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

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.