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Infantes Rodríguez JA. Nursing prescription. The story of a euphemism. Metas Enferm feb 2019; 22(1):4
Juan Ángel Infantes Rodríguez
Junta Directiva de SEMAP (Sociedad Madrileña de Enfermería Familiar y Comunitaria).
Contact email: email@example.com
Versión en Español
Iwill start this editorial article with a statement which is a self-evident truth: we nurses diagnose health problems and, consequently, we conduct interventions including the prescription of medications and healthcare products. It is important to stress this idea: yes, we nurses diagnose and prescribe, and some or many of these prescriptions are associated with medications.
But if this is so, why do we continue going round and round with the matter of nursing prescription? In my opinion, either due to lack of a clear idea at the time of acknowledging the nursing area of competence, or maybe due to lack of courage by our representatives to get this reality reflected in an adequate regulatory framework.
I have used “The Story of a Euphemism” as the subtitle for this editorial because this is how our professional skills have been often described, euphemistically, as pointed out by Hernández Yáñez (2017). “Euphemism” is described by the RAE as the gentle or befitting manifestation of ideas which would be harsh or rude if expressed directly and openly. Let’s see a couple of these “euphemistic moments” in our recent story:
- 1st moment: 2003, the Healthcare Professions Management Act (LOPS). While some professionals are assigned the diagnostic task in the setting of their respective competences, in the case of nurses it is determined that our task is the direction, evaluation and provision of patient care (…), ignoring our diagnostic ability which, by the way, was afterwards captured in the Royal Decree 1093/2010, which standardized nursing diagnosis as a basic piece of information in clinical reports.
- 2nd moment: 2009, The Law on guarantees and rational use of medicines and health products. A major part of the current problem lies in this law, which modifies the previous law from 2006, because it determines that only physicians, dentists (the traditional ones) and podiatrists (the new ones) can be considered prescribing professionals. Why podiatrists and not nurses? This was the moment to realize that there was a need to regulate by law what was already an acknowledged practice by nurses, supported by years of professional practice, and that benefits citizens and the healthcare system, wasn’t it? The law itself acknowledges that “Nursing practice (…) involves necessarily the use of medications and healthcare products”; but, just like the LOPS “missed” the fact that we nurses diagnose, in this occasion they also found a way to ignore reality at the time of addressing the relationship of nurses with medications, using the already famous “indication, use and authorization for dispensing”.
From the analysis of these two historic moments it is possible to infer, going back to the RAE, that it must have sounded “very hard” for some to admit the fact that we nurses DIAGNOSE and, therefore, it was necessary to “soften” the term, avoiding any reference to what should be reserved exclusively for other professions. Likewise, it must have been considered adequate to use language “in a befitting way” when referring to nurses, and therefore speak about INDICATION, in order to avoid the “rude” PRESCRIPTION, or AUTHORIZATION FOR DISPENSING in order to avoid the even worse TO PRESCRIBE (which is nothing else than writing a prescription).
The things we do when we are not brave and stop calling things by their name so as “not to upset”!
If, as it seems that our representatives have done so far, we forego to assert our reality and accept that Nursing is a “`parallel reality” or “second rate” within our healthcare system, or we accept that it is not important to ignore what we are already doing (let’s not forget that if we don’t name it, it doesn’t exist), we can be happy with the improvements made in Royal Decree 1302/2018 over the previous Royal Decree 954/2015:
- Even though the need for accreditation in order to be authorized for dispensing non-prescription medications and healthcare products is sustained, because it is in the law, this will be granted by certifying only one year of professional practice.
- It modifies the accreditation authority, which now will be the autonomous communities.
- Regarding medications under medical prescription, it regulates the involvement by nurses with a language less offensive than the previous decree, introducing the concept of collaboration.
- Even though vaccine administration was never the object of regulation by these decrees, their use is explicitly mentioned, thus avoiding the interpretations conducted with the previous Royal Decree.
- It adapts the use of gender in the wording of the paragraphs modified, using the terms “male and female nurses”.
I cannot avoid remembering the upheaval caused in some sectors of the medical profession when the term “nursing diagnosis” became standard, or the experience in one of the major hospitals in Madrid when it was impossible to implement the “Nursing Report at Discharge” until it was renamed with the euphemism “Document with Nursing Recommendations at Discharge”.
Just like in the feminist fight, which is certainly similar in some aspects to the fight of Nursing, the fact that the language “upsets” someone means that it makes evident a reality that leads to a feeling of loss of power and, therefore, the intention is to hide it.