Opinion

Isn’t it time emergency care nurses caught up with paramedics to administer agreed drugs?

The disadvantages emergency care nurses face because of a lack of agreed clinical guidelines at national level.

When considering administering glyceryl trinitrate to someone with angina, or salbutamol to a short-of-breath asthmatic, emergency care nurses are at a disadvantage to paramedics because of a lack of nationally agreed clinical guidelines.

For years, paramedics have been able to administer a list of more than 30 drugs so patients can receive appropriate, timely treatment.

But for emergency care nurses (ECNs), those patient group directives vary depending on the organisation in which they practise.

First to attend to patient

ECNs work in different clinical settings such as the armed forces, expedition medicine, offshore oil rigs and sports events, and are often the first clinician to assess and treat a patient as triage nurse, majors nurse practitioner, first responder or clinician in the resident medical facility.

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When considering administering glyceryl trinitrate to someone with angina, or salbutamol to a short-of-breath asthmatic, emergency care nurses are at a disadvantage to paramedics because of a lack of nationally agreed clinical guidelines.

prescription drugs
Is it time for a review in nationally agreed guidelines to prescribe drugs? Picture: iStock

For years, paramedics have been able to administer a list of more than 30 drugs so patients can receive appropriate, timely treatment.

But for emergency care nurses (ECNs), those patient group directives vary depending on the organisation in which they practise.

First to attend to patient

ECNs work in different clinical settings such as the armed forces, expedition medicine, offshore oil rigs and sports events, and are often the first clinician to assess and treat a patient as triage nurse, majors nurse practitioner, first responder or clinician in the resident medical facility.

In such cases, the nurse needs to seek out a doctor for an appropriate prescription or work to the varied guidelines the individual organisation endorses, limiting autonomy and speed of care.

Need for national guidelines

The trend is towards educating nurses to become independent prescribers; a role expansion which demonstrates nursing’s professional maturity, but adds logistical and financial pressures by diverting clinicians from practice to study and paying for places on courses.

Maybe it is time the Faculty of Emergency Nursing, Royal College of Nursing, NHS England, College of Paramedics and College of Emergency Medicine formulated nationally agreed guidelines.

It would involve closer working relationships between the organisations and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), which has already implemented a national standard for paramedics which works effectively.

It would encompass governance arrangements, legislative agreements, professional acknowledgment, medicines management backing and educational implementation, and could succeed with the will and vision to embrace challenges such an exciting expansion offered.

A precedent has already been set by the JRCALC. The challenge would be implementing such change within nursing’s all-graduate educational frameworks. This could be achieved through post-graduate education programmes or, more radically, as part of revised undergraduate programmes.

Streaming debate

As demands and pressures on healthcare delivery continue to evolve, maybe there is a debate to be had regarding the streaming of Year 3 undergraduate nurses, so students who wish to pursue a career in emergency care/pre-hospital nursing are streamed into their chosen speciality.

One aspect would be the student undertaking a specialist module in pharmacology and medicines management, linked to a nationally agreed set of patient group directives. All nursing graduates with a specialist qualification in emergency care/pre-hospital nursing would be so educated.

Emergency care is facing a number of challenges with problems retaining emergency care nurses, increasing attendance figures, reported pressure on out-of-hours medical cover and patients’ expectancy of health care constantly changing.

These are all reasons that underline how embarking on a nationally agreed set of patient group directives may provide a renewed autonomy and scope of practice for nurses in emergency care and pre-hospital settings, and provide improved and enhanced immediacy of care to the treatment of patients in future.


Robert Shelswell is an emergency care nurse practitioner and lecturer in Brixham, Devon

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