditions.
‘Managing these requires the expertise that doctors gain from study across a number of disciplines over at least nine years’ graduate and postgraduate training, the majority of which focuses on distinguishing diagnoses.
‘Nurse prescribing of medicines may result in unusual, and sometimes serious, conditions not being recognised and managed appropriately due to a lack of adequate training and expertise.
‘Nurses do not have the right diagnostic skills to identify all possible health issues arising from a consultation.’
The NMBA move comes soon after the Pharmacy Guild of Australia called for pharmacists to be able to independently prescribe certain medications during a Queensland Government review of the pharmacy sector.
The RACGP also strongly opposed this move, believing a push to expand the scope of pharmacy puts patients at risk of poorly coordinated care and wastes valuable health resources.

nurse nurse prescribing practitioner prescribing

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Dr Arshad Merchant   2/10/2018 6:25:24 AM

I support RACGP stand. We spend over five years in basic training and then another 3-5 years in GP training before qualifying to be a specialist in our field. As a GP I receive faxes and phone calls on daily basis if a resident n RACF even sneezes as part of nursing protocol. Imagine antibiotics and other medication on the roll. I have concern over nurse practitioners prescribing too as using symptomatic sorter and MIMS does not qualify anyone to be a prescriber.

Eus   2/10/2018 3:15:19 PM

Why should Nursing and pharmacy peak not advocate for their members to make extra money unlike RACGP which continue to punish the IMGs with very wicked policies
Constantly failing the IMGs for
Over 10 yrs of practice in Australia. Big Shame on you!!!

Anonymous   26/10/2018 8:07:20 AM

Just to play devils advocate: I am a Registered Nurse and while my experience is limited, I still find myself regularly paging Doctors requesting very common medications. These medications appear on my computer screen without any medical review; often after quite some time. I do not request drugs without considering co-morbidities, whether the patient is contraindicated and how the drug will effect my patient overall; RN prescribing simply speeds up this process.

Additionally; A frustration often encountered by RNs is chasing young Doctors who incorrectly prescribe. The interns prescribe in partnership with senior medical staff and this proposed structure is very much the same.

RN prescribing will not take the place of Medical prescribing - we know what we know and we know what we don't. The complex Medical treatment would definitely be left to the Doctors; but how can you argue that a patient with no allergies or contraindications should sit in a bed vomiting pending an order for an anti-emetic based solely on the assessment of the RN anyway?

Throughout my studies it was explained that Doctors manage the disease, whereas Nurses manage how the patient responds to the disease and medical treatment. This will only enable us to do our jobs more effectively.

Anon   29/10/2018 12:17:04 PM

After reading this article the main reasons I Identify from the RACGP being against RN’s prescribing is that RN’s do not have the appropriate clinical knowledge to recognise all potential outcomes of prescribing and that. Doctors haven’t gotten the message that patient care and the facilities that care is provided in do not solely depend on your 1 minute morning ward round.

Interesting enough multiple sociologists have touched based with similar subjects & I believe a term called medical dominance has been associated as the outcome of these reviews.

In modern healthcare autonomy and authority need to be shared as a multidisciplinary team I.e. Allied health, nursing / medical.

But back to the main point i believe the RACGP should reconsider this purposal. As a nurse with five years experience in various clinical departments the main issue I find prior to administration of medicine is that the prescribe order is invald due to multifactoral errors. If the RN had the authority to correct these issues or represceibe the drug correctly it would ensure that my work flow as a nurse is not disrupted and your work flow as a doctor isn’t disrupted.

Let’s face it RACGP if the doctors can’t do it right why not give the nurses a chance to not do it right either!

Nothing against the doctors you guys and girls study hard and work long hours but healthcare is progressing the role of an RN is also progressing and maybe it’s time for change.

Patient Advocate   24/05/2019 9:09:56 AM

It's not fragmented care it's multifaceted. There is no evidence to suggest patient outcomes would worsen with nurse prescribing, infact there is substantial evidence to the contrary; both internationally and in Australia.

Prescribing aside; studies show that debunking medical dominance in healthcare leads to fewer treatment errors, greater patient satisfaction and a more holistic, person centred delivery of care.

The RACGP response to this proposal invalidates not only Nurses as members of the multidisciplinary team, but all other professionals through the conveyed notion that Medical staff govern patient care across the board.

Annabella   29/05/2019 10:19:25 PM

I'm afraid in this case, that I DO agree with RACGP, as far as RN prescribing goes. Would you want YOUR elderly relative being prescribed treatment by an RN, Pharmacist, or a GP? I know what I would prefer - oh and BTW I am a veteran Nurse Practitioner, working in General Practice!! Our roles are all individual, but also collaborative.

Nurse Clinician   13/08/2022 7:34:53 AM

Clinical Nurse Consultants running clinics have solved so many medication issues and action plans for patients via GP already for years! they have also done university years and years of studying conditions (on top of nursing) and ending up specializing in one to full depths, spend more time with clients educating more than lots of GPs to explain everything that some GPs have no time to do and feed-back says so over the years.
Worse now when GP are charging, refusing Medicare! people are doing it tough and resort to go to EMERGENCY DEPARTMENTS.
Give nurses some deserved credits for the role they play and not even go to dispute their knowledge of conditions, drug interactions, polypharmacy and optimization of treatment. Nurses do lots of reconciliation and point out a lots of issues because they have the knowledge, experience and 24/7 with the patients observing and acting and some nurses are actually running departments without a doctor for ages.