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New Mexico State nursing professor compiles perspectives on prescribing drugs

As the first clinical nurse specialist in New Mexico to receive authority to prescribe drugs, in 2000, New Mexico State University nursing professor Ann Hales soon learned from experience that prescribing is as much art as science.

New Mexico State University nursing professor Ann Hales has prepared perspectives on drug prescribing using advice from 32 psychiatric advanced practice nurses. (New Mexico State University photo by Mindy Giles)

Hales decided to explore the topic by drawing on the experiences of other nurses who are pioneers in the prescribing arena. The results, a compilation of "pearls of wisdom" from 32 psychiatric advanced practice nurses (APNs), were presented at a conference of the Psychopharmacology for Advanced Practice Psychiatric Nurses Oct. 25-27 in Philadelphia. Her research also was published Oct. 24 in Perspectives in Psychiatric Care, a professional journal.

The New Mexico Legislature approved legislation allowing clinical nurse specialists to prescribe medication in 1998, but the process is lengthy and includes many classes, exams and 400 internship hours.

"Research indicates that psychiatric problems are caused by a chemical imbalance and adjusting those chemicals can help people start over," Hales said. "It's not just a science, but also an art and a responsibility. Historically, nurses have been the providers for disenfranchised people. By allowing psychiatric nurses to prescribe, you are better serving the people of your community."

Hales said her experiences in receiving the authority to prescribe drugs sparked her interest in the experiences of others. During a sabbatical in New Zealand, where APNs will soon be allowed to prescribe medication, she decided to explore the topic with psychiatric nurses with prescriptive authority in the United States and found their stories held a wealth of information.

"I felt like I had gone from being an expert as a psychiatric nurse back to being a novice when I began prescribing," she said. "I wanted to ask others, 'If you knew then what you know now ...?'"

The advice she compiled will be a valuable resource to all nurses who are taking on the responsibilities of prescribing drugs.

"A good mentor is essential. They are well worth any fee you may have to pay for ongoing consultation," said one of her respondents. "Don't hesitate to take complicated cases to your mentor for input and advice."

Another had this advice: "Equally as important as having one good mentor was spending time with many prescribers and asking them lots of questions." Another respondent agreed, "It is easy to inherit a mentor's biases if you don't get fresh perspectives."

When dealing with patients, one respondent said, "Give the client written directions. The script is not enough."

Respondents also recommended that prescribers spend more time educating clients about medication. "I provide every patient with education, so they are part of the decision-making process," one said.

Because the United States has no federal Nurse Practice Act, Hales' respondents told stories from the context of their state's Nurse Practice Act. Almost half of the respondents indicated their greatest concerns regarding prescribing revolved around having the knowledge and educational background to prescribe. Hales said continuing education on pharmacology is one of the biggest challenges any health provider with prescriptive authority faces.

Hales discovered five prevalent themes related to prescriptive authority -- acquisition of knowledge, professional and patient relationships, legislative logistics, balance within the role, and management of anxiety and the sense of responsibility. Advice from the stories was summarized for each theme and included in her findings.

Hales said prescriptive authority offers broad opportunities for advanced practice psychiatric nurses. Educational programs include competencies and skills for prescribing, but another learning tool is the use of collective practical knowledge and wisdom offered by psychiatric nurses who have gained prescriptive authority.

In addition to directing the psychiatric nurse practitioner program at New Mexico State, Hales works with patients at her practice, helps at the Student Health Center on campus and does counseling with students at Las Cruces High School. She has a bachelor's in nursing from the University of Tennessee, a master's in psychiatric nursing from the University of Colorado and a doctorate in health policy and planning from Cornell. She has worked as a therapist in community centers and with the Peace Corps.

Photo is available at http://ucommphoto.nmsu.edu/newsphoto/hales_ann.jpg.
CUTLINE: New Mexico State University nursing professor Ann Hales has prepared perspectives on drug prescribing using advice from 32 psychiatric advanced practice nurses. (New Mexico State University photo by Mindy Giles)

Julie M. Hughes
Nov. 11, 2002