Shenzhen first city to allow nurses to prescribe drugs

Shenzhen in Guangdong province has become the first city in China to allow specialist nurses to prescribe selected drugs and order diagnostic tests, in a move that is expected to increase efficiencies in the healthcare system and reduce the patient-load burden on physicians.

Under a new regulation released in October that took effect this month, eligible nurses will be authorized to order examinations, therapies and prescribe topical medications relevant to their area of expertise at specialist nursing clinics or community healthcare centers. Their prescriptions must be based on existing diagnoses issued by physicians.

Local health authorities will release catalogs of prescriptions that can be written by nurses and constantly adjust them.

To become a nursing specialist, applicants should have a bachelor's degree in nursing, five years of working experience, obtained an advanced nursing qualification, have attended a monthslong specialist training program and passed a final test.

"Medical institutions must promptly review inappropriate prescriptions or interventions made by nurses," said the regulation.

"Nursing specialists who are found to have given three or more improper prescriptions will have their prescribing power suspended for three to six months and will have to undergo retraining before regaining the authorization," it said.

In China, medical prescriptions can only be given by physicians. Worldwide, a number of countries, including the United States, Canada and the United Kingdom, have allowed nurses to write prescriptions.

The National Health Commission, China's top health authority, said in 2022 in a reply to a national political adviser's proposal that there is currently no legal basis for granting nurses prescriptive power.

"Considering the difference in professional positioning, medical education background and work experience between physicians and nurses, it is necessary to fully analyze the necessity and feasibility of the nurses' prescriptive authority," the commission said.

Zhou Wensi has a bachelor's degree in nursing and is now a specialist nurse in periodontitis, or gum disease, at Shenzhen Stomatology Hospital in the city's Pingshan district.

"Our hospital has not begun allowing us to prescribe. If the rule goes into effect in the future, we'll likely be able to directly prescribe mouthwash, anti-inflammatory drugs, painkillers and antihistamines to patients," she said.

However, she said that most patients visiting the hospital are in need of treatment delivered by doctors with assistance from nurses like her, so the new regulation is not expected to have a major impact.

But for specialist nurses at clinics for stoma care and care of peripherally inserted central catheters that require professional skills, the new rule could enable them to respond to patients' demands more easily and brighten their career prospects, she said.

Ren Hong, a nurse specializing in wound therapy at a community health center in Shanghai, said during an interview with local media that patients with acute conditions, such as those suffering burns, who need postoperative dressing changes and suture removal, management of drainage tubes, as well as patients with chronic conditions such as pressure ulcers and diabetic foot ulcers would benefit the most from the new rule.

"Such patients have to visit doctors frequently after an operation, which could be tiring, especially for elderly patients," she told Jiemian.com, a news outlet.

"If we nurses can undertake such work independently, we could alleviate pressure on doctors and also bring convenience to patients," she said.

Deng Yong, a law professor at Beijing University of Chinese Medicine, told Legal Daily that nurses' prescriptions should be implemented under the guidance of doctors and be piloted first targeting chronic disease patients in stable condition.

"It is also important to set clear boundaries," he added.