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Blog: Scripts and dilemmas

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Today I received an email asking my opinion about nurses signing scripts for nurses. The independent prescriber who sent the email has developed this over the last 12 months

While admitting they were taught NOT to do this during prescribing training, the nurse feels that it fits with the main aims of patient access to medicines, relieving GP workload, and not making patients stand around waiting for a GP's signature.

The nurse goes on to say that it is proving helpful to the smooth running of the treatment room. They use a risk assessment approach which includes the Nurses Knowledge Skills, experience and use of protocols and guidelines. They consult with the nurse on many prescriptions required around diagnosis and management, but with certain conditions such as UTI or regular pill check they sign other nurses' prescriptions - in the main with two nurses educated to level 3 in certain modules.

I felt really strongly that this was something the nurse should stop doing immediately. One of the benefits in training nurses to prescribe is the reduction of proxy prescribing where a nurse assesses a patient, makes a prescribing decision and waits for the doctor to be available to sign the prescription. The doctor is of course then accountable for that prescribing decision. This is not best practice. What this nurse is doing is no different and causes the same proxy prescribing issue.

In the NMC Standards of proficiency for nurse and midwife prescribers, Practice standard 2 says: "You are professionally accountable for your prescribing decisions, including actions and omissions and cannot delegate this accountability to any other person."

And Practice standard 3: "In order to prescribe for a patient/client you must satisfy yourself that you have undertaken a full assessment of the patient/client, including taking a thorough history and, where possible, accessing a full clinical record."

All nurse prescribers must familiarise themselves with and adhere to these standards.

Having undertaken the prescribing training, I'm sure this nurse must be aware that they make better prescribing decisions now than before doing the course. Their colleagues who are not qualified legally or professionally to make prescribing decisions should not be. If there were a mistake - and there easily could be - the NMC would call into question the conduct of this nurse and they could find themselves removed from the register.

Surely it would be much better if the nurses who clearly need to be prescribers undertook the training. Access to medicines is one thing, but safety and accountability must always take priority.

Fiona Peniston-Bird has arranged 3 Non Medical Prescribing, Continued Professional Development events which will be held in London during 2008. The first on 17 June and is for those working in primary/community care, the second being held on 20 May is for mental health and the third, on 10 July, is for secondary care.

Click here for more blogs and details of Fiona's work

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Readers' comments (1)

  • What on earth is this Nurse doing, first of all there is as you rightly describe the legal implications, and adhereing to the NMC standards. We I.N.P's have undergone this training, which a hard course, it is a hugely responsible role
    For years Nurses have allowed such a lot of their skills to be transferred without question, skills where we were assessed on in order to be allowed to practice. In some cases I think this is born out of laziness and lack of pride in what we are skilled in. How can we moan about differentials in pay when
    we are undermining ourselves. This is bad unsafe practice and we must ensure it is stamped out before it becomes the norm it bad unsafe practice

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