a patient in hospital bed checked by doctor

In many countries, such as Spain, Sweden, the UK, Denmark, Ireland and the USA, nurses are allowed to prescribe medicines in certain areas, but this is not yet possible in Portugal and the subject remains taboo. However, the Order of Nurses wants to break the paradigm.

According to specialists and heads of various professional associations in the health sector, heard by Diário de Notícias, it’s time to break the taboo on the subject. Luís Filipe Barreira, president of the Order of Nurses, has this issue as one of the priorities of his mandate, referring to “pharmacological interventions”, so as not to mess with the concept of prescription. “More and more we have to use the skills of each professional and not work on the basis of specific interventions just because there is a professional title,” he says.

“We are doing a survey of the countries with projects and where this practice is more widespread, so that we can analyze them and present a concrete proposal to the Ministry of Health,” explains the president of the Order of Nurses. The issue has been discussed informally several times and a specific proposal has even been presented for the area of Maternal and Obstetric Health, with the creation of Normal Birth Centers, but the competencies of nurses in this pharmacological aspect are not yet regulated.

Responsibility for such pharmacological interventions would fall to “specialist nurses, who have excellent training and the competence to assume the right to prescribe”.

Luís Filipe Barreira recalls that “prescribing by nurses has long been provided for in European law, precisely within the scope of the competences of specialist nurses in Maternal and Obstetric Health, since 2005, and was transposed into the Portuguese legal system in 2009, enshrining the issue that nurses can prescribe or advise tests deemed necessary for the early diagnosis of a high-risk pregnancy”. However, this is not the practice because the law has not been regulated.

The president stresses that the intention is not to transfer competences between professions, and gives examples such as monitoring post-operative patients, managing the treatment of elderly people with chronic illnesses or treating wounds. “It’s an autonomous treatment for nursing, but if something is missing, the nurse can’t prescribe and has to refer the patient to another professional,” he points out.

Manuel Lopes, a full professor and director of the doctoral course in Health and Wellness Sciences and Technology, told the same newspaper that the way forward will have to be one of “transprofessionalism”, and that the problems of the SNS won’t be solved with just more doctors.

“If there is an effort to regulate prescriptions for those who provide the closest care, it has been proven that the likelihood of the medication being followed is much greater,” says the specialist, about the possibility already applied in other countries for nurses to prescribe drugs.

Helder Mota Filipe, president of the Order of Pharmacists, says that the term “prescription is excessive”, preferring to refer to intervention, and says that the professional class he represents already has “some capacity for intervention in a number of pharmacological situations, namely in the list of medicines that are not subject to prescription”, but says that the role could be strengthened or extended.

“What we need to do is guarantee patients the best practice, the one that produces the best results. We need to focus more on the patient and the gains for the system and less on the professionals,” he says, advocating a change in attitude towards this pharmacological intervention by other health professionals.

“We have to discuss at every moment who has the appropriate competence to carry out a certain type of intervention instead of continuing to divide them up by professional class,” he concluded, calling for a “serious” discussion on the subject.

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