Prescribing Patterns of Nurse Practitioners

Abstract

The literature is replete with documentation of nurse practitioner function, including its effectiveness, safety, and client acceptance(l). Little information, though, is available about drug prescribing patterns by nurses, as the responsibility for prescribing drugs is almost exclusively held by the medical and dental professions. The recent report of the Graduate Medical Education National Advisory Committee (GMENAC) recommends that limited prescribing responsibility be granted to other professions, including nurses(2). Several states have enacted legislation permitting nurses to prescribe drugs. Michigan, for one, permits nurses to prescribe drugs with physician supervision (3,4). The clinical nurse specialists of the Primary Care Nursing Service (PCNS) of Detroit Receiving Hospital/University Health Center (DRH/UHC), an urban universityaffiliated ambulatory care facility, is one group of nurses who do prescribe drugs with physician supervision. The PCNS is staffed by six clinical nurse specialists (CNS) who offer primary nursing care to adults and adolescents. The primary care to clients is distinctive, as it is consistent with nursing philosophy and reconciles the philosophy to function(5). The approach to client management is health oriented and prevention centered and emphasizes care of the whole person. Each of these elements is integral to the nursing framework here and comprises the approach to care. Many clients use the PCNS as their entry point into the health care system. An ongoing relationship develops between client and nurse. The nurse assumes responsibility for coordination of additional health and medical care needs of the client through consultation with and referral to other health professionals. Physician consultation is available on site, which provides the legal and operational mechanism for prescribing drugs. The nurses are prepared at the master's degree level in nursing and are certified as nurse practitioners by the American Nurses' Association. All are adjunct assistant professors at the College of Nursing at Wayne State University. Sixty percent of their time is spent in clinical practice, with the remaining time centered on student education, both in the classroom and clinical area. All the nurses have had considerable direct client care experience, ranging from 9 to 17 years. Each nurse has had a basic pharmacology course in her undergraduate nursing curriculum. At the graduate level, each had additional classroom and clinical experience in DO()NNA Mt\NR()E. N(:, CSN. is assistant professor of nursing, University of Southern California, Dept. of Nursing, Los Angeles.