The first legislation in Shenzhen to give nurse specialists prescriptions: How long will it take for nurse prescriptions to become widespread?

On 28 June 2022, Shenzhen issued a revised version of the “Shenzhen Special Economic Zone Medical Regulations,” which specifies that nurses with specialist certificates can issue examination applications, treatment applications, topical drugs and other professional activities in nursing specialist clinics or community health service institutions. This regulation will be implemented on 1 January 2023. (Shenzhen Municipal People's Congress, 2022). This is the first time China has clarified in the legislation that nurses have prescriptions (Pan, 2022). However, it is worth noting that the users of nurse prescriptions in this regulation are nurse specialists, namely, expert nurses with a high level in a specific nursing field, rather than all nurses. In addition, the prescription of nurse specialists does not include oral drugs but external drugs. However, this is a considerable breakthrough compared with the previous. At the same time, this legislation has caused a hotly debated issue in Chinese society. Is it necessary to legislate on nursing prescriptions? Will the legislation on nursing prescriptions benefit patients? How to ensure the implementation of nursing prescriptions? This paper discusses these issues. Nurse prescription refers to the right nurses are granted to prescribe drugs and related examinations in clinical practice (Nissen & Kyle, 2010). Nurses in developed countries, including Britain, the United States, Australia and Canada, have obtained prescriptions (Maire, 2015). Nurses' prescriptions have also been opened in Hong Kong (Wei et al., 2009) and Taiwan (Li et al., 2015). Mainland China has not yet fully opened up the nurses' prescriptions. China's ageing population and chronic diseases have increased the demand for medical and health nursing services. The emergence of innovative service models of specialist nursing clinical, internet plus nursing and continuous nursing has promoted the emergence of nurse specialists and further generated the demand for nurse specialists' prescriptions. Some hospitals in China have begun to explore and practice. In 2017, Gao et al. (2017) reported that more than 900 specialist nursing clinics were opened in large general hospitals in 22 provinces of China. The development of specialist nursing clinical provides advantageous conditions for implementing nurses' prescriptions. However, there is currently no national health department legislation on nurse prescriptions in China, so the scope of use is minimal. Generally, nurses' prescription rights appear in hospitals in large cities and can only be used in hospitals where nurses work. Prescriptions are mainly non-drug prescriptions, including consultation, examination and nursing. The prescriptions include emergency, tumour, diabetes, traditional Chinese medicine and wound ostomy. Nurses' prescriptions are used in specialist nursing clinics and community health service institutions. The practice has proved that granting nurses the right to prescribe can improve patient satisfaction, reduce medical costs and facilitate patients' medical treatment (Carey & Stenner, 2011; Earle et al., 2011; Gielen et al., 2014; Kroezen et al., 2012). Granting prescriptions to nurses has become a global trend. However, there is still a big gap between the legislation and popularity of nurses' prescription rights in China and developed countries in Europe and the United States. The reasons are mainly the following three aspects. First, nurses' ability is insufficient. Due to the low access standards of Chinese nurses and the lack of academic and continuing education, nurses' diagnostic knowledge and skills training are insufficient. The China Health Statistics Yearbook (National Health Commission, 2019) stated that only 30% of nurses in China currently have a bachelor's degree or higher and that knowledge of prescription drugs and decision-making skills are lacking. Lacking ability is the root cause of the lag in developing nurse prescriptions. The second is the barrier of the traditional medical environment. In China, nurses are considered subordinate to doctors and do not have an equal relationship with each other. The traditional concept of doctors and patients believes that nurses can only perform medical orders and cannot prescribe. Some doctors believe that once nurses have a prescription, the professional advantage of clinicians will be affected (Maclellan et al., 2015), which may lead to conflicts between doctors and nurses. Some patients and families also are prejudiced against nurses and are particularly distrustful of nurses prescribing medication (Hou et al., 2021). Third, there is a lack of policy. At present, China's health department has not yet formulated a well-developed legal system on nurse specialist prescriptions, and there is no clear legal basis for the qualification of nurse specialists, the rights and obligations of nurse specialists who enjoy prescription which is not conducive to ensuring the standardisation and safety of nurse prescriptions implementation, as well as improving nurses' legal awareness (Fan et al., 2022). First, formulate laws, regulations and policies related to nurses' prescriptions. In addition to prescribing the access qualifications of nurses' prescriptions, it is also necessary to stipulate the rights and obligations of prescription nurses and clarify the legal status of prescription nurses. The policy gives nurses the corresponding remuneration for exercising prescriptions so that income and responsibility coexist and encourages nurses' prescription behaviour. In addition, the health department needs to formulate policies to include the charging items of prescriptions issued by nurses into the scope of medical insurance to facilitate patients' reimbursement of medical expenses (Feng et al., 2020), which is conducive to the long-term sustainable development of nurses' prescriptions. Second, improve the capacity of nurses through academic and continuing education. To wear crowns shall bear the heavy. Nurse prescriptions do represent not only rights but also responsibilities. Prescription places higher demands on nurses, requiring them to have competencies in health assessment, medication safety and integrated clinical decision-making. Nurses can only win the trust and respect of doctors and patients if they can prove through their competencies that they can prescribe competently. Third, starting from a small scale and gradually opening up nurses' prescriptions. Throughout the history of the development of nurse prescriptions in Europe and the United States, they have all undergone decades of development and improvement. We need to start with a specific range of prescriptions for nurse specialists according to our actual nursing needs, accumulate experience, continuously improve policies and systems, and gradually open up prescriptions. Promoting nurses' prescriptions in China still faces many challenges, such as nurses' lack of prescription-related knowledge and ability. It has not yet had a national policy on nurse prescriptions. However, with the increasing practice of specialist nursing clinics, valuable experience has been provided to improve nurses' prescription legislation. With the development of higher nursing education in China, the number of nurses with master's and doctoral degrees in nursing is increasing, providing a talent pool for nurse specialists. Chinese scholars have formed an “Expert Consensus on the Content of Nurse prescriptions in the New Era” (The First Hospital of Shanxi Medical University, Nursing College of Shanxi Medical University, Shanxi Nursing Association, 2018), which provides a reference basis for the legislation on nurse prescriptions in China. Prescription by nurses allows them to use their professional skills best to serve patients and meet their diverse needs. It will become a trend to grant nurses the prescription. The legislation of nurses' prescriptions in Shenzhen is just the beginning. We believe that China's nurses' prescription will make significant progress soon. This research was supported by the humanities and Social Sciences planning fund of the ministry of education of China (NO. 19YJAZH067). There are no conflicting interests to declare.