Personal Views: The nursing profession's coming of age
Authors: Ghislaine Young
Journal: BMJ (2005)

There has been much coverage in the media recently of the proposed extension of nurses' prescribing rights so that from next spring they will be authorised to prescribe all drugs apart from controlled drugs.

BMA spokespeople have voiced concerns (BMJ 2005;331: 1159) that patients' safety might be compromised if nurses who have done only a relatively short period of training are able to prescribe a wide variety of drugs. This is nonsense: nursing is a three year undergraduate or diploma level course, and nurse prescribers are highly trained and experienced nurses with many years of postgraduate and often specialist education.

I am a nurse practitioner working in a large general practice in West Yorkshire, where I am a salaried partner. Nurse practitioners have evolved as a distinct nursing discipline over the past 20 years in the United Kingdom, and yet few people know we even exist. Our emergence has in effect been a silent revolution in the delivery of health care. Our own regulatory body has finally agreed to regulate the role and to form a separate part of the nursing register for the “advanced nurse practitioner,” so that a uniformly high standard will be defined and only those nurses who have reached that competence may call themselves by that title.


Now we are challenging doctors on their own territory


Nurse practitioners are highly experienced nurses who have taken further education—often to master's level—to be able make diagnoses and treat patients with undifferentiated complaints. The further education that nurse practitioners undertake grounds them in advanced clinical examination skills as well as in the underlying sciences, such as pathophysiology and pharmacology, so that they can work safely and effectively. In response to the BMA's comments on our “limited education,” I added up all my years of training since starting as a nursing student. I have had 12 years of education, including an MSc in health science and my postgraduate diploma in autonomous nursing practice.

My job as a nursing practitioner in general practice and an extended nurse prescriber means that I work alongside the GPs and offer patients an alternative healthcare practitioner to consult. I improve access to medical services and am authorised to order all sorts of investigations, including radiography, and can refer patients for consultant opinion or even admit them as acute patients to hospital if need be. This all sounds like a traditional medical role, but we nurse practitioners are more than this: we inhabit a nursing ethos of which the essence is the therapeutic relationship. This allows us to connect with our patients and to understand their experience of their illness and to respond to their needs. Our critics say we are being mini-doctors, but actually we are maxi-nurses, and this is not mere semantics: the difference is important. There is much research evidence to show that in comparison with doctors we deliver safe and effective health care, but with a difference: patients often prefer consulting nurses because of our communication skills and because our approach centres on the whole patient.

I was not surprised that the BMA responded so negatively to nurses having enhanced responsibilities. A power struggle is going on. Historically nursing was a docile and predominantly female profession, but now we are challenging doctors on their own territory. In an emotive and defensive response last year the Royal College of General Practitioners said that the proposed expansion of nurse prescribing meant that the role of GPs was being eroded by nurses and would result in GPs being made redundant.

It is sad that instead of trying to enhance the care of patients and to develop better working between professional groups some doctors focus on protecting their turf. Fortunately most doctors do not share the limited view of their representative bodies and have generously pledged nurses their support and have full confidence in our ability to work autonomously in these expanded roles. To function most effectively, and for the good of patients, nurses and doctors need each other. The two professions have a symbiotic relationship, and I suspect it will ever be thus.

The distinction between medicine (diagnosis and cure) and nursing (care) has become increasingly blurred. Medicine and nursing are parts of a continuum, and where you are on that continuum—whether you are a doctor or a nurse—changes depending on what the patient needs from you at any one time.

In 2005 we have nurse practitioners as full profit sharing partners in general practice. Some practices are even nurse led—it is the nurses who employ the GPs, and patients are formally registered with the practice, not the doctor. It behoves us all to remember that professionals—nurses and doctors—should serve society. The practice of nursing is whatever the patient and nurse together agree it is. The only aim to consider is that we respond safely, sensitively, and effectively to our patients' needs.