Nurses at Scotland's largest cancer hospital claim they are being bullied and harassed in a row over "unsafe" prescribing practices.
The Herald understands that concerns were flagged several weeks ago by pharmacists based at the Beatson West of Scotland Cancer Centre in Glasgow after they discovered that Band 6 nurses without non-medical prescriber qualifications had been reviewing and prescribing systemic anti-cancer treatments (SACT) such as chemotherapy to patients over a number of years without a standard operating procedure (SOP) in place.
The issue mainly affects breast cancer patients.
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While there are some standard treatment pathways which can be handled by staff nurses because specific protocols are in place, the Beatson deals with a large number of complex patients who are on non-standard pathways where there was no SOP.
A source familiar with the situation said: "There will be some standard pathways where a staff nurse can do it because there’s a protocol in place, but there’s quite a lot of non-standard treatment pathways at the Beatson because of the type of care they are providing.
"Some of these require a level of clinical involvement which means it can’t just be the staff nurses who administer them.
"The treatment plan has to be signed off by a clinician, but now this is being pushed in the direction of the advanced nurse practitioners and the clinical nurse specialists, but they don’t have the time or the capacity to be able to do that for every patient who needs it and other nursing staff shouldn't be expected to work beyond their competency."
The Herald understands that when the situation was brought to the attention of management, it was proposed that the advanced nurse practitioners and clinical nurse specialists who do hold non-medical prescriber qualifications should counter-sign SACT prescriptions for Band 6 nurses while SOPs are drawn up to cover the affected treatment pathways.
However, this would mean counter-signing prescriptions without reviewing the patients first-hand.
This has prompted a pushback from the nurse prescribers worried that doing so could put them in breach of the code of conduct for their regulator, the Nursing and Midwifery Council (NMC), and would not be "safe or legal" practice.
By law, any healthcare practitioner prescribing a medicine is supposed to personally see and assess the person to whom the drug is being provided.
However, nurse prescribers say they are struggling with their existing workload and cannot be expected to take on an extra caseload of non-standard patients from Band 6 colleagues.
A source told the Herald that they feel under unfair pressure to do what management are asking amid warnings that unless they comply patient appointments could be cancelled or delayed.
They said: "Recently they have being asking prescribers such as [clinical nurse specialists] to countersign prescriptions for the Band 6 nurses in order to get prescriptions through and most prescribers are saying 'no, this is not safe or legal practice'.
"They have been spoken to and described as not agreeing to patient care...staff are now raising complaints to unions and management about being bullied, harassed and intimated."
They added that attempts to "rush through" newly-drafted SOPs have been blocked by pharmacists at the Beatson in some cases because they were deemed to be "inaccurate and not fit for purpose".
There are conflicting accounts as to whether SOPs for the affected treatment pathways existed in the past but have become outdated, or never existed at all.
A spokesman for the Royal College of Nursing (RCN) Scotland confirmed that it is "one of the trade unions that Beatson nurses have been seeking advice from".
In a statement, NHS Greater Glasgow and Clyde said: "At the Beatson West of Scotland Cancer Centre our procedures are safe and effective. Safe and person-centred care remain our key focus.
"For a number of years, the Beatson has worked with Nurse Led Standard Operating Procedures (SOPs), which allow experienced registered nurses to clinically assess patients and confirm and authorise pre-allocated prescriptions within defined parameters.
"This practice allows our multidisciplinary clinical teams to use their capacity efficiently and deliver timely and patient centred care.
"We have recently reviewed these SOPs, and during that process additional sign-off mechanisms were put in place, which has changed some working practices.
"We would urge any staff to speak directly with their Lead Nurse with any concerns.
"We are confident that our procedures continue to support the ongoing safe and effective use of the Nurse Led model.
"All patient treatment plans are decided by the Consultant in charge, and at no time is treatment prescribed or treatment plans altered by Nurses who follow these SOPs."
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