Nurses authorised to supply non-prescription drugs without seeking doctor's permission

'Permitted to prescribe where a prescription is not needed' appears a contradiction in terms at first, but a number of Spanish nurses have clarified what the new law means for them, and for those they treat.

An in-patient, or a patient waiting to be attended to in A&E who has a headache or other type of pain would normally have to wait until a doctor could be found to give permission and instruct the nurse what type of medication to administer or, if it was overnight and all doctors were asleep – woken only in the event of emergencies – the patient would have to suffer the pain until morning.

This could even go on for at least 12 hours, since doctors on their rounds may not reach the patient until mid-morning, or possibly not even then if the patient is not on his or her list to examine that day.

Likewise, ointment or even bandages for a wound, or any other type of what would typically be over-the-counter drugs could not be given to a patient in hospital unless a doctor was able to authorise it.

Despite this, nurses study the same number of university credits in pharmacology as doctors during their degree and some nurses even have higher levels of academic qualifications in their field than doctors – although it takes much less time to qualify as a nurse, many nurses go on to take master's degrees or even PhDs to specialise further, whilst many GPs or hospital consultants do not have a PhD, meaning in technical terms, although they are a 'doctor' by profession, they are not a 'doctor' by title.

As a result, despite initial public concerns that nurses being allowed to supply medication would mean lesser-qualified individuals handing out drugs on doctors' behalf, the reality is that most nurses are already perfectly competent enough to do so and the law change is a mere formality.

Some doctors even ask nurses' advice on the best drugs to give patients, since nurses are in constant contact with them whilst doctors only see them for a few minutes on their rounds.

Spanish nurses admit that they often do supply drugs, and even make decisions as to what to give patients – not just for pain relief, but even for deciding types and amounts of medication for stemming a haemorrhage.

But just giving an aspirin for a headache in A&E can mean a nurse is struck off and fired for 'practising without licence', which is also a criminal offence leading to fines and even imprisonment.

As one nurse explained, “we cannot dish out morphine, but we can give you a paracetamol for fever or a sore head.”

It will also save time, as it means not having to confer or examine patients before handing out drugs which, if the ill person was not in hospital, he or she would be able to buy from the pharmacy anyway.

Healthcare professionals believe that if a patient attends a nurse's station at a local GP clinic instead of waiting for an appointment with a doctor, the nurses are likely to be given a list of drugs they can supply by prescription or from the in-house dispensary without having to consult a medic.

As yet, they will not be able to issue repeat prescriptions for long-term or permanent medication – known as 'chronic prescriptions' – and only a patient's own doctor can renew one of these in full, although any GP or hospital medic can supply a one-off prescription for an individual box of pills or for a month's worth of drugs.