Community mental health nurses and authority to prescribe medications: the way forward?

Abstract

This paper explores a single dimension of the nurse practitioner role - whether community mental health nurse practitioners should have authority to prescribe medications. The paper is taken from a larger study about how these nurses promote wellness with clients experiencing an early episode of psychotic illness. The focus is timely as several Australian States have recently passed nurse practitioner legislation. This qualitative study used interviews and participant observation to collect data. The fieldwork was undertaken in the community, in regional and rural New South Wales, Australia and involved community mental health nurses. The findings show that expanding the nurse practitioner role to include authority to prescribe medications is currently contentious. Respondents envisaged that prescribing authority would include most medications that are used to treat mental illness but exclude drugs that treat medical illness. They identified a need for an appropriate educational course, and called for a system of clinical supervision and ongoing support for nurses assuming this role. Participants also claimed that individual nurses who choose to forgo prescribing authority should not be coerced into undertaking this role. The findings have professional, clinical, legal and educational implications for nurses as they seek authority to prescribe within the context of a nurse practitioner role and these are discussed.

Exploring the Expanded Practice Roles of Community Mental Health Nurses

“…The findings from this study support the findings of McCann and Baker (2002) in suggesting that community mental health nurses currently engage in expanded practice in the absence of the legal authority to do so. More specifically, CMHNs tend to undertake functions traditionally considered the legal domain of the medical profession including the prescription of medication, recommendations regarding community treatment orders, and the ordering of diagnostic tests.…”

“…More specifically, CMHNs tend to undertake functions traditionally considered the legal domain of the medical profession including the prescription of medication, recommendations regarding community treatment orders, and the ordering of diagnostic tests. As with the research of McCann and Baker (2002), the current study illuminated a range of nursing practices that constituted a form of expanded practice. In many instances it was a matter of recommendation, where the nurse might be influential but the ultimate decision was made and legally authorized by a medical practitioner.…”

“…The issue of the unofficial expanded practice role of community mental health nurses in Australia was raised by McCann and Baker (2002), who claimed that currently "nurses use an array of quasi legal and, perhaps, illegal measures in prescribing medications" (p. 175). These measures include the use of standing orders and informal individual arrangements where nurses use stopgap prescribing in remote settings where doctors are not available.…”

“…These measures include the use of standing orders and informal individual arrangements where nurses use stopgap prescribing in remote settings where doctors are not available. McCann and Baker (2002) contend that there has been little discussion about expanded practice in mental health nursing, either in relation to the NP role or otherwise, and even less about the issue of prescriptive authority for NPs in these settings. They also note that there have been very few studies focusing on clients' views about nurse prescriptive authority and no published studies about mental health nurse prescribing in Australia.…”

Expanded Practice Roles for Community Mental Health Nurses: What Do Consumers and Carers Have to Say?

“…As a consequence of the policy changes, community mental health nursing has developed a greater degree of autonomy and independence than has traditionally been associated with institutional and hospital-based care. The relationship between mental health professionals has also altered with a tendency for consumer care to be provided according to individual needs with less emphasis on the traditional roles associated with each professional group (Cleary, 2004;McCann & Baker, 2002;Rosen & Callaly, 2005).…”