Prescriptive Authority for Nurses: The Canadian Perspective

Abstract

Role clarity, strength in nursing focus, and support from administrators and legislation are required for prescriptive authority to be fully enacted.

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature

“…In the Netherlands, the aim of task reallocation in the health care sector and more particularly the undesirable situation in which nurses prescribe medicines on an illegal basis, have been the main driving force behind the introduction of nurse prescribing [117,118]. The objective of creating quicker and more efficient patient access to medicines has also been highly influential in the introduction process of nurse prescribing internationally, especially within the UK and Ireland [21,25,26,29,31,32,34-37,39,42,46,47,51,52,55,58,61,62,64,67,69,76,82-84,87,89,90,94,100,102,104,106,112,114][116,120,128,132,135-137,140]. Another important force in this process has been the aim to make better use of nurses' skills and knowledge, and to improve the use of both health professionals' and patients' time [5,6,23,26,30,34,37,39,41,42,44,46,47,51,52,55,56,60,64,66-69,73-76,79,84,86,87,89,90,92,93,100,102,103,106,109][115-118,124,125,130,…”

“…Whereas these seem to have been the main drivers behind the introduction of nurse prescribing in the UK and Ireland, forces originating from within the health professions appear to have prevailed in other countries. In Australia, Canada, New Zealand, Sweden and the USA nurses were granted prescribing rights in order to reduce the workload of doctors and physicians, address the shortage of physicians - partly resulting from the growing specialisation of health professionals - and meet the medication needs of patients in remote areas who were often suffering as a result of a shortage of physicians [5,6,22,28,30,33,34,41,51,59,61,85,85,86,107,120-122,124,125,127,128,131,135,138]. Moreover, prescriptive authority for nurses in Canada, New Zealand and the USA followed the development of advanced practice nurse (APN) roles [5,61,74,124], which clearly connects their prescribing privileges with internal developments within the nursing profession.…”

An Analysis of Canadian Psychiatric Mental Health Nursing through the Junctures of History, Gender, Nursing Education, and Quality of Work Life in Ontario, Manitoba, Alberta, and Saskatchewan

“…In Canada, there are no educational programs or legislated provisions for NPs who wish to specialize as a psychiatric NP or who already have extensive experience providing mental health care [37]. The existing situation for NPs practicing within mental health care settings is hampered by the absence of recognition for the psychiatric mental health nurse practitioner (PMHNP) in Canada.…”

“…Prescriptive authority can only be obtained in Ontario through registration in the extended class in the designated specialties, NP paediatrics, NP-Primary Health Care and NP-Adult. The educational programs that prepare NPs for these specialties focus on the medical and physiological aspects of the specialties with limited content on mental health [37]. In 2011, open prescribing became possible for Ontario NPs.…”

“…Communities with insufficient mental health care resources may be better served by nurses with an expanded scope of practice with specialized mental health education. In addition, although there have been changes to legislation, specifically regulation 965 of the Public Hospitals Act, that gives admitting and discharging privileges to NPs; changes to the mental health act have not been made and regulated forms enabling admission to a hospital for psychiatric assessment cannot be completed by Canadian NPs [37]. When the NP is the person's main care provider, it would seem prudent that the NP should be involved in decisions concerning psychiatric admission and discharge.…”