Is it a shock or an opportunity? Experts in Shanghai revealed: Relevant pilot projects are being steadily laid out, and Shenzhen announced that nurses will have the right to prescribe prescriptions
The saying "a doctor's words can break a nurse's legs" has long been outdated with the continuous development of medical services. "New era" nurses with doctoral degrees and innovative patents have increasingly entered the public eye in recent years, and another piece of good news has come: Recently, the Shenzhen Municipal Health Commission and the Municipal Medical Insurance Bureau jointly issued the "Shenzhen Specialist Nurse Training" and Management Measures", which will be implemented on January 1, 2024 and will be valid for 5 years. It stipulates that "Shenzhen specialist nurses can, under the authorization of medical institutions, issue prescriptions at specialist nursing clinics or community health service institutions in accordance with the catalog published by the municipal health department. Check the application form, treatment application form and external medicines.”
This means that nurses will have the right to prescribe, and the training of specialist nurses will also enter a new stage. What does it mean to have prescription rights? Will this have a new impact on the current status of medical services? Will the development of the nursing industry in Shanghai have similar prospects? However, there is no doubt that medical professionals generally regard this as a positive signal. Is the era of win-win cooperation for "doctors, nurses, and patients" coming soon?
Shenzhen’s “Measures” did not come out of nowhere. On June 23 last year, Shenzhen City passed the revised version of the "Shenzhen Special Economic Zone Medical Regulations". As the country's first local medical regulations after a lapse of five years, version 2.0, one of the highlights is that "nurses can also prescribe prescriptions." Article 64 of the "Regulations" proposes, "Establish a specialist nurse system. Nurses are encouraged to participate in specialist nurse professional training according to the needs of subject development and obtain a specialist nurse certificate. Nurses who have obtained a specialist nurse certificate can carry out the following in nursing specialist clinics or community health service institutions Practicing activities: issuing examination application forms, treatment application forms, etc.; issuing external medicines.”
At the same time, the "Regulations" also impose restrictions on the "entry threshold". To obtain a specialist nurse certificate, three conditions must be met, namely, a bachelor's degree or above in nursing, more than 5 years of clinical nursing work experience, and more than 2 years of work in related specialist positions. Experience and obtain intermediate or above nursing professional and technical qualifications.
Prescription power specifically refers to the authority granted to prescribe drugs and related examinations in clinical medical activities. In October this year, the National Health Commission released data showing that at the end of 2022, the total number of health personnel nationwide was 14.411 million, including 5.224 million registered nurses. The huge nursing team is facing increasingly diverse demands for medical services, especially the popularization of the family doctor system and the promotion of doctors' multi-site practices, which have posed challenges to nursing work. "Nurses can no longer just be mere executors of medical orders. Do chronic disease management, wound care, home bed services, etc. still need to be prescribed by doctors?" Cai Jiangnan, founder and executive chairman of Shanghai Chuangqi Health Development Research Institute, believes , at a time when the population is aging, nurses with prescription rights are beneficial to a large number of community patients with chronic diseases. This change is also in line with the development trend.
"Being able to find your own career development path is the greatest value of 'specialty'." At the Community Health Service Center of Tianshan Road Street in Changning District, nurse Ren Hong has obtained the Sino-German International Wound Therapist Qualification Certificate for a year. As the first nurse in the region to obtain this certification, she provides more professional technical and clinical support for the wound care clinic opened by the center. "In the acute phase, such as burns, postoperative dressing changes and suture removal, drainage tube wound treatment, etc.; in the chronic phase, such as pressure ulcers, lower limb arteriovenous ulcers, diabetic foot ulcers, etc., they are all common 'doorstep needs' of residents. It often takes several hours. Running around is very unfriendly to postoperative patients, especially elderly patients. If we can undertake this part of the work independently, we can relieve a lot of stress. "
In the eyes of many medical professionals, nurses are often the "earliest witnesses" of changes in a patient's condition. Sometimes they even cannot wait for medical advice and have to carry out emergency treatment. However, there is no "grey" area guaranteed by laws and policies, and they cannot be left alone. hands and feet. How is this problem being solved on a global scale?
"Many European and American countries have opened up the prescribing rights of nurses, and have laws and regulations to guarantee and standardize the relevant operations of nurses." Cai Jiangnan said that doctor resources are scarce in any country. Taking this step will inevitably liberate some doctors effectively. "But any 'decentralization' reform will encounter resistance initially, making some people feel uncomfortable. A balance needs to be struck in terms of law, technology and long-term social values."
