Psychiatric Bulletin (2002) 26: 440. doi: 10.1192/pb.26.11.440
© 2002 The Royal College of Psychiatrists
Psychiatric Bulletin (2002) 26: 440
© 2002 The Royal College of Psychiatrists
Maudsley Discussion Paper 11. Should Mental Health Nurses Prescribe?
By K. Gournay and R. Gray
F. Winstanley, Senior Lecturer in Community Nursing and Nurse Prescribing and
R. Dibblee, Community Mental Health Nurse
Suffolk College, School of Health and Applied Sciences, The Ipswich
Hospital NHS Trust, Heath Road, Ipswich IP4 5PD
London: Institute of Psychiatry. 21 pp. 2001. £4.00 (pb). ISBN:
0-9500289-4
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.
