No Greta, I never really bothered with the uniform, I could never get the frilly hat to stay on.... you see I never had enough hair for the grips to hold. Now if you had mentioned stockings....
----- Original Message -----
From: Greta Thornbory
To: [log in to unmask]
Sent: Wednesday, October 27, 2004 9:56 AM
Subject: Re: prescribing
Hey Bob you forgot the bit about the management and unions wanting the treatment nurse cos her blue dress and frilly white hat instilled confidence in the workforce! Or did you refuse to wear yours?
----- Original Message -----
From: Robert Dunn
To: [log in to unmask]
Sent: Wednesday, October 27, 2004 9:41 AM
Subject: Re: prescribing
I'm probably going to ruffle a few feathers, however, I agree with Greta. For OH Advisers to routinely prescribe would be a retrospective step back to the days where the nurse in industry was there to administer aspirin, tea and sympathy in varying amounts. I have worked (indeed started my OH career) for multi-national organisations where a treatment service was the backbone of OH within the company. Looking back I can firmly say that my assessment of that situation is that during those years true OH provision was sacrificed in the minds of management, unions and workforce to the level of the 'treatment nurse'! OH has (thankfully) moved on, and we are where we are today only because we have lost the image of 'nursey' dishing out all manner of appropriate?? and inappropriate medication. By all means use group protocols for vaccines and anaphylaxis treatment etc, but for goodness sake, leave prescribing to those who do it best, the physicians and pharmacists. Horses for courses..... that's what I say!!
----- Original Message -----
From: Greta Thornbory
To: [log in to unmask]
Sent: Tuesday, October 26, 2004 3:25 PM
Subject: Re: prescribing
I am very interested in your views and rationale for nurse prescribing in occupational health especially as during the 90s OH people at the RCN fought to stop the nurse prescribing module being a compulsory module of the OH degree course - it was supported by the (practicing) OH nurses on the curriculum development group. This was at the time when OH nurses and the first ever Nurse Practitioner courses were running in tandem under the direction of Barbara Stillwell, who pioneered nurse practitioners in the UK. Nurse practitioners are vital to today's primary and community care, however, OH nurses are not nurse practitioners. I definitely agree that we should keep up-to-date in every aspect of practice that we use in OH and should understand treatment regimes, it is an NMC and professional requirement to do so - but it is not necessary to study a specific pharmacology/nurse prescribing course to do this.
I am concerned too that you comment about the need for an OH physician and I wonder if you are suggesting that we should take on their role? To me nursing and medicine are two distinct professions which complement each other. However, I am not saying that nurses should not prescribe but there has to be a distinct need to do so, particularly in OH. It would be awful to think that nurse prescribing was a 'development' of nursing practice. To me it would be a return to the days of yesteryear when OH departments kept a pharmacy stock - e.g. Ford motor Co.OH dept. kept 250 medicines ranging from antibiotics to antidepressants not to mention digoxin!! A well known sweet manufacturer from another planet kept about the same. How do I know this - I actually did my dissertation at the time on the use of medicines in OH.
Jan Maw said it all (OH Feb 04) 'If OHNs are to embrace nurse prescribing alongside their nursing colleagues greater evidence is needed to support the benefit's . At the moment there is no evidence base to support the practice. I believe we should be considering the ways in which we can obtain the evidence before we go down this road.
Greta Thornbory
Consultant, Occupational Health & Education
Consultant Editor, OH Journal
www.gtenterprises-uk.com
Tel: 01235 770156
Mob: 07778 518 027
----- Original Message -----
From: "Jeanette Hogg" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, October 26, 2004 10:48 AM
Subject: prescribing
> Thanks to everyone for your responses about prescribing. I appreciate
> everyone's view on this but would just like to highlight a few issues.
> Prescribing is not just about writing a script - that's the easy bit. If
> its one thing that the course taught me its that we should keep focus on
> our nursing clinical skills and knowledge. During consultation if we advise
> regarding medication, treatment options and or distribute under PGD's or
> standing orders we are effectively prescribing and are accountable for
> those decisions and the advice given to the patient. So we should be
> keeping up to date with drugs and medications that we come across as
> advsiors/nurses. The course greatly enhanced my understanding of how
> medicines affect patient outcomes, improved my consultation skills by an
> increased knowledge into pharmocology and pharmacokinetics. How many
> patient's do we see on pain control, antidepressants etc. Do we really know
> enough about that treatment and it's effects to aid our decisions on how
> and when clients will respond effectively and acheive a return to good
> health? We are community/primary care workers in many ways and I have a far
> better rappor with GP's because I understand to some extent their treatment
> regimes and options for their patients and work with them.
>
> When do we need an occupational physician? Usually when diagnosis,
> medicines, investigations etc are involved in case management.I don't think
> we can categorically say that prescribing is not for us as advisors because
> if we do we are missing out on the development of nursing roles which are
> rapidly moving forward in terms of clinical skills that we rely on
> physicians for. So to dismiss this development will leave us behind in the
> nursing world. There are many experienced and highly clinically skilled
> nurse practitioners out there who work in primary care and could very
> easily move into occupational health. Its not about replacing physicians,
> but I do feel we need to keep up and be more effective - a qualification in
> Occhealth alone may not be enough. Medicines management is part of that
> nursing even in an advisory capacity. Just food for thought.
>
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