"It should be noted that the discussion on 'nurse prescribing rights' only involves a small number of nurses, namely 'specialist nurses', but how to define specialist?" Director of the Party Office of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Chairman of the Shanghai Nursing Association Wu Beiwen shared relevant experiences from abroad. "Taking the United States as an example, the career development path ranges from registered nurses, specialist nurses to APN. What we currently call 'specialist nurse' is actually closer to the connotation of APN, that is, in clinical nursing, management, education, research and other fields. Both have developed and can independently diagnose, treat, prescribe, and guide patients in self-management.”
In her view, personnel training and qualification certification are the most urgent areas for breakthrough. "Each medical institution may have specialist nurses, but they are not formally certified and are not recognized across hospitals. Relevant qualification certifications are not issued by the health department and require cooperation with the nursing society." At the same time, some specialist nurses are actually only "professional nurses" "For example, it takes many years for an oncology nurse to develop expertise in a certain subspecialty. If half of the people in the department are 'specialist nurses,' it will cause embarrassment in management."
After determining the "people", the next focus is the "post". What can specialist nurses do in the future? "The broader space should be in grassroots communities." Wu Beiwen said that as the Internet platform matures, first of all, nurses from tertiary hospitals can go down to provide consultation and other services. In the early stage, safety should be the priority. "When it matures, second and third-level hospitals will Hospital nurses can provide some initial diagnosis services, such as prescribing specialist examinations; at the same time, community hospital nurses can develop sub-health management and provide hierarchical diagnosis and treatment at the nursing service level.”
Many practitioners have said that there are actually nurses currently performing similar services, but they can only enter the doctor's job number in the background. "Compared with the subtle competition among doctors and nurses that may result in public imagination, perhaps doctors have a more urgent need for this development trend." A physician at a tertiary hospital said frankly that the standard for the identification of specialist nurses is not low, and the scope of practice is also within their professional scope. Internally, by rationalizing the procedures, it also frees up medical staff, ultimately allowing limited medical resources to serve more patients.
Of course, shaking up deeply ingrained beliefs about medical care is no easy task. At the end of September last year, West China Hospital of Sichuan University announced that it would become "the first hospital in the country to open up nurses' prescribing rights." However, within 10 days, the document was quietly deleted. According to people familiar with the matter, the main contradiction lies in the pilot program that allows nurses to prescribe medication, which has had a certain impact on the distribution and sales of medicines.
“Don’t take too big a step, slowly open up all links, and allow doctors, nurses, and patients to all have room to understand and adapt.” Wu Beiwen revealed that Shanghai has actually been laying out relevant reforms in recent years. “The Municipal Health Commission and Nursing Learn to cooperate and rely on nursing schools for training, first of all to build a talent team. "She said that for example, critical care training includes three months of theoretical courses and three months of practical teaching. "In the theoretical courses, half of the time is spent. It is a basic course from the school, and the other half of the time is provided by the professional committee after obtaining the specialist nurse qualification certificate.”
At the same time, the city will give priority to pilot outpatient clinics that are truly necessary, operable, and medically safe, such as PICC intravenous catheter care clinics, wound and stoma care, etc., and will actively work with the medical insurance department to open up charges so that nurses can also work in the background. For examinations within a limited range, the charges are the same as those of doctors. It is reported that relevant documents and policies are expected to be released in the near future. “We hope to avoid risks with more complete details and take a solid first step.”
"Although most patients rely more on doctors, in recent years, with the reform of medical services and the construction of grassroots service capabilities, more and more nurses have also shown their talents in their work." said Jin Chunlin, director of the Shanghai Hygiene and Health Development Research Center, For patients, it can effectively save medical resources, relieve the pressure of "difficulty in seeing a doctor", provide more timely nursing services, and shorten treatment time; for nurses, it can improve social status and professional value, and change the concept of "emphasis on medical care but not care" , which will ultimately help cultivate high-end practical nursing talents for the grassroots. "I believe that after improving relevant policies and standardizing personnel access, scope of responsibilities, legal responsibilities, etc., more specialist nurses who can 'take charge of their own' will emerge to provide Provide patients with more comprehensive and refined personalized services.”
